EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2011137116
Authors
McBride R.
Institution
(McBride) Axio Research, LLC, 2601 Fourth Ave., Seattle, WA 98121, United
States
Title
The role of niacin in raising high-density lipoprotein cholesterol to
reduce cardiovascular events in patients with atherosclerotic
cardiovascular disease and optimally treated low-density lipoprotein
cholesterol: Rationale and study design. the Atherothrombosis Intervention
in Metabolic syndrome with low HDL/high triglycerides: Impact on Global
Health outcomes (AIM-HIGH).
Source
American Heart Journal. 161 (3) (pp 471-477.e2), 2011. Date of
Publication: 03 Mar 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: The aim of this study was to test the hypothesis that patients
with atherosclerotic cardiovascular (CV) disease optimally treated on a
statin but with residual atherogenic dyslipidemia (low high-density
lipoprotein cholesterol [HDL-C] and high triglycerides) will benefit from
addition of niacin with fewer CV events compared with placebo. Statin
monotherapy trials have found 25%-35% CV risk reduction relative to
placebo, leaving significant residual risk. Patients with atherogenic
dyslipidemia have substantially increased CV risk. Methods: Participants
were men and women with established CV disease and atherogenic
dyslipidemia. Lipid entry criteria varied by gender and statin dose at
screening. All participants received simvastatin (or simvastatin plus
ezetimibe) at a dose sufficient to maintain low-density lipoprotein
cholesterol (LDL-C) 40-80 mg/dL (1.03-2.07 mmol/L). Participants were
randomized to extended-release niacin or matching placebo. The primary end
point was time to occurrence of the first of the following: coronary heart
disease death, nonfatal myocardial infarction, ischemic stroke,
hospitalization for acute coronary syndrome, or symptom-driven coronary or
cerebral revascularization. This event-driven trial will have 85% power to
show a 25% reduction in primary event frequency after 850 patients have
experienced a primary outcome event. Results: AIM-HIGH completed
enrollment in April 2010. Follow-up is expected to continue through 2012.
Summary: AIM-HIGH was designed to determine whether treating residual
dyslipidemia with niacin further reduces cardiovascular events in patients
with CV disease on a statin at target levels of low-density lipoprotein
cholesterol. 2011 Mosby, Inc. All rights reserved.

<2>
Accession Number
2011137117
Authors
Capodanno D. Tamburino C.
Institution
(Capodanno, Tamburino) Cardiology Department, Ferrarotto Hospital,
University of Catania, Via Citelli 6, 95124, Catania, Italy
(Capodanno, Tamburino) ETNA Foundation, Catania, Italy
Title
Integrating the Synergy between percutaneous coronary intervention with
Taxus and Cardiac Surgery (SYNTAX) score into practice: Use, pitfalls, and
new directions.
Source
American Heart Journal. 161 (3) (pp 462-470), 2011. Date of Publication:
03 Mar 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Risk stratification is key in optimizing care of patients undergoing
percutaneous coronary intervention (PCI). Score algorithms, in particular,
are useful prognostic tools to select the most appropriate strategy of
treatment and help patients and their families to get a better
understanding of issues relevant to treatment strategies and subsequent
risks. Most scores tested in the setting of PCI focus on clinical
variables. The SYNTAX score is a semiquantitative angiographic score
developed to prospectively characterize the disease complexity of the
coronary vasculature. This scoring system has recently been assessed in
numerous cohorts of patients undergoing coronary revascularization by PCI
or bypass surgery. When using the SYNTAX score, however, physicians are
still challenged with a labor-intensive calculation and conflicting
results from validation studies. Understanding how the SYNTAX score works,
for which patients it works best, and whether it predicts accurately
enough for its purpose is of paramount importance to get the maximum
benefit from its application. The present article provides an overview of
the background and the currently available evidences on the use of the
SYNTAX score in patients undergoing coronary revascularization along with
its limitations. 2011 Mosby, Inc. All rights reserved.

<3>
Accession Number
2011137119
Authors
Udelson J.E. Pearte C.A. Kimmelstiel C.D. Kruk M. Kufera J.A. Forman S.A.
Teresinska A. Bychowiec B. Marin-Neto J.A. Hochtl T. Cohen E.A. Caramori
P. Busz-Papiez B. Adlbrecht C. Sadowski Z.P. Ruzyllo W. Kinan D.J. Lamas
G.A. Hochman J.S.
Institution
(Udelson, Kimmelstiel, Kinan) Tufts Medical Center, Box 70, 800 Washington
Street, Boston, MA 02111, United States
(Pearte, Hochman) New York University School of Medicine, New York, NY,
United States
(Kufera) Kufera Consulting, Inc., Monkton, MD, United States
(Forman) Clinical Trials and Surveys Corporation, Owings Mills, MD, United
States
(Kruk, Teresinska, Sadowski, Ruzyllo) National Institute of Cardiology,
Warsaw, Poland
(Bychowiec) Poznan University of Medical Sciences, Poznan, Poland
(Marin-Neto) Hospital das Clinicas, Faculdade de Medicina de Ribeirao
Preto-USP, Ribeirao Preto, Brazil
(Hochtl) Wilhelminenhospital, Vienna, Austria
(Cohen) Sunnybrook Health Sciences Center, Toronto, ON, Canada
(Caramori) Hospital Sao Lucas-Pontificia, University Catolica Do Rio
Grande Do sul, Porto Alegre, Brazil
(Busz-Papiez) SP Wojewodzki Szpital Zespolony W Szczecinie, Szezecin,
Poland
(Adlbrecht) Medical University of Vienna, Vienna, Austria
(Lamas) Columbia University Division of Cardiology, Mount Sinai Medical
Center, Miami Beach, FL, United States
Title
The Occluded Artery Trial (OAT) Viability Ancillary Study (OAT-NUC):
Influence of infarct zone viability on left ventricular remodeling after
percutaneous coronary intervention versus optimal medical therapy alone.
Source
American Heart Journal. 161 (3) (pp 611-621), 2011. Date of Publication:
03 Mar 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: The Occluded Artery Trial (OAT) showed no difference in
outcomes between percutaneous coronary intervention (PCI) versus optimal
medical therapy (MED) in patients with persistent total occlusion of the
infarct-related artery 3 to 28 days post-myocardial infarction. Whether
PCI may benefit a subset of patients with preservation of infarct zone
(IZ) viability is unknown. Methods and Results: The OAT nuclear ancillary
study hypothesized that (1) IZ viability influences left ventricular (LV)
remodeling and that (2) PCI as compared with MED attenuates adverse
remodeling in post-myocardial infarction patients with preserved
viability. Enrolled were 124 OAT patients who underwent resting
nitroglycerin-enhanced technetium-99m sestamibi single-photon emission
computed tomography (SPECT) before OAT randomization, with repeat imaging
at 1 year. All images were quantitatively analyzed for infarct size, IZ
viability, LV volumes, and function in a core laboratory. At baseline,
mean infarct size was 26% +/- 18 of the LV, mean IZ viability was 43% +/-
8 of peak uptake, and most patients (70%) had at least moderately retained
IZ viability. There were no significant differences in 1-year
end-diastolic or end-systolic volume change between those with severely
reduced versus moderately retained IZ viability, or when compared by
treatment assignment PCI versus MED. In multivariable models, increasing
baseline viability independently predicted improvement in ejection
fraction (P = .005). There was no interaction between IZ viability and
treatment assignment for any measure of LV remodeling. Conclusions: In the
contemporary era of MED, PCI of the infarct-related artery compared with
MED alone does not impact LV remodeling irrespective of IZ viability.
2011 Mosby, Inc. All rights reserved.

