EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2011171144
Authors
Kroner A. van Iperen E. Horn J. Binnekade J.M. Spronk P.E. Stoker J.
Schultz M.J.
Institution
(Kroner, van Iperen, Horn, Binnekade, Schultz) Department of Intensive
Care Medicine, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Kroner) Department of Anesthesiology, Academic Medical Center, University
of Amsterdam, Amsterdam, Netherlands
(Spronk) Department of Intensive Care Medicine, Gelre Hospital, Location
Lukas, Apeldoorn, Netherlands
(Stoker) Department of Radiology, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Schultz) Laboratory of Experimental Intensive Care and Anesthesiology
(LEICA), Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Schultz) HERMES Critical Care Group, Amsterdam, Netherlands
Title
The low therapeutic efficacy of postoperative chest radiographs for
surgical intensive care unit patients.
Source
Minerva Anestesiologica. 77 (2) (pp 147-153), 2011. Date of Publication:
February 2011.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Background. The clinical value of postoperative chest radiographs (CXRs)
for surgical intensive care unit (ICU) patients is largely unknown. In the
present study, we determined the diagnostic and therapeutic efficacy of
postoperative CXRs for different surgical subgroups and related their
efficacy to the time after ICU admission. Methods. A prospective,
observational study of consecutive postoperative surgical ICU patients was
performed during a 10 month period. We restricted our analysis to CXRs
obtained within six hours after admission to the ICU. Diagnostic efficacy
was defined by the presence of predefined major abnormalities; therapeutic
efficacy was defined by predefined actions taken because of any
abnormality found on postoperative CXRs. Results. Of 857 surgical ICU
patients, 670 (78%) had a postoperative CXR after admission to the ICU. Of
these CXRs, 80 were performed for clinical reasons, and 590 were routinely
obtained (i.e., these CXRs were made without a reason other than admission
to the ICU itself). The diagnostic efficacy of clinically indicated and
routinely obtained CXRs was 18% (14/80) and 13% (79/590), respectively. Of
all predefined abnormalities found on CXRs, 60% involved the malposition
of invasive devices, such as endotracheal tubes or central venous lines.
The therapeutic efficacy of clinically indicated and routinely obtained
CXRs was 4% (3/80) and 4% (26/590), respectively. While the diagnostic and
therapeutic efficacy of routinely obtained CXRs were not dependent on
timing of admission, the diagnostic and therapeutic efficacy of clinically
indicated CXRs was higher for CXRs taken closer to the time of ICU
admission. Conclusion. Although the diagnostic efficacy of clinically
indicated and routinely obtained postoperative CXRs in surgical ICU
patients appears to be significant, their therapeutic efficacy is low.

<2>
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Accession Number
2011198013
Authors
Tyagi A. Seelan S. Sethi A.K. Mohta M.
Institution
(Tyagi, Seelan, Sethi, Mohta) Department of Anesthesiology and Critical
Care, University College of Medical Sciences, Guru Teg Bahadur Hospital,
103 Siddhartha Enclave, Delhi, India
Title
Role of thoracic epidural block in improving post-operative outcome for
septic patients: A preliminary report.
Source
European Journal of Anaesthesiology. 28 (4) (pp 291-297), 2011. Date of
Publication: April 2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Background and objectives Sepsis is considered a relative contraindication
for epidural blockade. Recent evidence indicates that thoracic epidural
blockade may be of benefit during sepsis by improving gut perfusion. This
study was planned to evaluate whether combining thoracic epidural blockade
with general anaesthesia could decrease the post-operative mortality and
morbidity in patients with sepsis due to perforation peritonitis. Methods
This randomised non-blinded study included consenting adult patients of
the American Society of Anesthesiologists grade II-III, undergoing
emergency laparotomy for small intestinal perforation peritonitis.
Severity of illness was evaluated using Mannheim Peritonitis Index, Acute
Physiology and Chronic Health Evaluation III score and clinical indicators
of systemic inflammatory response syndrome. Patients were randomised into
two groups depending on the anaesthetic technique [general anaesthesia
combined with thoracic epidural block (group GT) and general anaesthesia
(group GA), n=33 each. The thoracic block was extended from T5 to T10
using 0.125% bupivacaine in aliquots of 2-3 ml, with 50mg fentanyl.
Post-operatively, patients were followed for occurrence of any major
morbidity till discharge from hospital, and 30-day mortality. 'Major
morbidity' included development of organ failure. Post-operative markers
for gut motility and perfusion, that is, time to passage of flatus,
stools, resumption of oral feeds and occurrence of anastomotic leak were
also observed. Sample size was calculated at power of 80% and a error of
0.05, aiming to detect a decrease of 50% in the incidence of
post-operative major morbidity or mortality. Results Patients in the two
groups were similar with respect to demographic profile and severity of
sepsis. The number of patients with major morbidity or 30-day mortality
were statistically similar between the two groups (group GT, 0/33; group
GA 4/33; P=0.114). A significantly shorter time to pass stools and resume
oral feeds in group GT (4+/-2 vs. 3+/-1 days) (P=0.006 and 0.012,
respectively) and lesser incidence of anastomotic leak (0/33 vs. 4/33;
P=0.114) showed earlier recovery of gut motility and perfusion in that
group. Conclusion Use of intra-operative segmental thoracic epidural
blockade performed in addition to general anaesthesia suggested some
benefit in improving post-operative mortality or major morbidity, but the
trend was not significant, perhaps due to the small sample size. There
was, however, a significantly earlier return of bowel motility and earlier
discharge from hospital. 2011 Copyright European Society of
Anaesthesiology.

<3>
Accession Number
2011199416
Authors
Spotnitz M.E. Wang D.Y. Quinn T.A. Richmond M.E. Rusanov A. Johnston T.
Cheng B. Cabreriza S.E. Spotnitz H.M.
Institution
(Spotnitz, Cabreriza, Spotnitz) Department of Surgery, Columbia University
Medical Center, VC 10-1010, 622 West 168th Street, New York, NY
10032-3784, United States
(Wang) Department of Medicine, Columbia University Medical Center, New
York, NY, United States
(Richmond) Department of Pediatrics, Columbia University Medical Center,
New York, NY, United States
(Rusanov, Johnston) Department of Anesthesiology, Columbia University
Medical Center, New York, NY, United States
(Quinn) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
(Cheng) Department of Biostatistics, Mailman School of Public Health, New
York, NY, United States
Title
Hemodynamic stability during biventricular pacing after cardiopulmonary
bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (2) (pp 238-242),
2011. Date of Publication: April 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To assess the stability of cardiac output, mean arterial
pressure, and systemic vascular resistance during biventricular pacing
(BiVP) optimization. Design: Substudy analysis of data collected as part
of a randomized controlled study examining the effects of optimized
temporary BiVP after cardiopulmonary bypass (CPB). Setting: A
single-center study at a university-affiliated tertiary care hospital.
Participants: Cardiac surgery patients at risk of left ventricular failure
after CPB. Interventions: BiVP was optimized immediately after CPB.
Atrioventricular delay (7 unique settings) was optimized first, followed
by the left ventricular pacing site (3 unique settings) and then the
interventricular delay (9 unique settings). Each setting was tested twice
for 10 seconds each time. Vasoactive medication and fluid infusion rates
were held constant. Measurements and Main Results: Aortic flow velocity
and radial artery pressure were digitized, recorded, and averaged over
single respiratory cycles. Least squares and linear regression/Wilcoxon
analyses were applied to the first 7 patients studied. Subsequently,
curvilinear analysis was applied to 15 patients. Changes in mean arterial
pressure and systemic vascular resistance were statistically insignificant
or too small to be meaningful by least squares analysis. During
interventricular synchrony optimization, cardiac output and mean arterial
pressure decreased (mean changes -5.7% and -2.5%, respectively; with
standard errors 2.3% and 1.5%, respectively), whereas SVR increased (mean
change 3.1% with standard error 3.4%). Only the change in cardiac output
was statistically significant (p = 0.043). Curvilinear fits to data for 15
patients demonstrated progressive hemodynamic stability over the total
testing period. Conclusion: BiVP optimization may be done safely in
patients after CPB. With continuous monitoring of mean arterial pressure
and cardiac output, the procedure results in no harmful hemodynamic
perturbation. 2011 Elsevier Inc.

<4>
Accession Number
2011199417
Authors
Wang G. Bainbridge D. Martin J. Cheng D.
Institution
(Wang) Department of Anesthesiology, Cardiovascular Institute, Chinese
Academy of Medical Sciences, Beijing 100037, China
(Bainbridge, Martin, Cheng) Departments of Anesthesia and Perioperative
Medicine, Evidence-Based Perioperative Clinical Outcomes Research Group
(EPiCOR), University of Western Ontario, London, ON, Canada
(Martin) High Impact Technology Evaluation Centre, London Health Sciences
Centre, University of Western Ontario, London, ON, Canada
Title
N-acetylcysteine in cardiac surgery: Do the benefits outweigh the risks? A
meta-analytic reappraisal.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (2) (pp 268-275),
2011. Date of Publication: April 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: N-acetylcysteine (NAC) reduces proinflammatory cytokines,
oxygen free-radical production, and ameliorates ischemia reperfusion
injury; therefore, it may theoretically reduce postoperative complications
in cardiac surgery. The aim of this study was to determine, through
systematic review and meta-analysis of all relevant randomized trials,
whether NAC reduces mortality, morbidity, or resource utilization in
cardiac surgery. Design: Meta-analysis. Setting: University hospitals.
Participants: A total of 1,407 patients from 15 randomized studies were
included in the analysis. Interventions: None. Measurements and Main
Results: All randomized trials searched up to May 2009 comparing the use
of NAC versus placebo during cardiac surgery in any language and reporting
at least 1 predefined outcome were included. The random effect model was
used to calculate odds ratios (ORs, 95% confidence intervals [CIs]) and
weighted mean differences (WMD, 95% CI) for dichotomous and continuous
variables, respectively. During cardiac surgery, the use of NAC did not
significantly decrease acute renal failure requiring renal replacement
therapy (OR = 1.05; 95% CI, 0.52-2.11; p = 0.90), new atrial fibrillation
(OR = 0.67; 95% CI, 0.37-1.22; p = 0.19), or mortality (OR = 0.81; 95% CI,
0.39-1.68; p = 0.57). There were no differences in the incidence of
incremental increase in serum creatinine concentration greater than 25%
above baseline (OR = 0.86; 95% CI, 0.66-1.12; p = 0.26), acute myocardial
infarction (OR = 0.69; 95% CI, 0.29-1.61, p =0.39), stroke (OR = 0.78; 95%
CI, 0.30-2.03; p = 0.61), red blood cell transfusion requirement (OR =
0.77; 95% CI, 0.45-1.31; p = 0.33), re-exploration (OR = 1.33; 95% CI,
0.70-2.26; p = 0.29), or postoperative drainage (WMD = 33 mL; 95% CI,-125
to 191 mL; p = 0.69) between NAC and placebo. Conclusion: Current evidence
shows that the perioperative use of NAC has no proven benefit or risk on
clinically important outcomes in patients undergoing cardiac surgery.
2011 Elsevier Inc.

<5>
Accession Number
2011199424
Authors
Hudetz J.A. Patterson K.M. Iqbal Z. Gandhi S.D. Pagel P.S.
Institution
(Hudetz, Patterson, Iqbal, Gandhi, Pagel) Department of Anesthesiology,
Medical College of Wisconsin, Clement J. Zablocki Veterans Administration
Medical Center, Milwaukee, WI, United States
Title
Metabolic syndrome exacerbates short-term postoperative cognitive
dysfunction in patients undergoing cardiac surgery: Results of a pilot
study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (2) (pp 282-287),
2011. Date of Publication: April 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The authors tested the hypothesis that patients with metabolic
syndrome are more likely to develop short-term cognitive dysfunction after
cardiac surgery with cardiopulmonary bypass. Design: A prospective study.
Setting: Veterans Affairs medical center. Participants: Fifty-six age- and
education-balanced patients undergoing elective cardiac surgery with
cardiopulmonary bypass (28 patients with and without metabolic syndrome in
two separate groups) and 28 nonsurgical controls were enrolled.
Interventions: None. Measurements and Main Results: Recent verbal and
nonverbal memory and executive functions were assessed using a
psychometric test battery before and 1 week after cardiac surgery or at
1-week intervals in nonsurgical controls. Neurocognitive scores under the
baseline condition were at least 1 z score (1 standard deviation) worse in
surgical patients with compared without metabolic syndrome in all 3
cognitive areas (nonverbal and verbal recent memory and executive
functions). Neurocognitive performance further deteriorated after surgery
by at least 1 z score on 3 tests in the verbal memory modality (Immediate
and Delayed Story Recall and Delayed Word List Recall). Overall cognitive
performance (composite z score) after surgery was significantly (p = 0.03)
worse in metabolic syndrome patients compared with those who did not have
the disorder. Conclusions: The results indicate that short-term cognitive
functions were more profoundly impaired in patients with metabolic
syndrome undergoing cardiac surgery with cardiopulmonary bypass compared
with their healthier counterparts. 2011 Elsevier Inc.

<6>
Accession Number
2011199426
Authors
Elbers P.W.G. Wijbenga J. Solinger F. Yilmaz A. Van Iterson M. Van Dongen
E.P.A. Ince C.
Institution
(Elbers, Ince) Department of Physiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Elbers, Wijbenga, Van Iterson, Van Dongen) Department of Anesthesia,
Intensive Care and Pain Management, St. Antonius Hospital, Koekoekslaan 1,
3435 CM, Nieuwegein, Netherlands
(Solinger) Department of Perfusion, St. Antonius Hospital, Nieuwegein,
Netherlands
(Yilmaz) Department of Cardiothoracic Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
Title
Direct observation of the human microcirculation during cardiopulmonary
bypass: Effects of pulsatile perfusion.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (2) (pp 250-255),
2011. Date of Publication: April 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: Possible benefits of pulsatile perfusion during
cardiopulmonary bypass often are attributed to enhanced microvascular
flow. However, there is no evidence to support this in humans. Therefore,
the authors assessed whether pulsatile perfusion alters human
microvascular flow. Design: A prospective, randomized observational
crossover study. Setting: A tertiary cardiothoracic surgery referral
center. Participants: Sixteen patients undergoing routine cardiopulmonary
bypass for cardiac surgery. Interventions: All patients underwent both
pulsatile and nonpulsatile perfusion in random order. Measurements and
Main Results: The authors used sidestream dark-field imaging to record
video clips of the sublingual human microcirculation. Perfusion was
started either in the pulsatile (n = 8) or the nonpulsatile mode. After 10
minutes, microvascular recordings were made. The perfusion mode was then
switched, and after 10 minutes, new microvascular recordings were taken.
The authors quantified pulsatile perfusion-generated surplus hemodynamic
energy by calculating pulse pressure and energy-equivalent pressure.
Microvascular analysis included determination of the perfused vessel
density (mean +/- standard deviation). This did not differ between
nonpulsatile and pulsatile perfusion (6.65 +/- 1.39 v 6.83 +/- 1.23
mm^-1, p = 0.58, and 2.16 +/- 0.64 v 1.96 +/- 0.48
mm^-1, p = 0.20 for small and large microvessels, respectively,
cutoff diameter = 20 mum). Pulse pressure and energy-equivalent pressure
was higher during pulsatile perfusion. However, there was no correlation
between the difference in energy-equivalent pressure or pulse pressure and
perfused vessel density (r = -0.43, p = 0.13, and r = -0.09, p = 0.76,
respectively). Conclusion: Pulsatile perfusion does not alter human
microvascular perfusion using standard equipment in routine cardiac
surgery. Changes in pulse pressure or energy-equivalent pressure bear no
obvious relationship with microcirculatory parameters. 2011 Elsevier Inc.

<7>
Accession Number
2011199434
Authors
Zhang X. Wu Z. Peng X. Wu A. Yue Y. Martin J. Cheng D.
Institution
(Zhang, Wu, Yue) Department of Anesthesiology, Beijing Chaoyang Hospital,
8# Worker's Stadium South Road, Chaoyang District, Beijing 100020, China
(Wu) Department of Anesthesiology, Yingde People's Hospital, Guangdong,
China
(Peng) Department of Biostatistics and Epidemiology, School of Public
Health and Family Medicine, Capital Medical University, Beijing, China
(Martin, Cheng) Department of Anesthesia and Perioperative Medicine,
London Health Sciences Centre, University of Western Ontario, London, ON,
Canada
(Martin) High Impact Technology Evaluation Centre, London Health Sciences
Centre, University Hospital, London, ON, Canada
Title
Prognosis of diabetic patients undergoing coronary artery bypass surgery
compared with nondiabetics: A systematic review and meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (2) (pp 288-298),
2011. Date of Publication: April 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The influence of diabetes mellitus (DM) on mortality and
morbidity in patients undergoing coronary artery bypass graft (CABG)
surgery has remained uncertain due to conflicting conclusions from
clinical trials measuring the association between diabetes and
perioperative risk. Therefore, a quantitative meta-analysis was undertaken
to evaluate the available evidence from prospective and historic cohort
clinical trials. The purpose of this study was to determine the
significance and magnitude of impact of DM on mortality, morbidity and
resource-related outcomes for patients undergoing CABG over the past few
decades and in the contemporary setting. Methods: MEDILINE, EMBase, BIOSIS
Preview, CBMDisc, CNKI and WanFang databases were searched, supplemented
by hand search, without language limitations, for studies published from
January 1981 to October 2008. Data extraction included study design,
setting, inclusion/exclusion criteria, population characteristics,
statistical method, length of follow-up and clinical outcomes. Eligible
studies were assessed for quality. Results: Of the 132 identified studies,
24 cohort studies with a median follow-up of 4.3 years were selected for
analysis. A total of 100,217 patients (28,168 with DM and 72,049 without
DM), were included in the meta-analysis. The pooled RR (95% CI) for
mortality of diabetic versus non-diabetic patients was significantly
increased at 30 days (RR 1.64, 95% CI 1.39, 1.93), 1 year (RR 1.83, 95% CI
1.56, 2.15), 3 years (RR 1.81, 95% CI 1.58, 2.09), 5 years (RR 1.66, 95%
CI 1.53, 1.79) and 10 years (RR 1.55, 95% CI 1.43, 1.68) after CABG.
Significant differences were also found for DM versus non-DM patients
post-CABG for perioperative cerebrovascular accidents (RR 1.52; 95% CI
1.31, 1.77), postoperative acute renal failure (RR 1.63; 95% CI 1.48,
1.79), sternal infection (RR; 1.70, 95% CI 1.41-2.04) and blood
transfusion (RR 1.15; 95% CI 1.08, 1.21). No significant differences were
found for postoperative atrial fibrillation (AF), postoperative myocardial
infarction (MI) and re-exploration for bleeding. Insufficient and/or
heterogeneous data did not allow for pooled analysis of ventilator time,
ICU stay, angina recurrence, repeat revascularization, hospital stay and
hospital costs. Conclusions: Current evidence suggests that patients with
DM who are undergoing CABG are at increased risk of mortality, stroke,
renal failure, sternal infection and blood transfusion when compared to
those without DM. This increased relative risk for perioperative mortality
and complications has remained, despite evolving definitions of DM and
practice patterns. Future randomized studies should focus on interventions
targeted toward these complications to mitigate the risk for patients with
DM. 2011 Elsevier Inc.

<8>
Accession Number
2011199677
Authors
Wen Y. Meng L. Xie J. Ouyang J.
Institution
(Wen) Nanjing University Medical School, Department of Pathology, Nanjing,
China
(Meng, Ouyang) Affiliated Drum Tower Hospital, Nanjing University Medical
School, Department of Hematology, Nanjing, China
(Xie) Affiliated Drum Tower Hospital, Nanjing University Medical School,
Department of Cardiology, Nanjing, China
Title
Direct autologous bone marrow-derived stem cell transplantation for
ischemic heart disease: A meta-analysis.
Source
Expert Opinion on Biological Therapy. 11 (5) (pp 559-567), 2011. Date of
Publication: May 2011.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objective: Previous evaluation of intracoronary autologous bone
marrow-derived stem cell (BMSCs) therapy following ischemic heart disease
(IHD) suggested improvement of cardiac functional parameters. We performed
a meta-analysis to provide systematic assessment of the safety and
efficacy of direct (intramyocardial or endomyocardial) BMSCs
transplantation in patients with IHD. Research design and methods:
Randomized controlled Trials (RCTs) were identified in the MEDLINE (~ Oct.
2010), the Cochrane Central Register of Controlled Trials (Central) (~
Oct. 2010), EMBASE (~ Oct. 2010), and EBSCO (~ Oct. 2010), reviews, and
reference lists of relevant articles. Weighted mean difference (WMD) was
calculated for changes in left ventricular ejection fraction (LVEF), left
ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV) by
using a fixed effects model. Results: Eight RCTs with 307 participants
were eligible. Compared with controls, direct BMSCs transplantation
improved LVEF (8.4%, 95% CI, 6.49 to 10.31%; p < 0.01), reduced LVESV and
LVEDV (-14.85 ml, 95%CI,-27.29 to-2.41 ml, p = 0.02 and-12.79 ml, 95%
CI,-24.94 to-0.65 ml, p = 0.04, respectively). Conclusions: This
meta-analysis suggests that direct BMSCs transplantation is associated
with moderate but significant improvements over regular therapy in cardiac
functional parameters in patients with IHD, and supports conducting
further RCTs of a higher quality. 2011 Informa UK, Ltd.