<4>
Accession Number
2011137120
Authors
De Boer S.P.M. Barnes E.H. Westerhout C.M. Simes R.J. Granger C.B.
Kastrati A. Widimsky P. De Boer M.J. Zijlstra F. Boersma E.
Institution
(De Boer, Zijlstra, Boersma) Clinical Epidemiology Unit Thoraxcenter
Cardiology, Erasmus MC's, Gravendijkwal 230, 3015 CE Rotterdam,
Netherlands
(Barnes, Simes) National Health and Medical Research Council Clinical
Trials Centre, Sydney, Australia
(Westerhout) University of Alberta, Edmonton, AB, Canada
(Granger) Duke University Medical Center, Durham, NC, United States
(Kastrati) Deutschen Herzzentrum Munchen, Germany
(Widimsky) University Hospital Vinohrady, Prague, Czech Republic
(De Boer) Isala Klinieken, Zwolle, Netherlands
Title
High-risk patients with ST-elevation myocardial infarction derive greatest
absolute benefit from primary percutaneous coronary intervention: Results
from the Primary Coronary Angioplasty Trialist versus Thrombolysis
(PCAT)-2 Collaboration.
Source
American Heart Journal. 161 (3) (pp 500-507.e1), 2011. Date of
Publication: 03 Mar 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Meta-analyses of randomized trials show that primary
percutaneous coronary intervention (PPCI) results in lower mortality than
fibrinolytic therapy in patients with myocardial infarction. We
investigated which categories of patients with myocardial infarction would
benefit most from the strategy of PPCI and, thus, have lowest numbers
needed to treat to prevent a death. Methods: Individual patient data were
obtained from 22 (n = 6,763) randomized trials evaluating efficacy and
safety of PPCI versus fibrinolysis. A risk score was developed and
validated to estimate the probability of 30-day death in individuals.
Patients were then divided in quartiles according to risk. Subsequent
analyses were performed to evaluate if the treatment effect was modified
by estimated risk. Results: Overall, 446 patients (6.6%) died within 30
days after randomization. The mortality risk score contained clinical
characteristics, including the time from symptom onset to randomization.
The c-index was 0.76, and the Hosmer-Lemeshow test was nonsignificant,
reflecting adequate discrimination and calibration. Patients randomized to
PPCI had lower mortality than did patients randomized to fibrinolysis
(5.3% vs 7.9%, adjusted odds ratio 0.63, 95% CI 0.42-0.84, P < .001). The
interaction between risk score and allocated treatment interaction term
had no significant contribution (P = .52) to the model, indicating that
the relative mortality reduction by PPCI was similar at all levels of
estimated risk. In contrast, the absolute risk reduction was strongly
related to estimated risk at baseline: the numbers needed to treat to
prevent a death by PPCI versus fibrinolysis was 516 in the lowest quartile
of estimated risk compared with only 17 in the highest quartile.
Conclusion: Primary percutaneous coronary intervention is consistently
associated with a strong relative reduction in 30-day mortality,
irrespective of patient baseline risk, and should therefore be considered
as the first choice reperfusion strategy whenever feasible. If access to
percutaneous coronary intervention is >2 hours, fibrinolysis remains a
legitimate option in low-risk patients because of the small absolute risk
reduction by PPCI in this particular cohort. 2011 Mosby, Inc. All rights
reserved.

<5>
Accession Number
2011137156
Authors
Park S.-W. Kim Y.-H. Yun S.-C. Park D.-W. Lee C.W. Kang S.-J. Park S.-J.
Lee J.-H. Choi S.W. Seong I.-W. Lee N.-H. Cho Y.H. Shin W.-Y. Lee S.-J.
Lee S.-W. Hyon M.-S. Bang D.-W. Choi Y.-J. Kim H.-S. Lee B.-K. Lee K. Park
H.-K. Park C.-B. Lee S.-G. Kim M.-K. Park K.-H. Park W.-J.
Institution
(Lee, Park, Kim, Yun, Park, Lee, Kang, Park) Department of Medicine,
University of Ulsan College of Medicine, Asan Medical Center, 388-1
Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
(Lee, Choi, Seong) Chungnam National University Hospital, Daejeon, South
Korea
(Lee, Cho) Soon Chun Hyang University Bucheon Hospital, Bucheon, South
Korea
(Shin, Lee, Lee) Soon Chun Hyang University Cheonan Hospital, Cheonan,
South Korea
(Hyon, Bang) Soon Chun Hyang University Hospital, Seoul, South Korea
(Choi, Kim) Hallym University Sacred Heart Hospital, Pyeongchon, South
Korea
(Lee) Kangwon National University Hospital, Chuncheon, South Korea
(Lee, Park, Park) Seoul Veterans Hospital, Seoul, South Korea
(Lee) Ulsan University Hospital, Ulsan, South Korea
(Kim, Park, Park) Hangang Sacred Heart Hospital, Seoul, South Korea
Title
A randomized, double-blind, multicenter comparison study of triple
antiplatelet therapy with dual antiplatelet therapy to reduce restenosis
after drug-eluting stent implantation in long coronary lesions: Results
from the DECLARE-LONG II (Drug-eluting stenting followed by cilostazol
treatment reduces late restenosis in patients with long coronary lesions)
trial.
Source
Journal of the American College of Cardiology. 57 (11) (pp 1264-1270),
2011. Date of Publication: 15 Mar 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to determine whether cilostazol
reduces intimal hyperplasia in patients undergoing long
zotarolimus-eluting stent implantation (stent length: <30 mm) for native
long coronary lesions (length: <25 mm). Background: Restenosis after
drug-eluting stent implantation remains a significant clinical problem in
long coronary lesions. Methods: Patients (n = 499) were assigned randomly
to triple (aspirin, clopidogrel, and cilostazol, triple group: n = 250) or
dual antiplatelet therapy (aspirin and clopidogrel and placebo, dual
group: n = 249) for 8 months after long zotarolimus-eluting stent
implantation. The primary end point was in-stent late loss at the 8-month
angiography according to the intention-to-treat principle. Results: The 2
groups had similar baseline characteristics. The in-stent (0.56 +/- 0.55
mm vs. 0.68 +/- 0.59 mm, p = 0.045) and in-segment (0.32 +/- 0.54 mm vs.
0.47 +/- 0.54 mm, p = 0.006) late loss were significantly lower in the
triple versus dual group, as were 8-month in-stent restenosis (10.8% vs.
19.1%, p = 0.016), in-segment restenosis (12.2% vs. 20.0%, p = 0.028), and
12-month ischemic-driven target lesion revascularization (5.2% vs. 10.0%,
p = 0.042) rates. At 12 months, major adverse cardiac events including
death, myocardial infarction, and ischemic-driven target lesion
revascularization tended to be lower in the triple group than the dual
group (7.2% vs. 12.0%, p = 0.07). Percent intimal hyperplasia volume by
volumetric intravascular ultrasound analysis was reduced from 27.1 +/-
13.2% for the dual group to 22.1 +/- 9.9% for the triple group (p =
0.017). Conclusions: Patients receiving triple antiplatelet therapy after
long zotarolimus-eluting stent implantation had decreased extent of late
luminal loss, percent intimal hyperplasia volume, and angiographic
restenosis, resulting in a reduced risk of 12-month target lesion
revascularization compared with patients receiving dual antiplatelet
therapy. 2011 American College of Cardiology Foundation.

<6>
Accession Number
2011143305
Authors
Walther T. Kasimir M.-T. Doss M. Schuler G. Simon P. Schachinger V. Mohr
F.W. Wimmer-Greinecker G.
Institution
(Walther, Mohr) University Leipzig, Heartcenter, Department of Cardiac
Surgery, Leipzig, Germany
(Kasimir, Simon) University Hospital AKH, Department of Cardiothoracic
Surgery, Vienna, Austria
(Doss, Schachinger, Wimmer-Greinecker) Department of Thoracic and
Cardiovascular Surgery, JW Goethe University Frankfurt, Germany
(Schuler) University Leipzig, Heartcenter, Department of Cardiology,
Leipzig, Germany
Title
One-year interim follow-up results of the TRAVERCE trial: The initial
feasibility study for trans-apical aortic-valve implantation.
Source
European Journal of Cardio-thoracic Surgery. 39 (4) (pp 532-537), 2011.
Date of Publication: April 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objectives: To evaluate the interim results of the initial multicenter
feasibility trial for trans-apical aortic-valve implantation (TA-AVI) in
high-risk elderly patients with severe aortic stenosis. Methods: A total
of 168 patients were prospectively included in three European centers
between February 2006 and April 2008. The Cribier-Edwards or Edwards
SAPIEN Trans-catheter Heart Valve (23. mm and 26. mm) was implanted using
an oversizing concept. Interventions were performed in a hybrid operative
room (OR) (one center), with a mobile C-arm in the OR (one) and in the
catheterization laboratory (one). Inclusion criteria included age >=70
years and an increased risk profile (additive European System for Cardiac
Operative Risk Evaluation (EuroSCORE) >=9). Results: Patient age was 82.1
+/- 5.6 years, 76% were female and the EuroSCORE was 11.3 +/- 1.8
(additive) and 27 +/- 12.7% (logistic). Cardiopulmonary bypass was used by
intention in 14.2% during the initial phase, secondarily in 10.1% and 75%
of the patients were treated off-pump. Valve implantation led to a good
immediate result in 161 (95.8%) patients and problems were encountered in
seven patients (malposition (two patients), migration (three patients) and
severe incompetence (two patients)). Nine patients were converted to
conventional surgery, early stroke occurred in two (1.2%) patients and 10
(6%) patients received a new pacemaker. At 30 days, 25 patients died, 48%
of them due to cardiac-related causes. Overall survival at 30 days, 6
months and 1 year was 85%, 70% and 63%, respectively. Conclusions: The
initial multicenter feasibility trial for TA-AVI (TRAVERCE) shows
acceptable results of this promising technique, especially in view of the
high-risk profile of the patients. 2010 European Association for
Cardio-Thoracic Surgery.

<7>
Accession Number
2011145573
Authors
Hellstrom J. Owall A. Bergstrom J. Sackey P.V.
Institution
(Hellstrom, Owall) Institution of Molecular Medicine and Surgery, Section
of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet,
Stockholm, Sweden
(Bergstrom) Department of LIME, Section of Medical Statistics, Karolinska
Institutet, Stockholm, Sweden
(Sackey) Institution of Physiology and Pharmacology, Section of
Anesthesiology and Intensive Care Medicine, Karolinska Institutet,
Stockholm, Sweden
Title
Cardiac outcome after sevoflurane versus propofol sedation following
coronary bypass surgery: A pilot study.
Source
Acta Anaesthesiologica Scandinavica. 55 (4) (pp 460-467), 2011. Date of
Publication: April 2011.
Publisher
Blackwell Munksgaard (1 Rosenorns Alle, P.O. Box 227, Copenhagen V
DK-1502, Denmark)
Abstract
Background: Studies of volatile anesthetic administration during coronary
artery bypass grafting (CABG) report reduced serum levels of
post-operative cardiac troponin-T (cTnT). Our primary objective was to
evaluate whether short-term sedation with sevoflurane in the intensive
care unit (ICU) - after CABG - could affect the release of cTnT, compared
with propofol sedation. Methods: Following isolated CABG with
cardiopulmonary bypass, 100 patients were randomized to either sevoflurane
via the Anesthetic Conserving Device (AnaConDa) or propofol for ICU
sedation. Study drugs were administered for 2 h during mechanical
ventilation and thereafter until extubation criteria were met. The primary
endpoint was cTnT 12 h post-operatively. Crude cTnT data were not normally
distributed and therefore compared with the Mann-Whitney U-test. Because
of the skewed pre-operative and post-operative cTnT data, we performed a
post hoc analysis of the change in cTnT between pre-operative values and
12 h post-operatively. Results: There was no statistically significant
difference between groups in the primary endpoint cTnT values at 12 h
post-operatively, cardiac events or the need for hemodynamic support. In
the post hoc analysis, the cTnT increase from pre-operative values to 12 h
post-operatively was less pronounced in the sevoflurane group (P = 0.008).
Conclusion: Post-operative short-term sevoflurane sedation following CABG,
in comparison with propofol, did not affect the cTnT values at 12 h
post-operatively and clinical outcome was equal between groups. The result
from the post hoc analysis, with less cTnT change over time, is
nevertheless hypothesis-generating and warrants a larger study. 2011 The
Authors Acta Anaesthesiologica Scandinavica 2011 The Acta
Anaesthesiologica Scandinavica Foundation.

<8>
Accession Number
2011145575
Authors
Kwak Y.-L. Kim J.-C. Hong S.-W. Shim J.-K. Yoo K.-J. Chun D.-H.
Institution
(Kwak, Kim, Shim) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, Seoul, South Korea
(Hong) Department of Anesthesiology and Pain Medicine, Kyungpook National
University Hospital, Daegu, South Korea
(Yoo) Division of Cardiovascular Surgery, Yonsei University College of
Medicine, Seoul, South Korea
(Chun) Department of Anesthesiology and Pain Medicine, CHA Bundang Medical
Center, CHA University, Sungnam, South Korea
Title
Effect of N-acetylcystein on pulmonary function in patients undergoing
off-pump coronary artery bypass surgery.
Source
Acta Anaesthesiologica Scandinavica. 55 (4) (pp 452-459), 2011. Date of
Publication: April 2011.
Publisher
Blackwell Munksgaard (1 Rosenorns Alle, P.O. Box 227, Copenhagen V
DK-1502, Denmark)
Abstract
Background: Pulmonary dysfunction related to inflammatory response and
radical oxygen species remains a problem in off-pump coronary bypass graft
surgery (OPCAB), especially in patients with reduced left ventricular (LV)
function. The aim of this study was to evaluate the effect of
N-acetylcystein (NAC) on pulmonary function following OPCAB. Methods:
Patients with LV ejection fraction <= 40% were randomly assigned to
receive either a bolus of 100mg/kg of intravenous NAC over a 15-min period
immediately after anesthetic induction, followed by an intravenous
infusion at 40mg/kg/day for 24h (NAC group, n = 24), or a placebo (control
group, n = 24). Hemodynamic and pulmonary parameters, and the incidence of
acute lung injury (PaO₂/ FiO₂<300mmHg) were assessed
and compared. Results: The pulmonary vascular resistance index (PVRI) did
not change during mechanical heart displacement compared with the baseline
value in the NAC group while it was significantly increased in the control
group. Significantly less number of patients developed acute lung injury
at 2 h after the surgery in the NAC group. The other pulmonary parameters
and the duration of ventilator care were all similar. Conclusions: NAC
demonstrated promising results in terms of mitigating the increase in PVRI
during mechanical heart displacement and attenuating the development of
acute lung injury in the immediate post-operative period. However, NAC
could not induce a definite improvement in the other important pulmonary
variables including PaO ₂/FiO₂ and
Q_s/Q_t, and did not lead to a decreased duration of
ventilatory care or length of stay in the intensive care unit. 2011 The
Authors Acta Anaesthesiologica Scandinavica 2011 The Acta
Anaesthesiologica Scandinavica Foundation.

<9>
Accession Number
2011129608
Authors
Ng V.G. Lansky A.J. Hermiller J.B. Farhat N. Applegate R.J. Yaqub M. Sood
P. Su X. Simonton C.A. Sudhir K. Stone G.W.
Institution
(Ng, Stone) Columbia University, Medical Center, New York, NY, United
States
(Lansky) Yale University School of Medicine, New Haven, CT, United States
(Hermiller) Heart Center of Indianapolis, Indianapolis, IN, United States
(Farhat) EHM Regional Medical Center, Elyria, OH, United States
(Applegate) Wake Forest University Health Sciences, Winston-Salem, NC,
United States
(Yaqub, Sood, Su, Simonton, Sudhir) Abbott Vascular, Santa Clara, CA,
United States
Title
Three-year results of safety and efficacy of the everolimus-eluting
coronary stent in women (from the SPIRIT III randomized clinical trial).
Source
American Journal of Cardiology. 107 (6) (pp 841-848), 2011. Date of
Publication: 15 Mar 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Women treated with the XIENCE V have improved 1-year clinical outcomes
compared to women treated with TAXUS; whether benefits in women are
sustained at 3 years is unknown. Three-year follow-up of the SPIRIT III
trial revealed improved clinical outcomes of the XIENCE V
everolimus-eluting stent compared to the TAXUS paclitaxel-eluting stent.
One thousand two patients with coronary artery lesions <=28 mm in length
in 2.5- to 3.75-mm diameter vessels were prospectively randomized to
receive XIENCE V or TAXUS stents. A post hoc gender subset analysis was
performed. Six hundred sixty-nine patients (30% women) received XIENCE V
and 332 patients (34% women) received TAXUS. In the overall population,
women had higher 3-year rates of major adverse cardiac events (16.0% vs
10.0%, p = 0.01) and target lesion revascularization (10.2% vs 5.3%, p =
0.008) compared to men. In women, those with XIENCE V continued to have
lower major adverse cardiac event rates than those with TAXUS at 2 years
(9.5% vs 18.3%, p = 0.03) and 3 years (12.2% vs 22.6%, p = 0.03). Although
1-year target vessel failure rates were similar, at 2- and 3-year
follow-up women treated with XIENCE V had approximately 40% relative
decreases in target vessel failure rates compared to those treated with
TAXUS (12.7% vs 22.0%, p = 0.05; 16.0% vs 26.4%, p = 0.03, respectively).
Stent thrombosis and bleeding complication rates were similar between
treatment arms in the gender subgroups through 3 years. In conclusion,
women in the SPIRIT III trial have sustained clinical benefits from XIENCE
V implantation compared to TAXUS without increases in long-term
complications. 2011 Elsevier Inc.