<9>
Accession Number
2011201219
Authors
Hsia J. MacFadyen J.G. Monyak J. Ridker P.M.
Institution
(Hsia, Monyak) AstraZeneca LP, Wilmington, DE, United States
(MacFadyen, Ridker) Center for Cardiovascular Disease Prevention, Division
of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA,
United States
(Hsia) 1800 Concord Pike, P.O. Box 15437, Wilmington, DE 19850-5437,
United States
Title
Cardiovascular event reduction and adverse events among subjects attaining
low-density lipoprotein cholesterol <50 mg/dl with rosuvastatin: The
JUPITER trial (justification for the use of statins in prevention: An
intervention trial evaluating rosuvastatin).
Source
Journal of the American College of Cardiology. 57 (16) (pp 1666-1675),
2011. Date of Publication: 19 Apr 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to assess the impact on
cardiovascular and adverse events of attaining low-density lipoprotein
cholesterol (LDL-C) levels <50 mg/dl with rosuvastatin in apparently
healthy adults in the JUPITER (Justification for the Use of Statins in
Prevention: an Intervention Trial Evaluating Rosuvastatin) trial.
Background: The safety and magnitude of cardiovascular risk reduction
conferred by treatment to LDL-C levels below current recommended targets
remain uncertain. Methods: A cohort of 17,802 apparently healthy men and
women with high-sensitivity C-reactive protein <2 mg/l and LDL-C <130
mg/dl were randomly allocated to rosuvastatin 20 mg daily or placebo, and
followed up for all-cause mortality, major cardiovascular events, and
adverse events. In a post-hoc analysis, participants allocated to
rosuvastatin were categorized as to whether or not they had a follow-up
LDL-C level <50 mg/dl. Results: During a median follow-up of 2 years
(range up to 5 years), rates of the primary trial endpoint were 1.18,
0.86, and 0.44 per 100 person-years in the placebo group (n = 8,150) and
rosuvastatin groups without LDL-C <50 mg/dl (n = 4,000) or with LDL-C <50
mg/dl (n = 4,154), respectively (fully-adjusted hazard ratio: 0.76; 95%
confidence interval: 0.57 to 1.00 for subjects with no LDL-C <50 mg/dl vs.
placebo and 0.35, 95% confidence interval: 0.25 to 0.49 for subjects
attaining LDL-C <50 mg/dl; p for trend <0.0001). For all-cause mortality,
corresponding event rates were 0.67, 0.65, and 0.39 (p for trend = 0.004).
Rates of myalgia, muscle weakness, neuropsychiatric conditions, cancer,
and diabetes mellitus were not significantly different among
rosuvastatin-allocated participants with and without LDL-C <50 mg/dl.
Conclusions: Among adults with LDL-C <130 mg/dl and high-sensitivity
C-reactive protein <2 mg/l, rosuvastatin-allocated participants attaining
LDL-C <50 mg/dl had a lower risk of cardiovascular events without a
systematic increase in reported adverse events. 2011 American College of
Cardiology Foundation.

<10>
Accession Number
2011201232
Authors
Siegel R.J. Biner S. Rafique A.M. Rinaldi M. Lim S. Fail P. Hermiller J.
Smalling R. Whitlow P.L. Herrmann H.C. Foster E. Feldman T. Glower D. Kar
S.
Institution
(Siegel, Biner, Rafique, Kar) Cedars-Sinai Medical Center, 8700 Beverly
Boulevard, Los Angeles, CA 90048-1804, United States
(Rinaldi) Sanger Heart and Vascular Institute, Charlotte, NC, United
States
(Lim) University of Virginia, Charlottesville, VA, United States
(Fail) Terrebonne General Medical Center, Houma, LA, United States
(Hermiller) Care Group, Indianapolis, IN, United States
(Smalling) Houston Health Sciences Center, Houston, TX, United States
(Whitlow) Cleveland Clinic, Cleveland, OH, United States
(Herrmann) University of Pennsylvania, Philadelphia, PA, United States
(Foster) University of California at San Francisco, San Francisco, CA,
United States
(Feldman) Evanston Hospital, Evanston, IL, United States
(Glower) Duke University Medical Center, Durham, NC, United States
Title
The acute hemodynamic effects of mitraclip therapy.
Source
Journal of the American College of Cardiology. 57 (16) (pp 1658-1665),
2011. Date of Publication: 19 Apr 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The objective of this study was to evaluate the acute
hemodynamic consequences of mitral valve (MV) repair with the MitraClip
device (Abbott Vascular, Menlo Park, California). Background: Whether
surgical correction of mitral regurgitation (MR) results in a low cardiac
output (CO) state because of an acute increase in afterload remains
controversial. The acute hemodynamic consequences of MR reduction with the
MitraClip device have not been studied. Methods: We evaluated 107 patients
with cardiac catheterization before and immediately following percutaneous
MV repair with the MitraClip device. In addition, pre- and post-procedural
hemodynamic parameters were studied by transthoracic echocardiography.
Results: MitraClip treatment was attempted in 107 patients, and in 96
(90%) patients, a MitraClip was deployed. Successful MitraClip treatment
resulted in: 1) an increase in CO from 5.0 +/- 2.0 l/min to 5.7 +/- 1.9
l/min (p = 0.003); 2) an increase in forward stroke volume (FSV) from 57
+/- 17 ml to 65 +/- 18 ml (p < 0.001); and 3) a decrease in systemic
vascular resistance from 1,226 +/- 481 dyns/cm⁵ to 1,004 +/-
442 dyns/cm ⁵ (p < 0.001). In addition, there was left
ventricular (LV) unloading manifested by a decrease in LV end-diastolic
pressure from 11.4 +/- 9.0 mm Hg to 8.8 +/- 5.8 mm Hg (p = 0.016) and a
decrease in LV end-diastolic volume from 172 +/- 37 ml to 158 +/- 38 ml (p
< 0.001). None of the patients developed acute post-procedural low CO
state. Conclusions: Successful MV repair with the MitraClip system results
in an immediate and significant improvement in FSV, CO, and LV loading
conditions. There was no evidence of a low CO state following MitraClip
treatment for MR. These favorable hemodynamic effects with the MitraClip
appear to reduce the risk of developing a low CO state, a complication
occasionally observed after surgical MV repair for severe MR. (A Study of
the Evalve Cardiovascular Valve Repair System Endovascular Valve
Edge-to-Edge Repair Study [EVEREST I]; NCT00209339 and EVEREST II;
NCT00209274) 2011 American College of Cardiology Foundation.

<11>
Accession Number
2011201233
Authors
Buellesfeld L. Gerckens U. Schuler G. Bonan R. Kovac J. Serruys P.W.
Labinaz M. Den Heijer P. Mullen M. Tymchak W. Windecker S. Mueller R.
Grube E.
Institution
(Buellesfeld, Windecker) Swiss Cardiovascular Center Bern, Bern University
Hospital, Bern CH-3010, Switzerland
(Gerckens, Mueller) HELIOS Heart Center Siegburg, Siegburg, Germany
(Schuler) University of Leipzig Heart Centre, Leipzig, Germany
(Bonan) Montreal Heart Institute, Montreal, QC, Canada
(Kovac) University Hospitals Leicester, Leicester, United Kingdom
(Serruys) Erasmus University Medical Center, Rotterdam, Netherlands
(Labinaz) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Den Heijer) Amphia Hospital, Breda, Netherlands
(Mullen) Royal Brompton Hospital, London, United Kingdom
(Tymchak) University of Alberta Cardiac Surgery, Edmonton, AB, Canada
(Grube) Bonn University Hospital, Bonn, Germany
Title
2-year follow-up of patients undergoing transcatheter aortic valve
implantation using a self-expanding valve prosthesis.
Source
Journal of the American College of Cardiology. 57 (16) (pp 1650-1657),
2011. Date of Publication: 19 Apr 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to evaluate the safety, device
performance, and clinical outcome up to 2 years for patients undergoing
transcatheter aortic valve implantation (TAVI). Background: The role of
TAVI in the treatment of calcific aortic stenosis evolves rapidly, but
mid- and long-term results are scarce. Methods: We conducted a
prospective, multicenter, single-arm study with symptomatic patients
undergoing TAVI for treatment of severe aortic valve stenosis using the
18-F Medtronic CoreValve (Medtronic, Minneapolis, Minnesota) prosthesis.
Results: In all, 126 patients (mean age 82 years, 42.9% male, mean
logistic European System for Cardiac Operative Risk Evaluation score
23.4%) with severe aortic valve stenosis (mean gradient 46.8 mm Hg)
underwent the TAVI procedure. Access was transfemoral in all but 2 cases
with subclavian access. Retrospective risk stratification classified 54
patients as moderate surgical risk, 51 patients as high-risk operable, and
21 patients as high-risk inoperable. The overall technical success rate
was 83.1%. Thirty-day all-cause mortality was 15.2%, without significant
differences in the subgroups. At 2 years, all-cause mortality was 38.1%,
with a significant difference between the moderate-risk group and the
combined high-risk groups (27.8% vs. 45.8%, p = 0.04). This difference was
mainly attributable to an increased risk of noncardiac mortality among
patients constituting the high-risk groups. Hemodynamic results remained
unchanged during follow-up (mean gradient: 8.5 +/- 2.5 mm Hg at 30 days
and 9.0 +/- 3.4 mm Hg at 2 years). Functional class improved in 80% of
patients and remained stable over time. There was no incidence of
structural valve deterioration. Conclusions: The TAVI procedure provides
sustained clinical and hemodynamic benefits for as long as 2 years for
patients with symptomatic severe aortic stenosis at increased risk for
surgery. 2011 American College of Cardiology Foundation.

<12>
Accession Number
2011201321
Authors
Becker M. Altiok E. Lente C. Otten S. Friedman Z. Adam D. Koos R. Krombach
G. Marx N. Hoffmann R.
Institution
(Becker, Altiok, Otten, Hoffmann, Koos, Marx, Hoffmann) Department of
Cardiology, University Hospital RWTH Aachen, Aachen, Germany
(Lente) Department of Medical Statistics, University Hospital RWTH Aachen,
Aachen, Germany
(Friedman, Adam) Department of Biomedical Engineering, Technion Haifa,
Haifa, Israel
(Krombach) Department of Radiology, University Hospital RWTH Aachen,
Aachen, Germany
Title
Layer-specific analysis of myocardial function for accurate prediction of
reversible ischaemic dysfunction in intermediate viability defined by
contrast-enhanced MRI.
Source
Heart. 97 (9) (pp 748-756), 2011. Date of Publication: May 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background Contrast-enhanced MRI (ceMRI) has impaired accuracy in the
prediction of functional recovery after revascularisation in cases of
intermediate myocardial viability. Objective To evaluate the predictive
value of layer-specific myocardial deformation analysis for improvement in
ischaemic dysfunction after revascularisation. Methods In 132 patients
with ischaemic left ventricular dysfunction undergoing revascularisation,
myocardial viability was assessed by pixel-tracking-derived myocardial
deformation imaging and ceMRI. Peak systolic circumferential strain was
determined for total wall thickness and for three myocardial layers
(endocardial, mid-myocardial and epicardial) in a 16-segment model.
Analysis to predict recovery of function at 8+/-2 months after
revascularisation was performed considering all dysfunctional segments or
only segments with intermediate viability by ceMRI (hyperenhancement
25-75%, N=735 segments). Results Segments with functional recovery (N=568)
had higher circumferential strain in all myocardial layers and a smaller
degree of hyperenhancement than segments without functional recovery
(N=433). Analysis of all dysfunctional segments showed that the predictive
accuracy for functional recovery was high for endocardial strain, total
wall thickness strain and hyperenhancement by ceMRI (area under the curve
(AUC) 0.883, 0.782 and 0.834, respectively). Considering only segments
with intermediate viability by ceMRI, endocardial circumferential strain
allowed prediction of functional recovery with higher accuracy
(specificity 75%, sensitivity 78%, AUC=0.811, 95% CI 0.776 to 0.851) than
hyperenhancement analysis (specificity 59%, sensitivity 72%, AUC=0.705,
95% CI 0.659 to 0.747, p<0.05). Conclusion Analysis of layer-specific
myocardial function using deformation imaging allows accurate
identification of reversible myocardial dysfunction. In segments with
intermediate viability analysis of layer-specific deformation may have
special advantages for prediction of functional recovery.