<10>
Accession Number
2011129609
Authors
Applegate R.J. Yaqub M. Hermiller J.B. Sood P. Yu S. Doostzadeh J.
Williams J.E. Farhat N. Caputo R. Lansky A.J. Cutlip D.E. Sudhir K. Stone
G.W.
Institution
(Applegate) Wake Forest University Health Sciences, Winston-Salem, NC,
United States
(Yaqub, Sood, Yu, Doostzadeh, Sudhir) Abbott Vascular, Santa Clara, CA,
United States
(Hermiller) Heart Center of Indiana, Indianapolis, IN, United States
(Williams) Presbyterian Hospital, Charlotte, NC, United States
(Farhat) EMH Regional Medical Center, Elyria, OH, United States
(Caputo) St. Joseph's Hospital, Syracuse, NY, United States
(Cutlip) Harvard Clinical Research Institute, Boston, MA, United States
(Lansky, Stone) Columbia University, Medical Center, Cardiovascular
Research Foundation, New York, NY, United States
Title
Long-term (three-year) safety and efficacy of everolimus-eluting stents
compared to paclitaxel-eluting stents (from the SPIRIT III Trial).
Source
American Journal of Cardiology. 107 (6) (pp 833-840), 2011. Date of
Publication: 15 Mar 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The safety and efficacy of the XIENCE V everolimus-eluting stent (EES)
compared to the Taxus Express² paclitaxel-eluting stent (PES)
has been demonstrated through 2 years in the SPIRIT II and III randomized
clinical trials, but limited longer-term data have been reported. In the
SPIRIT III trial, 1,002 patients with up to 2 lesions in 2 coronary
arteries were randomized 2:1 to EESs versus PESs at 65 United States
sites. At completion of 3-year follow-up, treatment with EES compared to
PES resulted in a significant 30% decrease in the primary clinical end
point of target vessel failure (cardiac death, myocardial infarction, or
ischemic-driven target vessel revascularization, 13.5% vs 19.2%, hazard
ratio 0.70, 95% confidence interval 0.50 to 0.96, p = 0.03) and a 43%
decrease in major adverse cardiovascular events, cardiac death, myocardial
infarction, or ischemic-driven target lesion revascularization (9.1% vs
15.7%, hazard ratio 0.57, 95% confidence interval 0.39 to 0.83, p =
0.003). In a landmark analysis, major adverse cardiovascular events were
decreased to a similar extent with EES compared to PES 0 through 1 year
and 1 year through 3 years (hazard ratio 0.56, 95% confidence interval
0.35 to 0.90; hazard ratio 0.59, 95% confidence interval 0.31 to 1.11,
respectively). In conclusion, patients treated with EES rather than PES in
the SPIRIT III trial had significantly improved event-free survival at 3
years. From 1 year to 3 years hazard curves continued to diverge in favor
of EES, consistent with an improving long-term safety and efficacy profile
of EES compared to PES, with no evidence of late catchup. 2011 Elsevier
Inc.

<11>
Accession Number
2011132791
Authors
Mitchell J. Webb S.T.
Institution
(Mitchell) Department of Anaesthesia, Addenbrooke's Hospital, Cambridge
CB2 2QQ, United Kingdom
(Webb) Department of Anaesthesia and Critical Care, Papworth Hospital NHS
Foundation Trust, Papworth Everard, Cambridge CB23 3RE, United Kingdom
Title
Is brain natriuretic peptide a marker for adverse postoperative outcomes
in patients undergoing cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (3) (pp 467-472),
2011. Date of Publication: March 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic (BET) was constructed according to a structured
protocol. The question addressed was 'Is brain natriuretic peptide (BNP) a
marker for adverse postoperative outcomes in patients undergoing cardiac
surgery?' Nearly 200 papers were found using the reported search, of which
17 represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
BNP levels have been shown by several prospective observational cohort
studies to be a marker for cardiac dysfunction and adverse outcome in
patients undergoing cardiac surgery. BNP levels can be used to guide the
therapy of patients with heart failure which may reduce adverse cardiac
events. Whether BNP-guided therapy can be applied to patients undergoing
cardiac surgery is unknown. We conclude that preoperative and
postoperative measurement of natriuretic peptides could help predict
postoperative cardiac dysfunction and adverse outcome in patients
undergoing cardiac surgery. Furthermore, they may improve the ability of
commonly used risk assessment tools to predict outcome. 2011 Published by
European Association for Cardio-Thoracic Surgery.

<12>
Accession Number
2011132796
Authors
Matthews I.G. Fazal I.A. Bates M.G.D. Turley A.J.
Institution
(Matthews) Department of Cardiology, Freeman Hospital, High Heaton,
Newcastle Upon Tyne NE7 7DN, United Kingdom
(Fazal, Turley) Division of Cardiothoracic, James Cook University
Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom
(Bates) Mitochondrial Research Group, Institute for Ageing and Health,
Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom
Title
In patients undergoing aortic valve replacement, what factors predict the
requirement for permanent pacemaker implantation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (3) (pp 475-479),
2011. Date of Publication: March 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question was to determine what preoperative,
perioperative and postoperative factors influence the requirement for
permanent pacemaker (PPM) implantation postisolated aortic valve
replacement (AVR). Transcatheter aortic valve intervention was not
included in this analysis. Using the reported search method outlined
below, 705 papers were found. No randomised controlled trials,
meta-analyses or registries were identified. Seven single-centre
retrospective observational studies represent the best evidence on the
subject. The author, journal, date and country of publication, level of
evidence, patient group studied, study type, outcomes and results were
tabulated. The incidence of PPM implantation following AVR varied from
3.0% to 11.8% (mean 7.0%, median 7.2%). Current best available evidence
suggests that baseline evidence of conducting system disease - first
degree atrioventricular block (AVB), left anterior hemiblock, right bundle
branch block (RBBB) or left bundle branch block (LBBB) is the most
powerful independent predictor of PPM requirement following AVR. Other
important predictors are surgery for aortic regurgitation, preoperative
myocardial infarction and longer perioperative cardiopulmonary bypass
time. No consistent postoperative factors were identified. The mean time
to PPM implant postAVR ranged from 6 to 13 days in the four studies that
reported it. Current European Society of Cardiology guidelines recommend a
period of seven days of persistent AVB postsurgery prior to PPM
implantation. 2011 Published by European Association for Cardio-Thoracic
Surgery.

<13>
Accession Number
2011132797
Authors
Zahid I. Sharif S. Routledge T. Scarci M.
Institution
(Zahid, Sharif) Imperial College London, South Kensington Campus, London
SW7 2AZ, United Kingdom
(Routledge, Scarci) Department of Thoracic Surgery, Guy's Hospital, Great
Maze Pond, London SE1 9RT, United Kingdom
Title
Is lung volume reduction surgery effective in the treatment of advanced
emphysema?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (3) (pp 480-486),
2011. Date of Publication: March 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether lung volume
reduction surgery (LVRS) might be superior to medical treatment in the
management of patients with severe emphysema. Overall 497 papers were
found using the reported search, of which 12 represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results are tabulated. We conclude that LVRS produces superior patient
outcomes compared to medical treatment in terms of exercise capacity, lung
function, quality of life and long-term (>1 year postoperative) survival.
A large proportion of the best evidence on this topic is based on analysis
of the National Emphysema Treatment Trial (NETT). Seven studies compared
LVRS to medical treatment alone (MTA) using data generated by the NETT
trial. They found higher quality of life scores (45.3 vs. 27.5, P<0.001),
improved maximum ventilation (32.8 vs. 29.6 l/min, P=0.001) and lower
exacerbation rate per person-year (0.27 vs. 0.37%, P=0.0005) with LVRS
than MTA. Mortality rates for LVRS were greater up to one year (P=0.01),
equivalent by three years (P=0.15) and lower after four years (P=0.06)
postoperative compared to MTA. Patients with upper-lobe-predominant
disease and low exercise capacity (0.36 vs. 0.54, P=0.003) benefited the
most from undergoing LVRS rather than MTA in terms of probability of death
at five years compared to patients with non-upper-lobe disease (0.38 vs.
0.45, Ps0.03) or upper-lobe disease with high exercise capacity (0.33 vs.
0.38, P=0.32). Five studies compared LVRS to MTA using data independent
from the NETT trial. They found greater six-minute walking distances (433
vs. 300 m, P<0.002), improved total lung capacity (18.8 vs. 7.9%
predicted, P<0.02) and quality of life scores (47 vs. 23.2, P<0.05) with
LVRS compared to MTA. Even though LVRS has a much greater cost per person
over five years ($137,000 vs. $100,200, P<0.001), its improved lung
function, greater exercise capacity and better quality of life scores make
it a preferable treatment option to MTA, with particular indications for
patients with upper-lobe-predominant disease and low exercise capacity.
2011 Published by European Association for Cardio-Thoracic Surgery.

<14>
Accession Number
2011136872
Authors
Inaba Y. Chen J.A. Bergmann S.R.
Institution
(Chen, Bergmann) Division of Cardiology, Beth Israel Medical Center, New
York, NY, United States
Title
Prediction of future cardiovascular outcomes by flow-mediated
vasodilatation of brachial artery: A meta-analysis.
Source
International Journal of Cardiovascular Imaging. 26 (6) (pp 631-640),
2010. Date of Publication: August 2010.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Background: We conducted a meta-analysis of observational studies which
examined the association between flow-mediated dilatation (FMD) of
brachial artery, a noninvasive measure of endothelial function, and future
cardiovascular events. Methods: Electronic databases were searched using a
predefined search strategy. Data was independently abstracted on study
characteristics, study quality, and outcomes by two reviewers. The
multivariate relative risks, adjusted for confounding factors, were
calculated from individual studies and then pooled using random-effects
models. Statistical heterogeneity was evaluated using I2 statistics.
Subgroup analyses and meta-regression analyses were conducted to assess
the robustness of the meta-analysis. Publication bias was examined with
funnel plot analysis and Egger's test. Results: Four population-based
cohort studies and ten convenience-cohort studies, involving 5,547
participants, were included in the meta-analysis. The pooled relative
risks of cardiovascular events per 1% increase in brachial FMD, adjusted
for confounding risk factors, was 0.87 (95% CI, 0.83-0.91). The
significant associations between brachial FMD and cardiovascular events
were consistent among all subgroups evaluated, suggesting the robustness
of the meta-analysis. However, the presence of heterogeneity in study
quality, the remaining confounding factors, and publication bias in the
available literature prevent a definitive evaluation of the additional
predictive value of brachial FMD beyond traditional cardiovascular risk
factors. Conclusions: The meta-analysis of heterogeneous studies with
moderate methodological quality suggested that impairment of brachial FMD
is significantly associated with future cardiovascular events. Further
prospective randomized trials are warranted to confirm the efficacy of the
usage of brachial FMD in the management of cardiovascular diseases.
Springer Science+Business Media, B.V. 2010.