<13>
Accession Number
2011205041
Authors
Hu X. Zhao Q.
Institution
(Hu, Zhao) Department of Cardiac Surgery, Shanghai Jiao Tong University,
Ruijin Hospital, Shanghai 200025, China
Title
Systematic comparison of the effectiveness of radial artery and saphenous
vein or right internal thoracic artery coronary bypass grafts in non-left
anterior descending coronary arteries.
Source
Journal of Zhejiang University: Science B. 12 (4) (pp 273-279), 2011.
Date of Publication: April 2011.
Publisher
Zhejiang University Press (Hangzhou Post Bureau, Hangzhou 310000, China)
Abstract
Coronary artery bypass grafting surgery is increasingly being carried out
on patients with multi-vessel coronary artery disease, but the best
grafting candidate for non-left anterior descending coronary arteries is
unclear. This research sought to systematically compare the efficacies and
safeties of coronary bypass with radial artery and other available grafts.
A systematic literature retrieval was performed for all clinical trials
comparing the outcomes of coronary artery bypass surgery with radial
artery and other grafts in PubMed, EMBASE, and the Cochrane Library. Seven
eligible clinical studies, comparing radial artery and great saphenous
vein grafts, were found between 1966 and 2010: one prospective
non-randomized and six prospective randomized trials. The pooling analysis
obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial
arteries compared with great saphenous veins. There was a significantly
lower infection rate in arms (i.e., harvest sites for radial arteries)
relative to legs (harvest sites for veins), with a pooled relative risk of
0.140 (P<0.05). From the reports on mortality after follow-up ranging from
one year to six years, there was no significant difference in mortality
between the two graft types (P=0.927). In addition, four cohort controlled
trials for radial and right internal thoracic artery grafts were included.
The radial graft was associated with less cardiac related events relative
to the right internal thoracic artery graft (P=0.014), but with comparable
mortality and comparable rates of repeat percutaneous transluminal
coronary angioplasty. Subjects with radial arteries seemed to have a lower
occlusion rate and a lower graft harvest site infection rate than those
with great saphenous veins. Moreover there were fewer cardiac related
events with radial arteries relative to the right internal thoracic artery
grafts. More studies are needed to confirm these findings concerning the
favorable outcomes of coronary artery bypass grafting with radial arteries
on long-term patency and mortality. 2011 Zhejiang University and
Springer-Verlag Berlin Heidelberg.

<14>
Accession Number
2011207500
Authors
Jay M.
Title
Can cognitive behavioral therapy prevent recurrent cardiovascular events?
Commentary.
Source
Journal of Clinical Outcomes Management. 18 (4) (pp 150-152), 2011. Date
of Publication: April 2011.
Publisher
Turner White Communications Inc. (125 Strafford Avenue, Suite 220, Wayne
PA 19087-3391, United States)

<15>
Accession Number
2011209400
Authors
Murtuza B. Pepper J.R. Jones C. Nihoyannopoulos P. Darzi A. Athanasiou T.
Institution
(Murtuza, Pepper) Department of Cardiothoracic Surgery, Royal Brompton
Hospital, Faculty of Medicine, Imperial College, London, United Kingdom
(Athanasiou) Department of Cardiothoracic Surgery, St Mary's Hospital,
Faculty of Medicine, Imperial College, London, United Kingdom
(Murtuza, Jones, Darzi, Athanasiou) Department of Surgical Oncology and
Technology, St Mary's Hospital, Faculty of Medicine, Imperial College,
London, United Kingdom
(Nihoyannopoulos) Department of Echocardiography, Hammersmith Hospital
London, London, United Kingdom
Title
Does stentless aortic valve implantation increase perioperative risk? A
critical appraisal of the literature and risk of bias analysis.
Source
European Journal of Cardio-thoracic Surgery. 39 (5) (pp 643-652), 2011.
Date of Publication: May 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Stentless aortic valve replacement has potential benefits in terms of
valve hemodynamics and clinical outcomes, although these may be offset by
greater technical complexity of implantation with longer cardiopulmonary
bypass and cross-clamp times compared with stented valves. Meta-analyses
of the small number of published randomized trials have been limited by
their lack of critical synthesis of the literature, including evaluation
of the Risk of Bias. Our objective was to determine whether stentless
aortic valves increase perioperative risk of mortality. We also examined
secondary clinical outcomes of neurological, renal and respiratory
complications as well as hemodynamic changes reported by studies following
implantation of the two types of aortic prosthesis. The methodology used
to answer this question was a rigorous meta-analysis of randomized
controlled trials, using bias-assessment techniques designed to address
limitations of conventional meta-analysis. Our findings show that many of
the existing randomized trials have a high or uncertain risk of bias.
Analysis of studies with low risk of bias reveals that stentless valves do
not increase perioperative risk in terms of 30-day mortality and morbidity
though neither do they exhibit benefits in hemodynamics or clinical
outcomes compared with stented valves. Larger, more stringent randomized
studies would be required to identify any robust clinical difference.
2010 European Association for Cardio-Thoracic Surgery.

<16>
Accession Number
2011209405
Authors
Narayan P. Rogers C.A. Bayliss K.M. Rahaman N.C. Panayiotou N. Angelini
G.D. Ascione R.
Institution
(Narayan, Rogers, Bayliss, Rahaman, Panayiotou, Angelini, Ascione) Bristol
Heart Institute, University of Bristol, Bristol, United Kingdom
Title
On-pump coronary surgery with and without cardioplegic arrest: Comparison
of inflammation, myocardial, cerebral and renal injury and early and late
health outcome in a single-centre randomised controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 39 (5) (pp 675-683), 2011.
Date of Publication: May 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: To assess the safety and efficacy of on-pump beating heart
coronary surgery on organ function, and early and late health outcome as
compared with conventional technique. Methods: A total of 81 patients were
randomised to (1) coronary surgery with cardiopulmonary bypass (CPB) and
cardioplegic arrest (CA) (on-pump with CA, n = 41) or to (2) CPB without
CA (on-pump without CA, n = 40). Primary outcomes included serial
measurement of interleukins (IL-6, IL-8 and IL-10) for inflammation,
troponin I for myocardial injury, protein S100 for cerebral injury and
creatinine clearance (CrCl) and urinary N-acetyl-beta- d-glucosaminidase
(NAG) for renal injury. In-hospital health outcome and 5-year event-free
survival were secondary outcomes. Results: Baseline and intra-operative
characteristics were similar between groups. A marked release of ILs was
observed in both groups, but no significant differences between the groups
were found (IL-6 +9%, 95% confidence interval (CI) -15% to +39%, p = 0.49;
IL-8 +4%, 95% CI -34% to +63%, p = 0.86; IL-10 -0.1%, 95% CI -19% to +21%,
p = 0.93). Troponin I rose in both groups and was on average 34% higher in
the on-pump without CA group but this did not reach statistical
significance (95% CI -0.4% to +87%, p = 0.08). S100 protein was higher in
the on-pump without CA group at 12. h (p = 0.04) but did not differ at
other times (p = 0.16). The level of CrCl was higher 1. h in the on-pump
without CA group (+23%, 95% CI +1% to +50%, p = 0.04), but not thereafter.
NAG release was similar in both groups (+1% 95% CI -23% to +33%, p =
0.91). Early and 5-year health outcomes were similar. Conclusions: On-pump
without CA coronary surgery does not provide any obvious advantage when
compared with the conventional technique of on-pump with CA in elective
patients. Both techniques provide a comparable degree of inflammatory
activation, myocardial, cerebral and renal injury with similar 5-year
event-free survival. 2010 European Association for Cardio-Thoracic
Surgery.

<17>
Accession Number
2011210418
Authors
Zheng S. Zheng Z. Hou J. Hu S.
Institution
(Zheng, Zheng, Hou, Hu) Department of Surgery, Fuwai Hospital, Chinese
Academy of Medical Sciences, 167A Beilishi Rd, Beijing 100037, China
Title
Comparison between drug-eluting stents and coronary artery bypass grafting
for unprotected left main coronary artery disease: A meta-analysis of two
randomized trials and thirteen observational studies.
Source
Cardiology. 118 (1) (pp 22-32), 2011. Date of Publication: April 2011.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Objective: The clinical outcomes for unprotected left main coronary artery
(LMCA) between coronary artery bypass grafting (CABG) and drug-eluting
stents (DES) are still controversial. The objective was to compare safety
and efficacy between DES and CABG for unprotected LMCA. Methods:
Electronic databases and article references were systematically searched
(2000-2010) to access relevant studies. Results: Fifteen studies with
5,479 patients were finally involved in the present study. The mortality
was similar in DES and CABG groups at 1 year [odds ratio (95% confidence
interval): 0.71 (0.5-1.03)], 2 years [1.28 (0.93-1.76)], 3 years [0.88
(0.53-1.46)], 4 years [0.46 (0.18-1.17)], and 5 years [1.16 (0.85-1.57)].
No significant difference was found between DES and CABG in the risk of
composite endpoint of death, myocardial infarction and cerebrovascular
events during 5 years' follow-up [1 year, 0.95 (0.63-1.43); 2 years, 1.34
(0.67-2.57); 3 years, 1.06 (0.59-1.90); 4 years, 0.53 (0.26-1.08); 5
years, 0.83 (0.33-2.07)]. However, the risk of repeat revascularization
was significantly higher in the DES group than the CABG group at 1 year
[5.00 (2.85-8.77)], 2 years [4.79 (2.72-8.45)], 3 years [5.72
(3.07-10.65)], 4 years [2.16 (1.17-4.01)], and 5 years [5.65 (3.44-9.27)].
Conclusion: Our meta-analysis indicates that there are no significant
differences in the safety between CABG and DES in patients with
unprotected LMCA in the 5 years after intervention. But CABG is superior
to DES for repeat revascularization. Copyright 2011 S. Karger AG, Basel.

<18>
Accession Number
21057441
Authors
Jebeli M. Esmaili H.R. Mandegar M.H. Rasouli M.R. Eghtesadi-Araghi P.
Mohammadzadeh R. Darehzereshki A. Dianat S.
Institution
(Jebeli, Mandegar) Department of Cardiac Surgery, Shariati hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Esmaili) Department of Cardiac Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Rasouli, Eghtesadi-Araghi, Mohammadzadeh, Darehzereshki, Dianat) Cardiac
surgery and Transplantation Research Center (CTRC), Shariati hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Rasouli) Sina Trauma and Surgery Research Center, Sina hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Evaluation of the effects of ischemic preconditioning with a short
reperfusion phase on patients undergoing a coronary artery bypass graft.
Source
Annals of Thoracic and Cardiovascular Surgery. 16 (4) (pp 248-252), 2010.
Date of Publication: August, 2010.
Publisher
Japanese Association for Coronary Artery Surgery (2-1 Nibancho,
Chiyoda-ku, Tokyo 102-0084, Japan)
Abstract
Purpose: This study was conducted to evaluate the effects of ischemic
preconditioning (IP) with a short period of reperfusion (2 min) during
brief ischemic preconditioning (6 min) on patients undergoing coronary
artery bypass grafting (CABG). Methods: In a randomized controlled trial,
40 patients undergoing on-pump CABG with cold blood cardioplegia were
allocated into two groups, one IP and one control. IP was induced by 2
cycles of ascending aorta clamping (2 min for each) followed by two
reperfusion phases (1 min for each). Left ventricular ejection fraction
(LVEF) was measured before and after surgery. Creatine phosphokinase (CK)
and CK-MB were measured 12 hrs before surgery, immediately after aortic
clamping, and 24 hrs after CABG. Postoperative myocardial infarction (MI),
ventricular arrhythmia, duration of inotropic support, and hemodynamic
parameters were also noted. Results: More patients in the control group
needed inotropic support (65% vs. 40%, P<0.05). Moreover, duration of
inotropic support was longer in the control group (9 +/- 1.2 vs. 3.8 +/-
1.4 hrs, P<0.05). There were no significant differences between two groups
regarding development of ventricular arrhythmia, MI, values of CK, CK-MB,
and postoperative LVEF. No patient needed an intra-aortic balloon pump,
and no deaths occurred. Conclusion: A short period of reperfusion phase
declined post-CABG inotrope requirements; however, it did not reduce the
cardiac enzymes. Our results suggested that reperfusion should be longer
than 2 min to be capable of reducing cardiac enzymes. 2010 The Editorial
Committee of Annals of Thoracic and Cardiovascular Surgery.