<15>
Accession Number
2011137920
Authors
Itakura H. Yokoyama M. Matsuzaki M. Saito Y. Origasa H. Ishikawa Y. Oikawa
S. Sasaki J. Hishida H. Kita T. Kitabatake A. Nakaya N. Sakata T. Shimada
K. Shirato K. Matsuzawa Y.
Institution
(Itakura) Shinagawa East One Medical Clinic, Tokyo, Japan
(Yokoyama) Hyogo Prefectural Awaji Hospital, Sumoto, Japan
(Matsuzaki) Division of Cardiology, Department of Medicine and Clinical
Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
(Saito) Chiba University, Chiba, Japan
(Origasa) Division of Biostatistics and Clinical Epidemiology, University
of Toyama, Toyama, Japan
(Ishikawa) Kakogawa Municipal Hospital, Kakogawa, Japan
(Oikawa) Division of Endocrinology and Metabolism, Department of Medicine,
Nippon Medical School, Tokyo, Japan
(Sasaki) International University of Health, Welfare Graduate School of
Public Health Medicine, Fukuoka, Japan
(Hishida) Division of Cardiology, Department of Internal Medicine, Fujita
Health University School of Medicine, Toyoake, Japan
(Kita) Kobe City Medical Center General Hospital, Kobe, Japan
(Kitabatake) Hiraoka Hospital, Osaka, Japan
(Nakaya) Nakaya Clinic, Tokyo, Japan
(Sakata) Hisatsune Hospital, Fukuoka, Japan
(Shimada) Division of Cardiovascular Medicine, Department of Medicine,
Jichi Medical School, Tochigi, Japan
(Shirato) Saito Hospital, Miyagi, Japan
(Matsuzawa) Sumitomo Hospital, Osaka, Japan
Title
Relationships between plasma fatty acid composition and coronary artery
disease.
Source
Journal of Atherosclerosis and Thrombosis. 18 (2) (pp 99-107), 2011.
Date of Publication: 2011.
Publisher
Japan Atherosclerosis Society (2-20-15 Shinbashi, Minato-ku, Tokyo
105-0004, Japan)
Abstract
Aim: The Japan EPA Lipid Intervention Study (JELIS) was the first
prospective randomized clinical trial to demonstrate prevention of
coronary events by pure eicosapentaenoic acid (EPA). The aim of this study
was to examine the relationships between various plasma fatty acid
concentrations and the risk of coronary events in JELIS participants.
Methods: In 15,534 participants, we calculated the hazard ratio for major
coronary events (sudden cardiac death, fatal or nonfatal myocardial
infarction, unstable angina pectoris, and angioplasty/ stenting or
coronary artery bypass grafting) relative to the on-treatment average
level of plasma fatty acids with the Cox proportional hazard model.
Results: As a result of EPA intervention, the plasma EPA concentration
increased, but the docosahexaenoic acid (DHA) concentration did not. The
other fatty acids measured decreased slightly. The higher plasma level of
EPA (hazard ratio = 0.83, p = 0.049, in all participants and hazard ratio
= 0.71, p = 0.018, in the EPA intervention group), but not of DHA, was
inversely associated with the risk of major coronary events. The
associations between other fatty acids and the risk of major coronary
events were not significant. In all JELIS participants, the risk of major
coronary events was significantly decreased (20%) in the group with high
(150 mug/mL or more) on-treatment plasma EPA concentration compared with
that in the low (less than 87 mug/mL) group. Conclusion: The risk of
coronary artery disease is influenced by variations in plasma fatty acid
composition. Among n-3 polyunsaturated fatty acids, EPA and DHA exhibited
differences in the correlation with the risk of major coronary events.

<16>
Accession Number
2011143100
Authors
Janssen M.F. Lubetkin E.I. Sekhobo J.P. Pickard A.S.
Institution
(Janssen, Lubetkin, Pickard) EuroQol Group, Rotterdam, Netherlands
(Lubetkin) Department of Community Health and Social Medicine, Sophie
Davis School of Biomedical Education at The City College of New York, New
York, United States
(Sekhobo) Evaluation and Analysis Unit, Bureau of Administration and
Evaluation, Division of Nutrition, New York State Department of Health,
Albany, NY, United States
(Pickard) Center for Pharmacoeconomic Research, Department of Pharmacy
Practice and Pharmacy Administration, College of Pharmacy, University of
Illinois at Chicago, Chicago, IL, United States
Title
The use of the EQ-5D preference-based health status measure in adults with
Type 2 diabetes mellitus.
Source
Diabetic Medicine. 28 (4) (pp 395-413), 2011. Date of Publication: April
2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background The EQ-5D is a generic preference-based health status measure
that has been widely applied to measure the impact of Type2 diabetes
mellitus. This review summarizes evidence on the validity, reliability and
responsiveness of the EQ-5D in studies of Type2 diabetes and provides a
catalogue of EQ-5D index scores for Type2 diabetes and various
complications and subgroups. Methods A structured search was conducted
(1987-2009) using keywords relevant to Type2 diabetes and the EQ-5D.
Original research studies in Type2 diabetes that reported EQ-5D results
and/or measurement properties were included. Results Of the 59 included
articles, 54 publications reported EQ-5D responses and 39 papers presented
evidence on the measurement properties of the EQ-5D. Studies that reported
measurement properties supported construct, convergent and discriminant
validity, test-retest reliability and responsiveness of the EQ-5D in Type2
diabetes. Several studies reported a ceiling effect for the EQ-5D and an
inability to capture multiple complications was observed. EQ-5D index
scores ranged from 0.20 (severe diabetic peripheral neuropathic pain) to
0.88 (general population: good HbA_1c level). For six subgroups,
sufficient studies were available to calculate pooled mean index scores
(95% CI): general population 0.67 (0.59-0.75), no complications 0.76
(0.68-0.83), microvascular complications 0.73 (0.57-0.89), macrovascular
complications 0.73 (0.57-0.88), diabetic peripheral neuropathic pain 0.45
(0.39-0.51) and retinopathy 0.57 (0.46-0.69). Conclusions Evidence
supported validity, reliability and responsiveness of the EQ-5D in Type2
diabetes. EQ-5D index scores associated with Type2 diabetes and various
complications can be useful for modelling health outcomes in economic
evaluations of health programmes for Type2 diabetes. 2011 The Authors.
Diabetic Medicine 2011 Diabetes UK.

<17>
Accession Number
2011143296
Authors
Nowicki M. Misterski M. Malinska A. Perek B. Ostalska-Nowicka D. Jemielity
M. Witkiewicz W. Zabel M.
Institution
(Nowicki, Malinska, Ostalska-Nowicka, Witkiewicz, Zabel) Regional
Specialized Hospital in Wroclaw, Research and Development Centre, Wroclaw,
Poland
(Nowicki, Malinska, Zabel) Department of Histology and Embryology,
University of Medical Sciences in Poznan, Poznan, Poland
(Misterski, Perek, Jemielity) Department of Cardiac Surgery, University of
Medical Sciences in Poznan, Poznan, Poland
(Ostalska-Nowicka) Department of Pediatric Cardiology and Nephrology,
University of Medical Sciences in Poznan, Poznan, Poland
Title
Endothelial integrity of radial artery grafts harvested by minimally
invasive surgery - immunohistochemical studies of CD31 and endothelial
nitric oxide synthase expressions: A randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 39 (4) (pp 471-477), 2011.
Date of Publication: April 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: To compare the endothelial integrity of radial artery grafts
harvested by minimally invasive surgery and arteries harvested
conventionally for coronary artery bypass surgery (CABG) in 200
participants, who were assigned to interventions by using random
allocation. Methods: An immunohistochemical procedure with monoclonal
antibodies was employed to estimate CD31 antigen and endothelial nitric
oxide synthase (eNOS) expressions - markers defining endothelial
integrity. Results: The CD31 immunostaining revealed that the endothelial
cell integrity of the minimally invasive harvested arteries was preserved
in 76.1 +/- 7.4% of the circumference of luminal endothelium, which was
similar to results obtained in conventionally harvested grafts (77.2 +/-
9.8%; not significant). On the other hand, eNOS immunostaining indicated
that the endothelial integrity of the minimally invasive harvested grafts
was preserved in 75.4 +/- 10.5% while in conventionally harvested grafts
it was reduced to 42.4 +/- 14.5% of the total luminal endothelium
circumference (P< 0.05). Conclusions: The endothelial integrity of radial
artery grafts harvested by minimally invasive surgery is better preserved
than in the grafts obtained by the conventional manner. This could play an
important role in improving graft patency and might represent a
preliminary condition of stable functioning in coronary arterial bypasses.
2010 European Association for Cardio-Thoracic Surgery.

<18>
Accession Number
2011143297
Authors
Damgaard S. Lund J.T. Lilleor N.B. Perko M.J. Madsen J.K. Steinbruchel
D.A.
Institution
(Damgaard, Lund, Lilleor, Perko, Steinbruchel) Department of
Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital,
Blegdamsvej 9, DK-2100 Copenhagen, Denmark
(Madsen) Department of Cardiology, Gentofte Hospital, Copenhagen
University Hospital, Hellerup, Denmark
Title
Comparably improved health-related quality of life after total arterial
revascularization versus conventional coronary surgery-Copenhagen arterial
revascularization randomized patency and outcome trial.
Source
European Journal of Cardio-thoracic Surgery. 39 (4) (pp 478-483), 2011.
Date of Publication: April 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: We compared health-related quality of life up to 11 months
after coronary artery bypass grafting using total arterial
revascularization versus conventional coronary surgery. Methods: In this
randomized single-center trial, 161 patients underwent total arterial
revascularization using single or bilateral internal thoracic artery (ITA)
and radial artery grafts versus 170 patients conventionally revascularized
using left ITA and saphenous vein grafts. Preoperatively, and at 3 and 11
months, postoperatively, patients filled in the generic questionnaire
Short Form-36 (SF-36). Results: The mean age was 59 +/- 8 years and 39
were women (12%). Median EuroSCORE (European System for Cardiac Risk
Evaluation) was 2 (interquartile range 1-4). More than 90% of patients
filled in the questionnaire at all three time points. Preoperatively, all
scores were lower (P< 0.001) than for a sample of the general Danish
population. On all scales of the SF-36, there was statistically
significant improvement at 3 and 11 months in both groups. For 'social
functioning', the improvement following total arterial revascularization
was significantly higher than following conventional revascularization (P=
0.01). For total arterial revascularization, there were also not
statistically significant improvements for 'physical component summary'
(P= 0.09), 'bodily pain' (P= 0.07) and 'vitality' (P= 0.08). Conclusion:
Health-related quality of life up to 1 year after total arterial
revascularization is equal or slightly better than results after
conventional coronary surgery. 2010 European Association for
Cardio-Thoracic Surgery.

<19>
Accession Number
2011143301
Authors
Sinisalo J.P. Sreeram N. Jokinen E. Qureshi S.A.
Institution
(Sinisalo) Department of Medicine, Division of Cardiology, Helsinki
University Central Hospital, Helsinki, Finland
(Sreeram) Department of Pediatric Cardiology, University Hospital of
Cologne, Cologne, Germany
(Jokinen) Children's Hospital, Division of Cardiology, Helsinki University
Central Hospital, Helsinki, Finland
(Qureshi) Evelina Children's Hospital, Guy's and St Thomas Foundation
Trust, London, United Kingdom
Title
Acquired left ventricular-right atrium shunts.
Source
European Journal of Cardio-thoracic Surgery. 39 (4) (pp 500-506), 2011.
Date of Publication: April 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Left ventricular to right atrial (LV-RA) shunt is an unusual type of
ventricular septal defect (VSD). This article concentrates on acquired
LV-RA shunts, which may be due to complications of cardiac operation,
endocarditis, trauma or myocardial infarction. A previous cardiac
operation is its most common cause. The diagnosis of LV-RA communication
is not easy, and it should be remembered in patients who do not recover
normally. Diagnosis can be confirmed with ultrasound or magnetic resonance
image (MRI). Surgical correction is usually the treatment of choice, but
closing the communication percutaneously should be considered as an
option. 2010 European Association for Cardio-Thoracic Surgery.

<20>
Accession Number
2011143302
Authors
Rehman S.M. Vecht J.A. Perera R. Jalil R. Saso S. Anderson J.R. von
Segesser L.K. Athanasiou T.
Institution
(Rehman, Perera, Jalil, Athanasiou) Department of Cardiothoracic Surgery,
St. Mary's Hospital - Imperial Healthcare Trust, Praed Street, London W2
1NY, United Kingdom
(Vecht, Saso, Athanasiou) Department of Surgery and Cancer, St. Mary's
Hospital - Imperial Healthcare Trust, Praed Street, London W2 1NY, United
Kingdom
(Anderson) Department of Cardiothoracic Surgery, Hammersmith Hospital -
Imperial Healthcare Trust, Du Cane Road, London W12 0HS, United Kingdom
(von Segesser) University Hospital CHUV, Rue du Bugnon 46, Lausanne
CH-1011, Switzerland
Title
How to manage the left subclavian artery during endovascular stenting of
the thoracic aorta.
Source
European Journal of Cardio-thoracic Surgery. 39 (4) (pp 507-518), 2011.
Date of Publication: April 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
We performed a systematic review of the literature to establish whether
revascularisation of the left subclavian territory is necessary when this
artery is covered by a stent. We retrieved data from 99 studies
incorporating 4906 patients. Incidences of left-arm ischaemia (0.0% vs
9.2%, p= 0.002) and stroke (4.7% vs 7.2%, p< 0.001) were significantly
less following revascularisation, although mortality (10.5% vs 3.4%, p=
0.032) and endoleak incidence (25.8% vs 12.6%, p= 0.008) were increased.
No significant differences in spinal-cord ischaemia were seen.
Revascularisation may reduce downstream ischaemic complications but can
cause significant risk. Indications must be carefully considered on an
individual patient basis. 2010 European Association for Cardio-Thoracic
Surgery.

<21>
Accession Number
2011143307
Authors
Balduyck B. Hendriks J.M. Lauwers P. Mercelis R. Ten Broecke P. Van Schil
P.
Institution
(Balduyck, Hendriks, Lauwers, Mercelis, Ten Broecke, Van Schil) Antwerp
University Hospital, Edegem, Belgium
Title
Quality of life after anterior mediastinal mass resection: A prospective
study comparing open with robotic-assisted thoracoscopic resection.
Source
European Journal of Cardio-thoracic Surgery. 39 (4) (pp 543-548), 2011.
Date of Publication: April 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: To prospectively evaluate quality of life (QoL) evolution after
robotic-assisted thoracoscopic or open anterior mediastinal tumour
resection with the European Organisation for Research and Treatment of
Cancer (EORTC) QoL Questionnaire-C30 and the lung cancer-specific module,
LC-13. Methods: From January 2004 to December 2008, QoL was prospectively
recorded in all patients undergoing surgery for mediastinal tumours. A
total of 14 patients underwent thoracoscopic resection using the da Vinci
robotic system (Intuitive Surgical, Inc., Mountain View, CA, USA), and 22
patients open resection through sternotomy. Questionnaires were
administered before surgery and 1, 3, 6 and 12 months, postoperatively,
with response rates of 100%, 86.1%, 94.4%; 75.0% and 86.1%, respectively.
Results: Both approaches had comparable preoperative patients'
characteristics and QoL subscales. Open resection by sternotomy was
characterised by a significant decrease in general functioning 1 month
after surgery (physical functioning p= 0.001, role functioning p= 0.001,
and social functioning p= 0.044). Patients also complained of increased
thoracic pain in the first 3 months after surgery (p= 0.017). After a da
Vinci robotic resection QoL scores approximated baseline preoperative
values 1 month after surgery, with the exception of increase in thoracic
and shoulder pain the first 3 months after surgery (p= 0.028 and 0.029,
respectively). Conclusions: Numerous techniques have been published with
different degrees of invasiveness, generating the existing controversy as
to which is the best surgical approach for anterior mediastinal tumours.
The high burden of decreased physical functioning reported after
sternotomy is not seen after a da Vinci robotic-assisted thoracoscopic
resection. The initial experience and postoperative QoL data are excellent
and, therefore, the da Vinci robot will stay our future technique of
choice for the treatment of resectable mediastinal tumours smaller than 4.
cm on imaging techniques. 2010 European Association for Cardio-Thoracic
Surgery.