<19>
Accession Number
70391331
Authors
Oto A. Ergene O. Erol M.K. Kucukoglu S. Ozdemir O. Tan M.
Institution
(Oto) Hacettepe University School of Medicine, Department of Cardiology,
Ankara, Turkey
(Ergene) Izmir Ataturk Training and Research Hospital, Izmir, Turkey
(Erol) Erzurum Ataturk University School of Medicine, Erzurum, Turkey
(Kucukoglu) Istanbul University Institute of Cardiology, Istanbul, Turkey
(Ozdemir) Yorum Consulting Ltd., Istanbul, Turkey
(Tan) Servier Ilac Ve Arastirma, Istanbul, Turkey
Source
International Journal of Cardiology. Conference: 7th International
Congress of Update in Cardiology and Cardiovascular Surgery in Association
with TCT Mediterranean Antalya Turkey. Conference Start: 20110324
Conference End: 20110327. Conference Publication: (var.pagings). 147
(pp S62-S63), 2011. Date of Publication: March 2011.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Beta-blockers take place in the first line of the recommended
drugs in the treatment of stable angina pectoris (SAP). However, in some
patients, beta-blockers either can not be started or have to be stopped,
due to the contraindications or side effects. Ivabradine, leads isolated
decrease in the heart rate and prevents myocardial ischemia and coronary
event rate. This analysis presents the comparison of cost-effectiveness of
ivabradine with comparators, in the treatment of SAP. Methods: A
Markov-chain model, in which, patients with SAP treated with ivabradine
and comparators are followed for twenty years, was built. Annual rates of
revascularization, other cardiovascular events and mortality were
calculated. Direct costs were taken into account from the perspective of
social security institution. Randomized clinical studies, other
comparative studies and meta-analysis were taken as sources of inputs.
Results: Annual revascularization rate was 5.0% for ivabradine, while it
was 6.5-7.0% for comparators and 8.3% for the patients under routine
treatment. Estimated number of revascularizations within 20 years was 120
procedures per 100 patients with ivabradine as compared to 135-139 with
others. Nearly 15-19 revascularization will be saved per 100 patients
within 20 years. It was calculated that revascularization will be needed
in 64 of every 100 patients within 20 years, while this figure was 74-77
for comparators. Annual cardiovascular event rate was 7.5% for ivabradine
while it was 10.4-10.9% for comparators and 12.0% in patients under
routine treatment. Total number of cardiovascular events within 20 years
was 151 events per 100 patients with ivabradine as compared to 207-219
with others. This shows that cost of 57-68 cardiovascular events will be
saved per 100 patients within 20 years. It was calculated that, with
ivabradine, cardiovascular event will occur in 79 of 100 patients within
20 years, while this figure was around 89-90 with other drugs. Duration of
event-free life years was 9.9 years with ivabradine and 7.7-8.1 years with
others. Nearly 1.9-2.2 more event-free life years will be gained with
ivabradine as compared with other drugs. Incremental Cost Effectiveness
Ratio for ivabradine decreased down to cost-effectiveness threshold (three
times GDP per capita per one event-free life year) within the first year
versus isosorbide mononitrate and verapamil, and in the second year versus
amlodipine and diltiazem. Conclusions: When savings provided by the
decreases in revascularization and cardiovascular event rates are taken
into account, annual treatment cost difference between ivabradine and
other drugs decreases. Ivabradine provides longer life years and
event-free life years and this makes it a cost effective choice for SAP.

<20>
Accession Number
70391400
Authors
Idris N.S. Sastroasmoro S.
Institution
(Idris, Sastroasmoro) Department of Child Health, Medical School
University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Source
International Journal of Cardiology. Conference: 7th International
Congress of Update in Cardiology and Cardiovascular Surgery in Association
with TCT Mediterranean Antalya Turkey. Conference Start: 20110324
Conference End: 20110327. Conference Publication: (var.pagings). 147
(pp S88-S89), 2011. Date of Publication: March 2011.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: To evaluate whether angiotensin converting enzyme (ACE)
inhibitors are effective for the treatment of heart failure due to large
left-to-right shunts in infants. Methods: We systematically searched The
MEDLINE, OLDMEDLINE, Cochrane Central Register of Controlled Trials and
reference lists of identified studies. No language restriction is applied.
Randomised trials or quasi-randomised trials comparing captopril with
placebo, no treatment, or standard treatment were eligible. Non-randomised
trial will be included if the baseline characteristics of the subjects
were clinically comparable. Two reviewers independently extracted data and
assessed trial quality. Results: We found 13 studies evaluating the use of
ACE inhibitors in left-to-right shunt lesions in infants/children, however
11 were uncontrolled studies. The remaining 2 studies were too
methodologically flawed to draw meaningful conclusions. One is a
randomized controlled trial comparing captoril and placebo in very small
number of subjects (n = 6ineachgroup) and assessed only the side effect of
captopril on blood pressure. Compared to pre-treatment level, the blood
pressure decreased significantly after treatment in the captopril group,
but there was no significant difference in blood pressure between the
captopril and placebo groups. The other study was a retrospective study
comparing unconcomittant treatment of captopril and propranolol, which was
also limited by its small number of subjects (n = 11 in each group). This
study reported that propranolol was superior to captopril in terms of
heart failure score improvement, length of hospital stay, weight gain,
left atrial pressure, end diastolic ventricular pressure. Conclusions:
Despite its wide use, studies conducted to date in children provide
insufficient evidence for the routine clinical use of ACE inhibitor(s) in
the management of heart failure due to 'left-to-right' shunt lesions.

<21>
Accession Number
70392244
Authors
Yin H. Tse M. Wong F.
Institution
(Yin, Tse, Wong) School of Nursing, Hong Kong Polytechnic University Hung
Hom, Kowloon, Hong Kong
Source
Journal of Pain. Conference: 30th Annual Scientific Meeting of the
American Pain Society Austin, TX United States. Conference Start: 20110519
Conference End: 20110521. Conference Publication: (var.pagings). 12 (4
SUPPL. 1) (pp P78), 2011. Date of Publication: April 2011.
Publisher
Churchill Livingstone Inc.
Abstract
Major thoracotomy operation causes extremely distressing pain experience
for patients. The purpose of the study is to investigate the effectiveness
of a pain management programme on postoperative pain experience, patient's
use of drug or non-drug methods, patient-related barriers to pain
management, and clinical outcomes in Chinese adult patients undergoing
thoracic surgery. A randomized controlled trial with single-blinded design
was adopted for the present study and conducted in a general hospital in
Mainland China. A total of 94 patients (N=94) undergoing scheduled major
thoracotomy were recruited and randomly assigned to the experimental and
comparison group. Preoperative pain education was provided to both groups,
while the postoperative pain round was only implemented for the
experimental group from postoperative day 1 till discharge. Outcomes were
pain intensity, pain interferences with daily activities (BPI-C), a log
record of using drug or non-drug methods to relieve pain, and patient's
concerns about reporting pain and taking analgesics (BQT-S). Data
collection was conducted before preoperative pain education and throughout
the postoperative period during hospitalization. Results revealed that the
experimental group reported much lower scores of pain severity and pain
interferences with activities than the comparison group from postoperative
day 1 till day 10 (P<0.05). Patients used more non-drug methods to relieve
pain than those in comparison group from postoperative day 1 to14
(P<0.05). The experimental group expressed less barrier scores of total
BQT-S and subscales of BQT-S than that in the comparison group (P<0.05),
except for the subscales of fear of injections and fatalism(P>0.05).
However, no significant differences were found between group comparisons
in the amount of analgesic use, length of chest-tube insitu, and incidence
of postoperative complications. This study provides evidence of the
positive effects of a comprehensive approach integrated preoperative pain
education and postoperative reinforcing intervention for postoperative
pain management in Chinese patients.

<22>
Accession Number
70393011
Authors
Saravanan P. O'Neill S.C. Bridgewater B. Davidson N.C.
Institution
(Saravanan, O'Neill, Bridgewater, Davidson) University Hospital of South
Manchester, Wythenshawe, Manchester, United Kingdom
(Saravanan, O'Neill, Bridgewater, Davidson) University of Manchester,
Manchester, United Kingdom
Source
Heart Rhythm. Conference: 30th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2009 Boston, MA United States. Conference
Start: 20090513 Conference End: 20090516. Conference Publication:
(var.pagings). 6 (5 SUPPL. 1) (pp S283), 2009. Date of Publication: May
2009.
Publisher
Elsevier
Abstract
Introduction: Fish oils reduce risk of fatal ventricular arrhythmias but
their effect on atrial arrhythmias is unclear. We report the findings of a
randomized, double blind, placebo controlled, clinical trial of short term
fish oil supplementation in patients undergoing CABG surgery with robust
monitoring for post-operative AF. Methods: Patients undergoing isolated
CABG surgery randomized to receive 2g/day of OmacorTM or placebo at least
5 days prior to surgery & until discharge. Baseline & peak levels of
omega-3 fatty acids (n-3 FA) measured in serum, white cells & right atrial
appendage tissue. Echocardiography to assess left ventricular(LV) function
and left atrial(LA)dimensions. Postoperative continuous ECG monitoring
(LifecardTM) for 5 days or until discharge if earlier. Recordings analyzed
for episodes of AF>30 seconds. Results: 108 patients enrolled & 100
completed the study (Table-1). No significant differences among the 2
groups in comorbidities, LV function, LA dimensions, beta blocker therapy,
bypass time & cross clamp time, number of vessels grafted, inotrope use
and anti-arrhythmic therapy. Conclusions: In a study with objective
assessment of n-3 levels and continuous ECG monitoring, we have shown that
fish oils do not reduce the risk of atrial fibrillation following CABG.
This contradicts the outcome of a previous study & compares with some
epidemiological studies showing no benefit or increased risk of AF with
fish intake. Our findings indicate the need for a large scale
interventional study to clarify the role of fish oils in the management of
AF. (Table presented).