<22>
Accession Number
2011143312
Authors
Bayram A.S. Ozcan M. Kaya F.N. Gebitekin C.
Institution
(Bayram, Ozcan, Gebitekin) Department of Thoracic Surgery, Uludag
University, School of Medicine, Bursa, Turkey
(Kaya) Department of Anesthesiology and Reanimation, Uludag University,
School of Medicine, Bursa, Turkey
Title
Rib approximation without intercostal nerve compression reduces
post-thoracotomy pain: A prospective randomized study.
Source
European Journal of Cardio-thoracic Surgery. 39 (4) (pp 570-574), 2011.
Date of Publication: April 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: One of the most important considerations in the care of
thoracic surgery patients is the control of pain, which leads to increased
morbidity and relevant mortality. Methods: Between February and May 2009,
60 patients undergoing full muscle-sparing posterior minithoracotomy were
prospectively randomized into two groups, according to the thoracotomy
closure techniques. In the first group (group A), two holes were drilled
into the sixth rib using a hand perforator, and sutures were passed
through the holes in the sixth rib and were circled from the upper edge of
the fifth rib, thereby compressing the intercostal nerve underneath the
fifth rib. In the second group (group B), the intercostal muscle
underneath the fifth rib was partially dissected along with the
intercostal nerve, corresponding to the holes on the sixth rib. Two 1/0
polyglactin (Vicyrl) sutures were passed through the holes in the sixth
rib and above the intercostal nerve. Results: There were 30 patients in
each group. The visual analog score, observer verbal ranking scale (OVRS)
scores for pain, and Ramsay sedation scores were used to follow-up on
postoperative analgesia and sedation. The von Frey hair test was used to
evaluate hyperalgesia of the patients. The patients in group B had lower
visual analog scores at rest and during coughing. The patients in group B
had lower OVRS scores than group A patients. The groups were not
statistically different in terms of the Ramsay sedation scores and von
Frey hair tests. Conclusions: Thoracotomy closure by a technique that
avoids intercostal nerve compression significantly decreases
post-thoracotomy pain. 2010 European Association for Cardio-Thoracic
Surgery.

<23>
Accession Number
2011133406
Authors
Catalan P. Leta R. Hidalgo A. Montiel J. Alomar X. Vilades D. Barros A.
Pujadas S. Carreras F. Padro J.M. Cinca J. Pons-Llado G.
Institution
(Catalan, Leta, Hidalgo, Alomar, Barros, Pujadas, Carreras, Pons-Llado)
Cardiac Imaging Unit, Hospital de la Santa Creu I Sant Pau, Universitat
Autonoma de Barcelona, Barcelona 08034, Spain
(Montiel, Padro) Department of Cardiovascular Surgery, Hospital de la
Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona 08034,
Spain
(Vilades, Cinca) Department of Cardiology, Hospital de la Santa Creu I
Sant Pau, Universitat Autonoma de Barcelona, Reina Elisenda de Montcada
17, Barcelona 08034, Spain
Title
Ruling out coronary artery disease with noninvasive coronary multidetector
CT angiography before noncoronary cardiovascular surgery.
Source
Radiology. 258 (2) (pp 426-434), 2011. Date of Publication: February
2011.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States)
Abstract
Purpose: To assess the usefulness of preoperative coronary computed
tomographic (CT) angiography in the detection of coronary artery disease
(CAD) in nonselected patients scheduled to undergo noncoronary
cardiovascular surgery to avoid unnecessary invasive coronary angiography
(ICA). Materials and Methods: The institutional review board approved the
study protocol; informed consent was given. This prospective study
involved 161 consecutive patients who underwent coronary calcium scoring
and coronary CT angiography before undergoing noncoronary cardiovascular
surgery. Seven patients were excluded because of contraindications to CT
angiography. The major indication of noncoronary cardiovascular surgery
was valvular heart disease (121 patients). Follow-up was performed at a
median of 20 months to define ischemic events described as acute coronary
syndrome or death secondary to acute coronary syndrome, arrhythmias, or
cardiac failure. Multivariate analysis was performed to determine
predictors of nondiagnostic coronary CT angiography. Kaplan-Meier analysis
was performed to evaluate outcome at follow-up. Results: Twenty-one
patients did not undergo surgery, which left 133 patients as the study
group. Atrial fibrillation was present in 45 of 133 patients. The
interquartile range of the Agatston coronary calcium score was 0-471.
Coronary CT angiography was diagnostic in 108 of 133 patients. Of these,
93 of 108 had no significant CAD (<= 50% stenosis), and noncoronary
cardiovascular surgery was performed in them without preoperative ICA. No
patients in this group had postoperative ischemic events at follow-up.
Coronary CT angiography was nondiagnostic in 25 of 133 patients who were
referred for preoperative ICA. Multivariate analysis showed Agatston score
to be the only independent predictor of nondiagnostic coronary CT
angiography (odds ratio = 1.002; 95% confidence interval: 1.001, 1.003; P
=.001). The best Agatston score cutoff for diagnostic coronary CT
angiography was 579. Conclusion: In nonselected patients scheduled to
undergo noncoronary cardiovascular surgery, preoperative coronary CT
angiography was diagnostic in 81% of cases. Preoperative ICA could be
safely avoided in patients without significant CAD by using coronary CT
angiography. The Agatston score, but not the presence of atrial
fibrillation, was an independent predictor of nondiagnostic coronary CT
angiography. RSNA, 2010.

<24>
Accession Number
2011137999
Authors
Taghipour H.R. Naseri M.H. Safiarian R. Dadjoo Y. Pishgoo B. Mohebbi H.A.
Daftari Besheli L. Malekzadeh M. Kabir A.
Institution
(Taghipour, Naseri, Safiarian, Dadjoo, Pishgoo, Mohebbi, Malekzadeh)
Trauma Research Center, Department of Cardiology and Cardiothoracic
Surgery, Bagiyatallah University of Medical Sciences, Iran, Islamic
Republic of
(Daftari Besheli, Kabir) Department of Epidemiology, Shahid Beheshti
University of Medical Sciences, Iran, Islamic Republic of
(Kabir) Center for Educational Research in Medical Sciences, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Quality of life one year after coronary artery bypass graft surgery.
Source
Iranian Red Crescent Medical Journal. 13 (3) (pp 171-177), 2011. Date of
Publication: 2011.
Publisher
Iranian Red Crescent Society (PO Box: 2330, Dubai , UAE, United Arab
Emirates)
Abstract
Background: Coronary artery bypass graft (CABG) is a treatment strategy to
relieve the symptoms of coronary artery disease (CAD). Based on
determining the long term outcome of CABG using SF-36 Health Related
Quality Of Life (HRQOL) questionnaire, the present study was conducted in
our center to determine the CABG results one-year after the operation.
Methods: Between March 2005 and August 2009, 112 patients with coronary
heart disease (CHD) who underwent coronary artery bypass graft (CABG) were
enrolled. Patients completed SF-36 HRQOL general health status
questionnaire. Stepwise multiple linear regression models were used to
detect independent variables predicting changes in each eight subscales of
SF-36 questionnaire. Results: The mean age of patients was 61.4+/-0.9
years and most of them were male with three vessel diseases that were on
pump CABG. The mean physical and mental component summary scores were
59.5+/-0.9 and 60.2+/-0.9, respectively. Physical functioning (PF) and
role physical (RP) improved in males. Regression models showed that there
were some statistical models with low R-square to predict role emotional
(RE), general health (GH), PF and RP according to ejection fraction after
surgery, diabetes, pump type of CABG and male gender. Conclusion: CABG has
led to higher and more satisfactory outcomes for PF, RP and RE but lower
in other scales comparing with normative data of the society and one-year
post-operative scores of other studies. It could mostly be attributed to
unmodified risk factors and progression of existing comorbidities.
Iranian Red Crescent Medical Journal.

<25>
Accession Number
2011138559
Authors
Hayward P.A.R. Buxton B.F.
Institution
(Hayward, Buxton) Department of Cardiac Surgery, Austin Hospital,
Victoria, Australia
(Hayward, Buxton) Department of Surgery, University of Melbourne,
Victoria, Australia
Title
The Radial Artery Patency and Clinical Outcomes Trial: Design,
Intermediate Term Results and Future Direction.
Source
Heart Lung and Circulation. 20 (3) (pp 187-192), 2011. Date of
Publication: March 2011.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
The Radial Artery Patency and Clinical Outcomes Study (RAPCO) was devised
and implemented in Melbourne in order to establish the appropriate place
of the radial artery in the hierarchy of conduits available to the modern
coronary bypass surgeon. Designed as a biological comparison with
minimisation of other confounding variables, it compares this free
arterial graft with the right internal thoracic artery and saphenous vein,
with all conduits used in an identical fashion in two parallel cohorts of
different age ranges. Enrolment was completed in 2004 and 10-year
follow-up is in progress, with mean duration of about seven years at
present. The midterm clinical and angiographic results to date are
reviewed here, but definitive conclusions will not be possible until full
completion angiographic data is available. The trial data provides a
number of potential substudies of conduits, risk factors for failure and
the natural history of treated coronary disease. 2011.

<26>
Accession Number
2011140932
Authors
Schulz P. Lottman D.J. Barkmeier T.L. Zimmerman L. Barnason S. Hertzog M.
Institution
(Schulz, Lottman, Barkmeier, Zimmerman, Barnason, Hertzog) UNMC College of
Nursing-Lincoln Division, Lincoln, NE, United States
Title
Medications and associated symptoms/problems after coronary artery bypass
surgery.
Source
Heart and Lung: Journal of Acute and Critical Care. 40 (2) (pp 130-138),
2011. Date of Publication: March-April 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The purpose of this secondary analysis was to describe
medication use and examine the relationship between medications and
postoperative symptoms/problems in the first 3 months after coronary
artery bypass surgery (CABS). Methods: The sample consisted of older (>=65
years) men and women (n = 232) who had undergone CABS. Medication data
were collected through self-report 3 and 6 weeks and 3 months after
surgery. Results: Most patients reported taking aspirin (88.2%-85.7%),
statins or cholesterol-lowering drugs (88.6%-87%), and beta-blockers
(68%-55.6%). No significant differences were found between the proportion
of patients taking and not taking beta-blockers, antiarrhythmics,
cholesterol-lowering drugs, or angiotensin-converting enzyme inhibitor
medications for common medication-specific symptoms/problems. Conclusion:
Patients experience symptoms after surgery, but these symptoms did not
seem to be side effects from medications. Nursing assessments and
interventions targeting postoperative symptoms, symptom management, and
medication side effects can enhance recovery and reinforce medication
adherence. 2011 Elsevier Inc.

<27>
Accession Number
2011126316
Authors
Jeger R.V. Urban P. Harkness S.M. Tseng C.-H. Stauffer J.-C. Lejemtel T.H.
Sleeper L.A. Pfisterer M.E. Hochman J.S.
Institution
(Jeger, Tseng, Hochman) Cardiovascular Clinical Research Center, New York
University School of Medicine, New York, NY, United States
(Jeger, Pfisterer) Department of Cardiology, University Hospital Basel,
Petersgraben 4, 4031 Basel, Switzerland
(Urban) Cardiovascular Department, La Tour Hospital, Geneva, Switzerland
(Harkness, Sleeper) New England Research Institutes, Watertown, MA, United
States
(Stauffer) Division of Cardiology, University Hospital Lausanne, Lausanne,
Switzerland
(Lejemtel) Section of Cardiology, Tulane University School of Medicine,
New Orleans, LA, United States
Title
Early revascularization is beneficial across all ages and a wide spectrum
of cardiogenic shock severity: A pooled analysis of trials.
Source
Acute Cardiac Care. 13 (1) (pp 14-20), 2011. Date of Publication: March
2011.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Background: A pooled analysis in cardiogenic shock due to acute coronary
syndromes is desirable to assess the effect of early revascularization
(ERV) across all ages and a wide spectrum of disease severity. Methods:
Only two randomized controlled trials (RCT), i.e. SMASH and SHOCK, met the
inclusion criteria and were combined for a pooled analysis using
individual patient data (n = 348). Results: SMASH patients (n = 54, 16%)
had more severe disease than SHOCK patients (n = 294, 84%). After
adjustment for age, anoxic brain damage, non-inferior myocardial
infarction, prior coronary artery bypass graft surgery, renal failure,
systolic blood pressure, and selection for coronary angiography, one-year
mortality was similar (relative risk SHOCK versus SMASH 0.87, 95% CI:
0.61-1.25). Relative risk of one-year death for ERV versus initial medical
stabilization was 0.82 (95% CI: 0.70-0.96). There was no significant
difference in the treatment effect by age (<=75 years relative risk at one
year 0.79, 95% CI: 0.63-0.99; > 75 years relative risk at one year 0.93,
95% CI: 0.56-1.53; interaction P = 0.10). Conclusions: Only two RCT have
been published emphasizing the difficulty of enrolling critically ill
patients. Despite large differences in shock severity, ERV benefit is
similar across all ages and not significantly different for the elderly.
2011 Informa UK, Ltd.

<28>
Accession Number
2011132770
Authors
van Breugel N.H. Bidar E. Essers B.A. Nieman F.H. Accord R.E. Severens
J.L. Vrakking R. Maessen J.G.
Institution
(van Breugel, Bidar, Accord, Maessen) Department of Cardiothoracic
Surgery, University Hospital of Maastricht, Maastricht, Netherlands
(Essers, Nieman, Severens) Department of Clinical Epidemiology and Medical
Technology Assessment, University Hospital of Maastricht, Maastricht,
Netherlands
(Severens) Department of Health Organisation, Policy and Economics, CAPHRI
Research Institute, Maastricht University, Maastricht, Netherlands
(Vrakking) Department of Cardiothoracic Surgery, Amphia Hospital Breda,
Breda, Netherlands
Title
Cost-effectiveness of ablation surgery in patients with atrial
fibrillation undergoing cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (3) (pp 394-398),
2011. Date of Publication: March 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
This study was performed to assess the cost-effectiveness of concomitant
ablation surgery (AS) compared to regular cardiac surgery in atrial
fibrillation (AF) patients over a one-year follow-up. Cost analysis was
performed from a societal perspective alongside a prospective, randomised,
double-blinded, multicentre trial. One hundred and fifty patients with
documented AF were randomly assigned to undergo cardiac surgery with or
without AS. One hundred and thirty-two patients were included in the
cost-effectiveness study. All costs (medical and non-medical) were
measured during follow-up. Costs data were combined with quality adjusted
life years (QALYs) to obtain the incremental costs per QALY. Total costs
of the AS group were significantly higher compared to the regular cardiac
surgery group [cost difference bootstrap: 4,724; 95% uncertainty interval
(UI), 2,770-76,678]. The bootstrapped difference in QALYs was not
statistically significant (0.06; 95% UI: -0.024 to 0.14). The incremental
cost-effectiveness ratio is 73,359 per QALY. The acceptability curve
showed that, even in the case of a maximum threshold value of 80,000 per
QALY gained, the probability of AS being more cost-effective than regular
cardiac surgery did not reach beyond 50%. Concluding that concomitant AS
in AF is not cost-effective after a one-year follow-up compared to regular
cardiac surgery. 2011 Published by European Association for
Cardio-Thoracic Surgery.

<29>
Accession Number
2011130839
Authors
Hulten E.A. Carbonaro S. Petrillo S.P. Mitchell J.D. Villines T.C.
Institution
(Hulten, Carbonaro, Villines) Cardiology Service, Walter Reed Army Medical
Center, 6900 Georgia Avenue, NW, Washington, DC 20307, United States
(Mitchell) Department of Medicine, Walter Reed Army Medical Center,
Washington, DC, United States
(Petrillo) Mid-Atlantic Permanente Group, Rockville, MD, United States
Title
Prognostic value of cardiac computed tomography angiography: A systematic
review and meta-analysis.
Source
Journal of the American College of Cardiology. 57 (10) (pp 1237-1247),
2011. Date of Publication: 08 Mar 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives The purpose of this study was to systematically review and
perform a meta-analysis of the ability of cardiac computed tomography
angiography (CCTA) to predict future cardiovascular events and death.
Background The diagnostic accuracy of CCTA is well reported. The
prognostic value of CCTA has been described in several studies, but many
were underpowered. Pooling outcomes increases the power to predict rare
events. Methods We searched multiple databases for longitudinal studies of
CCTA with at least 3 months follow-up of symptomatic patients with
suspected coronary artery disease (CAD) reporting major adverse
cardiovascular events (MACE), consisting of death, myocardial infarction
(MI), and revascularization. Annualized event rates were pooled using a
bivariate mixed-effects binomial regression model to calculate summary
likelihood ratios and receiver-operating characteristic curves. Results
Eighteen studies evaluated 9,592 patients with a median follow-up of 20
months. The pooled annualized event rate for obstructive (any vessel with
>50% luminal stenosis) versus normal CCTA was 8.8% versus 0.17% per year
for MACE (p < 0.05) and 3.2% versus 0.15% for death or MI (p < 0.05). The
pooled negative likelihood ratio for MACE after normal CCTA findings was
0.008 (95% confidence interval [CI]: 0.0004 to 0.17, p < 0.001), the
positive likelihood ratio was 1.70 (95% CI: 1.42 to 2.02, p < 0.001),
sensitivity was 0.99 (95% CI: 0.93 to 1.00, p < 0.001), and specificity
was 0.41 (95% CI: 0.31 to 0.52, p < 0.001). Stratifying by no CAD,
nonobstructive CAD (worst stenosis <50%), or obstructive CAD, there were
incrementally increasing adverse events. Conclusions Adverse
cardiovascular events among patients with normal findings on CCTA are
rare. There are incrementally increasing future MACE with increasing CAD
by CCTA. 2011 American College of Cardiology Foundation.