<23>
Accession Number
70393177
Authors
Adabag S. Mithani S. Al Aloul B. Collins D. Bertog S. Bloomfield H.E.
Institution
(Adabag, Mithani, Al Aloul, Collins, Bertog, Bloomfield) University of
Minnesota, Minneapolis, MN, United States
(Adabag, Mithani, Al Aloul, Collins, Bertog, Bloomfield) VA Medical
Center, Minneapolis, MN, United States
(Adabag, Mithani, Al Aloul, Collins, Bertog, Bloomfield) Veterans Affairs
HDL Cholesterol Intervention Trial Study Group, Minneapolis, MN, United
States
Source
Heart Rhythm. Conference: 30th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2009 Boston, MA United States. Conference
Start: 20090513 Conference End: 20090516. Conference Publication:
(var.pagings). 6 (5 SUPPL. 1) (pp S345), 2009. Date of Publication: May
2009.
Publisher
Elsevier
Abstract
Introduction: Inflammation plays an important role in the initiation and
maintenance of atrial fibrillation (AF). Peroxisome proliferator-activated
receptor alpha (PPARalpha) activators reduce inflammation and oxidative
stress, akin to pleiotropic effects of statins. It has been suggested that
PPARalpha activators may have antiarrhythmic properties, however, no
clinical data exist. The objective of this study was to investigate
whether PPARalpha activator gemfibrozil prevents the development of AF in
patients with coronary heart disease (CHD). Methods: We retrospectively
analyzed the electrocardiograms (ECG) performed in the Veterans Affairs
High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT), a
multicenter, randomized, double blinded, trial of gemfibrozil versus
placebo in men with CHD. The ECGs were performed annually or biannually
and when clinically indicated. Participants who were in AF on baseline ECG
were excluded from this analysis. Relative risk for AF was calculated from
Cox regression analysis with death as a competing risk factor. Results: A
total of 12,605 ECGs from 2,130 participants were interpreted (5.9+2.1
ECGs/participant; range 2-20). At baseline, the gemfibrozil (n=1070) and
placebo (n=1060) groups were well matched. Mean age was 64.1+7.1 years.
Over 4.4+1.5 years of follow-up, 123 (5.8%) participants developed AF.
Participants who developed AF were older and more likely to have a history
of hypertension, heart failure and coronary revascularization than those
who maintained sinus rhythm. AF incidence was similar between the
gemfibrozil and placebo groups (64/1070 versus 59/1060, respectively;
p=0.33). In Cox regression, the risk of AF was similar between the two
study groups (hazard ratio 1.04; 95% confidence interval 0.73 to 1.49;
p=0.82). Conclusions: In this post-hoc analysis of a multicenter,
doubleblinded, randomized controlled trial, the PPARalpha activator
gemfibrozil did not reduce the 4-year incidence of AF among men with
coronary heart disease. These are, to our knowledge, the first clinical
data on the effects of a PPARalpha activator on AF.

<24>
Accession Number
70390552
Authors
Masrani S. Novak E. Chen J. Faddis M. Gleva M. Smith T. Cuculich P.
Institution
(Masrani, Novak, Chen, Faddis, Gleva, Smith, Cuculich) Barnes-Jewish
Hospital, Washington University, School of Medicine, Saint Louis, MO,
United States
Source
Heart Rhythm. Conference: 32nd Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm San Francisco, CA United States. Conference
Start: 20110504 Conference End: 20110507. Conference Publication:
(var.pagings). 8 (5 SUPPL. 1) (pp S229), 2011. Date of Publication: May
2011.
Publisher
Elsevier
Abstract
Introduction: Meta-analyses of randomized trials have not demonstrated
survival benefit for women with cardiomyopathy who receive an implantable
cardioverter-defibrillator (ICD) for primary prevention of sudden death
(SD). This may be due to a lower rate of SD or dissimilar mortality rates
in female patients. This retrospective study evaluated the impact of
gender on appropriate ICD therapy and mortality. Methods: 525 consecutive
patients with ischemic or nonischemic cardiomyopathy underwent ICD
implantation for primary prevention of SD. Demographic, comorbid illnesses
and medications were evaluated. Mean follow up was 3.8 years. End points
were mortality and appropriate ICD therapy at 4 years. Results: Baseline
characteristics of 121 women (23.1%) were similar to men in regards to age
(women 61 years; men 62.5 years), ejection fraction (25%), comorbidities
and medication use. Significant differences included race (81% white male
vs. 63% white female, p<0.001), tobacco use (63% male vs. 43% female,
p<0.001), and prior coronary bypass surgery (50% male vs. 26% female,
p<0.001). There were 160 deaths: 47 of 121 women (38.9%) and 113 of 404
men (30.0%). There were 87 appropriate ICD therapies: 18 of 121 women
(14.9%) and 69 of 404 men (17.1%). Kaplan Meier analysis verified a
significant difference in four-year survival (p=0.039) but no difference
in rate of appropriate ICD therapy (see graphs). Conclusions: Women who
received an ICD for prevention of SD had a similar arrhythmic event rate
as men. However, the impact of primary prevention ICD therapy is
attenuated by increased mortality rate in female patients. (Figure
presented).

<25>
Accession Number
70390878
Authors
Erkapic D. Bauernfeind T. De Rosa S. Hohnloser S.
Institution
(Erkapic, Bauernfeind, De Rosa, Hohnloser) University of Frankfurt,
Frankfurt, Germany
Source
Heart Rhythm. Conference: 32nd Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm San Francisco, CA United States. Conference
Start: 20110504 Conference End: 20110507. Conference Publication:
(var.pagings). 8 (5 SUPPL. 1) (pp S356-S357), 2011. Date of Publication:
May 2011.
Publisher
Elsevier
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) is considered
as an alternative therapy to conventional open heart surgery in high risk
patients with severe aortic stenosis. Atrioventricular (AV) block with
subsequent need of permanent pacemaker (PM) therapy is a known
complication of TAVI. There are, however, no systematic data concerning
this complication. Methods: We conducted a Medline search of the
literature dealing with PM requirements following TAVI. Since only one
controlled randomized study was available, we included also all
observational studies published in English language which comprised at
least 30 patients. Results: Thirteen studies were identified comprising
data on 2182 TAVI patients. An ESP had been implanted in 1808 pts whereas
374 pts had received a CVP. Of the 1808 pts with an ESP, 109 (6%)
developed PM-requiring AV block. Of the 374 CVP pts, 102 (27%) had to
receive a permanent PM (OR 5.84, 95% CI 4.33-7.88, p<0.001; compared to
ESP). Fifty-four percent of AV-blocks requiring PM implantation occurred
within 24 hours after TAVI, 34% within 7 days, 10% within one month and 2%
within one year. Oversizing of the annulus and depth of prothesis
implantation were reported to be potential predictors for PM implantation
after TAVI. The prevalence of a new left bundle branch block increased
significantly after TAVI (40% in CVP, 18% in ESP). Right bundle branch
block (RBBB) before TAVI in pts receiving a CVP was associated with
increased risk for PM necessity (57 to100%; mean 61%). Conclusions:
Patients undergoing TAVI with implantation of a CVP are at significantly
higher risk for the development of AV block and subsequent need for
permanent PM. Since AV block occurs in 90% within the first week after the
procedure, careful monitoring should be performed for at least 7 days
following TAVI. Prospective studies of prophylactic PM implantation (i.e.
in pts with risk factors such as RBBB) are warranted.

<26>
Accession Number
70391051
Authors
Farquharson A.L. Metcalf R.G. Stuklis R. Edwards J.R.M. Cleland L.G. James
M.J. Sanders P. Young G.D.
Institution
(Farquharson, Metcalf, Stuklis, Edwards, Cleland, James, Sanders, Young)
University of Adelaide, Adelaide, Australia
(Farquharson, Metcalf, Stuklis, Edwards, Cleland, James, Sanders, Young)
Royal Adelaide Hospital, Adelaide, Australia
Source
Heart Rhythm. Conference: 32nd Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm San Francisco, CA United States. Conference
Start: 20110504 Conference End: 20110507. Conference Publication:
(var.pagings). 8 (5 SUPPL. 1) (pp S425), 2011. Date of Publication: May
2011.
Publisher
Elsevier
Abstract
Introduction: Atrial fibrillation (AF) POst cardiac surgery especially in
the intensive care unit (ICU) period can prolong ICU stay, result in
adverse outcomes and increased cost of care. We rePOrt a double blind
randomised controlled trial to examine the effectiveness of an unmodified
fish oil supplement on the time to first occurrence of AF and length of
stay in the ICU period POst cardiac surgery. Methods: 200 participants
were randomly allocated to ingest 15 mL citrus-flavoured fish oil (18%EPA,
12 %DHA) or sunola oil (monounsaturated) each day commencing 3 weeks
before the scheduled surgery date, and continued during the POstoperative
in-patient period. Analysis of time to first episode of AF was performed
by the Kaplan-Meier method. Cox proPOrtional hazards regression was used
to compare the treatment groups while controlling for confounding effects
of gender and surgery type. Length of time in the ICU and total length of
stay were assessed using negative binomial regression. Results: 194
subjects completed the study, 97 subjects in the control group and 97
subjects in the fish oil group. The overall incidence of in-hospital AF
was 43%. Kaplan-Meier estimates of the time to first occurrence of AF show
of a consistently delayed time to AF in the fish oil group compared with
the control group, p = 0.06. Following Cox proPOrtional hazards regression
analysis, the unadjusted hazard ratio (HR) for time to first episode of AF
associated with fish oil was 0.66 (95% CI 0.43 - 1.01, p = 0.06), and 0.71
(95% CI 0.46 - 1.12, p = 0.14), following adjustment for gender and type
of surgery (CABG only vs. valve). The length of stay in cardiac ICU was
significantly reduced in the fish oil group compared with the control
group (67 +/- 52 and 95 +/- 158 hrs respectively, unadjusted ratio of
means = 0.71; 95% CI 0.56 - 0.90, p = 0.005. Following adjustment for
gender and surgery type, the difference between the groups remained
unchanged (ratio of means = 0.71; 95% CI 0.56 - 0.90, p = 0.006).
Conclusions: Peri-operative fish oil supplementation in patients
undergoing cardiac surgery was associated with a delay to devloping AF and
a shorter stay in intensive care.

<27>
Accession Number
70391231
Authors
Mathew J. Katz R. Dixit S. Gerstenfeld E.P. Sutton M.St.J. Gold M.R.
Shlipak M.G. Linde C. Deo R.
Institution
(Mathew, Katz, Dixit, Gerstenfeld, Sutton, Gold, Shlipak, Linde, Deo)
University of Pennsylvania, Philadelphia, PA, United States
(Mathew, Katz, Dixit, Gerstenfeld, Sutton, Gold, Shlipak, Linde, Deo)
University of Washington, Seattle, WA, United States
(Mathew, Katz, Dixit, Gerstenfeld, Sutton, Gold, Shlipak, Linde, Deo)
Medical University of South Carolina, Charleston, SC, United States
(Mathew, Katz, Dixit, Gerstenfeld, Sutton, Gold, Shlipak, Linde, Deo)
University of California, San Francisco, San Francisco, CA, United States
(Mathew, Katz, Dixit, Gerstenfeld, Sutton, Gold, Shlipak, Linde, Deo)
Karolinska University Hospital, Stockholm, Sweden
Source
Heart Rhythm. Conference: 32nd Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm San Francisco, CA United States. Conference
Start: 20110504 Conference End: 20110507. Conference Publication:
(var.pagings). 8 (5 SUPPL. 1) (pp S496), 2011. Date of Publication: May
2011.
Publisher
Elsevier
Abstract
Introduction: Chronic kidney disease (CKD) is associated with changes in
cardiac remodeling. We evaluated whether CKD affects left ventricular
remodeling among patients with cardiac resynchronization therapy (CRT).
Methods: REVERSE was a randomized, controlled trial evaluating CRT therapy
in patients with NYHA Class I/II heart failure. The baseline estimated
glomerular filtration rate (eGFR) was calculated in all participants, and
CKD was defined as an eGFR < 60ml/min. We compared changes in LV size and
function over the course of 12 months between the normal kidney function
group and the CKD group. We created a linear mixed model to assess whether
kidney function is associated with changes in cardiac remodeling after
adjustment for demographics, comorbidities, medications, cardiomyopathy
etiology, and CRT status. Finally, we tested for interactions of eGFR with
CRT status on 12 month changes in LV size and function using interaction
product terms. Results: Among the 561 participants in our study, 160 (29%)
had CKD. Participants with normal kidney function were noted to have
greater improvements in LV structural parameters than those with CKD.
These differences in LV remodeling between the two groups were independent
of age, gender, race, blood pressure, diabetes, smoking, medications, and
the etiology of the cardiomyopathy. In addition there was a significant
interaction between CKD and CRT status for most LV parameters (table 1).
Conclusions: CRT improves LV structure and function among people with CKD;
however, reverse remodeling is attenuated in CKD patients compared to
those with normal kidney function. (Table presented).

<28>
Accession Number
2011161824
Authors
Lee E.-H. Lee H.-M. Chung C.-H. Chin J.-H. Choi D.-K. Chung H.-J. Sim
J.-Y. Choi I.-C.
Institution
(Lee, Lee, Chin, Choi, Sim, Choi) Department of Anaesthesiology and Pain
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, South Korea
(Chung) Department of Thoracic and Cardiovascular Surgery, Asan Medical
Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong,
Songpa-gu, Seoul 138-736, South Korea
(Chung) Department of Laboratory Medicine, Cheil General Hospital,
KwanDong University College of Medicine, Seoul, South Korea
Title
Impact of intravenous lidocaine on myocardial injury after off-pump
coronary artery surgery.
Source
British Journal of Anaesthesia. 106 (4) (pp 487-493), 2011. Date of
Publication: April 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Background. Lidocaine has been demonstrated to exert cardioprotective
effects against myocardial ischaemia and reperfusion injury. We evaluated
whether a continuous i.v. infusion of lidocaine reduced myocardial injury
in patients undergoing off-pump coronary artery bypass graft surgery
(OPCAB). Methods. In this randomized, double-blinded trial, 99 patients
received i.v. lidocaine 2% (i.e. a 1.5 mg kg^-1 bolus at
induction of anaesthesia followed by a 2.0 mg kg^-1
h^-1 infusion intraoperatively) or an equal volume of saline.
Serum creatine kinase-myocardial band (CK-MB) and troponin I (TnI)
concentrations were measured before surgery, upon arrival in the intensive
care unit, and at 6, 24, 48, and 72 h after surgery. Cardiac enzymes,
other biological markers, and rate of postoperative adverse events were
compared between the groups. Results. The median (25-75% inter-quartile
range) TnI [0.90 (0.43-1.81) vs 1.71 (0.88-3.02) ng ml^-1,
P=0.027] and CK-MB [6.5 (3.9-12.3) vs 9.8 (6.0-18.6) ng ml^-1,
P=0.005] concentrations 24 h after surgery were significantly lower in the
lidocaine group than in the control group. Moreover, lidocaine infusion
reduced the total area under the curve of TnI and CK-MB release after
surgery by 42% and 27%, respectively, compared with control. Conclusions.
Continuous i.v. infusion of lidocaine during surgery reduces myocardial
injury in patients undergoing OPCAB. The Author [2010]. Published by
Oxford University Press on behalf of the British Journal of Anaesthesia.
All rights reserved.

<29>
[Use Link to view the full text]
Accession Number
2011198817
Authors
Steigen T.K. Buller C.E. Mancini G.B.J. Jorapur V. Cantor W.J. Rankin J.M.
Thomas B. Webb J.G. Kronsberg S.S. Atchison D.J. Lamas G.A. Hochman J.S.
Dzavik V.
Institution
(Steigen) University of Tromsoe, Tromsoe, Norway
(Buller, Mancini) Division of Cardiology, Vancouver General Hospital,
Vancouver, BC, Canada
(Jorapur, Lamas) Columbia University Division of Cardiology, Mount Sinai
Medical Center, Miami Beach, FL, United States
(Cantor) Division of Cardiology, Southlake Regional Health Center,
Newmarket, ON, Canada
(Rankin) Department of Cardiovascular Medicine, Royal Perth Hospital,
Perth, Australia
(Thomas) Hospital Fernando Fonseca, Lisbon, Portugal
(Webb) St Paul's Hospital, Vancouver, BC, Canada
(Kronsberg) Maryland Medical Research Institute, Baltimore, MD, United
States
(Atchison, Dzavik) Peter Munk Cardiac Centre, University Health Network,
Toronto, ON, Canada
(Hochman) Division of Cardiology, New York University School of Medicine,
New York, NY, United States
Title
Myocardial perfusion grade after late infarct artery recanalization is
associated with global and regional left ventricular function at one year
analysis from the total occlusion study of Canada-2.
Source
Circulation: Cardiovascular Interventions. 3 (6) (pp 549-555), 2010.
Date of Publication: December 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-Whether myocardial perfusion grade (MPG) following late
recanalization of infarct-related arteries (IRAs) predicts left
ventricular (LV) function recovery beyond the acute phase of myocardial
infarction (MI) is unknown. Methods and Results-The Total Occlusion Study
of Canada-2 enrolled stable patients with a persistently occluded IRA
beyond 24 hours and up to 28 days post-MI. We studied the relationship
between the initial MPG and changes in LV function and volume as well as
the change in MPG from immediate post-percutaneous coronary intervention
(PCI) to 1 year in 139 PCI patients with thrombolysis in myocardial
infarction grade 3 epicardial flow post-PCI and with paired values grouped
into impaired or good MPG groups (MPG 0/1 or MPG 2/3). MPG 0/1 patients
were more likely to have received thrombolytic therapy and to have a left
anterior descending IRA. They had lower blood pressure and LV ejection
fraction (LVEF) and a higher heart rate and systolic sphericity index at
baseline. Changes in the MPG 0/1 and MPG 2/3 groups from baseline to 1
year were LVEF, 3.3+/-9.0% and 4.8+/-8.9% (P=0.42); LV end-systolic volume
index (LVESVI), -1.1+/-9.2 and -4.7+/-12.3 mL/m² (P=0.25); LV
end-diastolic volume index (LVEDVI), 0.08+/-19.1 and -2.4+/-22.2
mL/m² (P=0.67); and SDs/chord for infarct zone wall motion
index (WMI), 0.38+/-0.70 and 0.84+/-1.11 (P=0.01). By covariateadjusted
analysis, post-PCI MPG 0/1 predicted lower WMI (P<0.001), lower LVEF
(P<0.001), and higher LVESVI (P<0.01) but not LVEDVI at 1 year. Of the MPG
0/1 patients, 60% were MPG 2 or 3 at 1 year. Conclusions-Preserved MPG is
present in a high proportion of patients following late PCI of occluded
IRAs post-MI. Poor MPG post-PCI frequently improves MPG over 1 year. MPG
graded after IRA recanalization undertaken days to weeks post MI is
associated with LV recovery, indicating that MPG determined in the
subacute post-MI period remains a marker of viability. 2010 American
Heart Association, Inc.

<30>
[Use Link to view the full text]
Accession Number
2011198818
Authors
Ormiston J.A. Abizaid A. Spertus J. Fajadet J. Mauri L. Schofer J. Verheye
S. Dens J. Thuesen L. Dubois C. Hoffmann R. Wijns W. Fitzgerald P.J. Popma
J.J. Macours N. Cebrian A. Stoll H.-P. Rogers C. Spaulding C.
Institution
(Ormiston) North Shore Hospital, PO Box 9911, Newmarket, Auckland, New
Zealand
(Abizaid) Instituto Dante Pazzanese, Sao Paolo, Brazil
(Spertus) St Luke's Hospital, Kansas City, MO, United States
(Fajadet) Clinique Pasteur, Toulouse, France
(Mauri) Brigham and Women's Hospital, Boston, MA, United States
(Schofer) Herzkatheterlabor und Praxisklinik, Hamburg, Germany
(Verheye) Middelheim Hospital, Antwerp, Belgium
(Dens) Ziekenhuis Oost-Limburg, Genk, Belgium
(Thuesen) Skejby Sygehus, Aarhus, Denmark
(Dubois) University Hospital, Leuven, Belgium
(Hoffmann) University Hospital, Aachen, Germany
(Wijns) Onze-Lieve-Vrouweziekenhuis, Aalst, Belgium
(Fitzgerald) Stanford University School of Medicine, Stanford, CA, United
States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Macours, Cebrian, Stoll, Rogers) Cordis Clinical Research, Waterloo,
Belgium
(Macours, Cebrian, Stoll, Rogers) Cordis Clinical Research, Bridgewater,
NJ, United States
(Spaulding) Hopital Cochin, Assitance-Publique Hopitaux de Paris, Paris
Descartes University, Paris, France
Title
Six-month results of the NEVO res-elution I (NEVO RES-I) Trial : A
randomized, multicenter comparison of the nevo sirolimus-eluting coronary
stent with the taxus liberte paclitaxel-eluting stent in de novo native
coronary artery lesions.
Source
Circulation: Cardiovascular Interventions. 3 (6) (pp 556-564), 2010.
Date of Publication: December 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-Drug-eluting stents reduce restenosis and reintervention rates
but are complicated by stent thrombosis, which may be related to polymer
coating. The NEVO sirolimus-eluting coronary stent (NEVO SES) is designed
to improve long-term percutaneous coronary intervention safety by
combining sirolimus release from reservoirs with bioabsorbable polymer to
reduce spatial and temporal polymer exposure. Methods and Results-NEVO
ResElution-I was a prospective randomized study in 394 patients with
coronary artery disease comparing the NEVO SES with the TAXUS Liberte
paclitaxel-eluting coronary stent (TAXUS Liberte PES) stent. The primary
end point was in-stent angiographic late loss at 6 months. Six months
after percutaneous coronary intervention (PCI), the primary end point
favored NEVO SES (0.13+/-0.31 mm versus 0.36+/-0.48 mm, P<0.001 for
noninferiority and superiority). The study was not powered for clinical
end points and showed no significant difference for NEVO SES versus TAXUS
Liberte PES: death: 0.5 versus 1.6%, P=0.36; myocardial infarction: 2.0
versus 2.6%, P<0.75; target lesion revascularization: 1.5 versus 3.2%,
P=0.33; major adverse cardiac events: 4.0 versus 7.4%, P<0.19. No stent
thrombosis was observed with NEVO SES, whereas 2 cases occurred in TAXUS
Liberte PES. Intravascular ultrasound showed lower percent volume
obstruction for NEVO SES (5.5+/-11% versus 11.5+/-9.7%, P<0.016).
Conclusions-This trial proved the superiority of NEVO SES over TAXUS
Liberte PES for the primary angiographic end point of in-stent late loss.
No stent thrombosis occurred in the NEVO SES group. 2010 American Heart
Association, Inc.

<31>
Accession Number
2011157689
Authors
Cohen D.J. Van Hout B. Serruys P.W. Mohr F.W. Macaya C. Den Heijer P.
Vrakking M.M. Wang K. Mahoney E.M. Audi S. Leadley K. Dawkins K.D.
Kappetein A.P.
Institution
(Cohen, Wang, Mahoney) Saint Luke's Mid America Heart Institute,
University of Missouri-Kansas City, Kansas City, MO, United States
(Van Hout) University of Sheffield, Sheffield, United Kingdom
(Serruys, Kappetein) Erasmus University Medical Center Rotterdam,
Rotterdam, Netherlands
(Den Heijer, Vrakking) Amphia Ziekenhuis, Breda, Netherlands
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
(Macaya) Hospital Clinico Universitario San Carlos, Madrid, Spain
(Audi, Leadley, Dawkins) Boston Scientific, Natick, MA, United States
Title
Quality of life after PCI with drug-eluting stents or coronary-artery
bypass surgery.
Source
New England Journal of Medicine. 364 (11) (pp 1016-1026), 2011. Date of
Publication: 17 Mar 2011.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Previous studies have shown that among patients undergoing
multivessel revascularization, coronary-artery bypass grafting (CABG), as
compared with percutaneous coronary intervention (PCI) either by means of
balloon angioplasty or with the use of bare-metal stents, results in
greater relief from angina and improved quality of life. The effect of PCI
with the use of drug-eluting stents on these outcomes is unknown. METHODS:
In a large, randomized trial, we assigned 1800 patients with three-vessel
or left main coronary artery disease to undergo either CABG (897 patients)
or PCI with paclitaxeleluting stents (903 patients). Health-related
quality of life was assessed at baseline and at 1, 6, and 12 months with
the use of the Seattle Angina Questionnaire (SAQ) and the Medical Outcomes
Study 36-Item Short-Form Health Survey (SF-36). The primary end point was
the score on the angina-frequency subscale of the SAQ (on which scores
range from 0 to 100, with higher scores indicating better health status).
RESULTS: The scores on each of the SAQ and SF-36 subscales were
significantly higher at 6 and 12 months than at baseline in both groups.
The score on the angina-frequency subscale of the SAQ increased to a
greater extent with CABG than with PCI at both 6 and 12 months (P = 0.04
and P = 0.03, respectively), but the between-group differences were small
(mean treatment effect of 1.7 points at both time points). The proportion
of patients who were free from angina was similar in the two groups at 1
month and 6 months and was higher in the CABG group than in the PCI group
at 12 months (76.3% vs. 71.6%, P = 0.05). Scores on all the other SAQ and
SF-36 subscales were either higher in the PCI group (mainly at 1 month) or
were similar in the two groups throughout the follow-up period.
CONCLUSIONS: Among patients with three-vessel or left main coronary artery
disease, there was greater relief from angina after CABG than after PCI at
6 and 12 months, although the extent of the benefit was small. (Funded by
Boston Scientific; ClinicalTrials.gov number, NCT00114972.). Copyright
2011 Massachusetts Medical Society. All rights reserved.

<32>
Accession Number
2011189603
Authors
Kilger E. Heyn J. Beiras-Fernandez A. Luchting B. Weis F.
Institution
(Kilger, Heyn, Luchting, Weis) Department of Anesthesiology, University
Hospital Munich, Grosshadern, Munich, Germany
(Beiras-Fernandez) Department of Cardiac Surgery, Grosshadern University
Hospital, LM-University, Munich, Germany
Title
Stress doses of hydrocortisone reduce systemic inflammatory response in
patients undergoing cardiac surgery without cardiopulmonary bypass.
Source
Minerva Anestesiologica. 77 (3) (pp 268-274), 2011. Date of Publication:
March 2011.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Background: Systemic inflammatory response occurs after cardiac surgery
(CS) and leads to a worse outcome in many cases. Stress doses of
hydrocortisone have been successfully used to reduce SIRS and to improve
outcome of patients after CS with cardiopulmonary bypass grafting (on-pump
CABG), but the effect of hydrocortisone on patients undergoing CS without
cardiopulmonary bypass grafting (off-pump CABG) is unclear. Therefore, we
evaluated the effect of stress doses of hydrocortisone in this group of
patients. Methods: A total of 305 patients undergoing off-pump CABG were
enrolled in a prospective randomized trial according to the study
protocol. The patients either received stress doses of hydrocortisone or
placebo. We measured various laboratory and clinical variables
characterizing the patients' outcomes. Results: The two study groups did
not differ with regard to demographic data. Patients receiving
hydrocortisone had an increased Higgins score and a decreased ejection
fraction. Furthermore, patients from the hydrocortisone group had
significantly lower levels of IL-6 (275 [162/677] pg/mL vs. 450 [320/660]
pg/mL, P=0.001) and a shorter stay in the ICU (1 [1/3] day vs. 2 [2/3]
days, P=0.04). Both groups did not differ in regard to catecholamine
support, duration of mechanical ventilation, incidence of postoperative
atrial fibrillation, blood loss, and mortality rate. Conclusion: We
conclude that intravenous stress doses of hydrocortisone lead to a
reduction of systemic inflammation and to a potential improvement in the
early outcome of patients undergoing off-pump CABG. Minerva Medica.

<33>
Accession Number
2011191760
Authors
Hou Y.-Y. Zhou P.
Institution
(Hou, Zhou) School of Biomedical Engineering, Capital Medical University,
Beijing 100069, China
Title
Effects of cardiothoracic ratio following cardiac valve replacement: A
Meta-analysis.
Source
Journal of Clinical Rehabilitative Tissue Engineering Research. 14 (44)
(pp 8220-8224), 2010. Date of Publication: October 2010.
Publisher
Journal of Clinical Rehabilitative (P.O. Box 1200, Shenyang 110004, China)
Abstract
BACKGROUND: Because of the high risk and high cost of cardiac valve
replacement, it is necessary to perform pre -operative assessment for a
successful operation. It can accurately measure cardiothoracic ratio (CTR)
and clearly show the structure and function of the heart from the chest
X-ray. If the CTR >= 0.7, it means severe cardiac valve disease, and
operation risk is higher. OBJECTIVE: To investigate the effects of CTR on
mortality rate and complications after cardiac valve replacement according
to Meta analysis, and to calculate the CTR mean of four heart function
using the data mining method. METHODS: The CNKI database, Wanfang
database, and Vip database were retrieved. The literatures addressing
cardiac valve replacement in China were collected from the relevant date.
Meta analysis was carried out based on two groups of CTR > 0.7 and CTR <
0.7. The differences in evaluation were expressed by odds ratio (OR) and
95% confidence interval (CI). RevMan 4.2 software was used for statistical
analysis. The preoperative CTR mean of four cardiac functions was
calculated by the data mining method. RESULTS AND CONCLUSION: A total of 8
articles about mortality rate, and 9 articles about complications were
included. Result of meta-analysis showed that CTR had significant effects
on postoperative mortality rate and complications in the two groups of
CTR. Eight sets of data in postoperative mortality in the 8 literature had
the same results after the heterogeneity inspection (P=0.19); however, 6
sets of data in postoperative complications in the 9 literature had the
inconsistent results after the heterogeneity test (P < 0.000 1). The CTR
mean of preoperative cardiac function in II, III, IV patients was 0.555 9,
0.669 0, and 0.671 2 respectively. It is indicated that if preoperative
CTR > 0.7 in patients, the early mortality rate and complications is
higher after the cardiac valve replacement. The CTR can be used as one of
the preoperative risk assessment indexes for cardiac valve replacement. It
is valuable to statistics CTR according to preoperative heart level.

<34>
Accession Number
2011194944
Authors
Navarese E.P. de Servi S. Gibson C.M. Buffon A. Castriota F. Kubica J.
Petronio A.S. Andreotti F. de Luca G.
Institution
(Navarese, Buffon, Andreotti) Institute of Cardiology, Catholic University
of the Sacred Heart, Rome, Italy
(Navarese, de Servi) Department of Cardiovascular diseases, Civic
Hospital, Legnano, Italy
(Navarese, Gibson) Cardiovascular Division, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
(Navarese, Castriota) GVM Care and Research, Interventional
Cardio-Angiology Unit, Cotignola, Italy
(Navarese, Kubica) Nicolaus Copernicus University, Bydgoszcz, Poland
(Petronio) Cardiothoracic Department, Azienda Ospedaliero-Universitaria
Pisana, Pisa, Italy
(de Luca) Division of Cardiology, Maggiore della Carita' Hospital, Eastern
Piedmont University A. Avogadro, Novara, Italy
Title
Early vs. delayed invasive strategy in patients with acute coronary
syndromes without ST-segment elevation: A meta-analysis of randomized
studies.
Source
QJM. 104 (3) (pp 193-200), 2011. Date of Publication: March 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Although early percutaneous coronary intervention has been demonstrated to
reduce the risk of mortality in patients with non-ST-segment elevation
acute coronary syndromes (NSTE-ACS), there are emerging conflicting data
as to whether the catheterization needs to be done very early or whether
it could be delayed while the patient receives medical therapy. The aim of
the current study was to perform a meta-analysis of randomized controlled
trials (RCTs) comparing early vs. delayed invasive strategies for NSTE-ACS
patients. Medline/CENTRAL and the Web were searched for RCTs comparing
early vs. delayed invasive strategies for NSTE-ACS patients. The primary
endpoint was all cause mortality, whereas myocardial infarction (MI),
coronary revascularizations and 30-day major bleeding complications were
secondary end points. Fixed or random effects models were used based on
statistical heterogeneity. As a sensitivity analysis, Bayesian random
effects meta-analysis was performed in addition to the classical random
effects metaanalysis. A total of 5 RCTs were finally included, enrolling
4155 patients. As compared with a delayed strategy, an early invasive
approach did not significantly reduce the rates of death [odds ratio (OR)
95% confidence interval (95% CI) = 0.81 (95% CI 0.60-1.09), P = 0.17], MI
[OR = 1.18 (95% CI 0.68-2.05), P=0.55] or revascularizations [OR=0.97
(0.77-1.24), P = 0.82]. There was a not significant trend toward fewer
major bleeding complications for the early invasive approach [OR (95% CI)
= 0.76 (0.55-1.04), P = 0.08]. The present meta-analysis shows that for
NSTE-ACS patients a routine early invasive strategy does not significantly
improve survival nor reduce MI and revascularization rates as compared
with a delayed approach. The Author 2011. Published by Oxford University
Press on behalf of the Association of Physicians. All rights reserved.

<35>
Accession Number
2011195489
Authors
Fraisse A. Butrous G. Taylor M.B. Oakes M. Dilleen M. Wessel D.L.
Institution
(Fraisse) Cardiologie Pediatrique, Pole de Pediatrie, Hopital de la
Timone, 264 rue St Pierre, Marseille Cedex 05 13385, France
(Butrous) University of Kent, Canterbury, United Kingdom
(Taylor) Vanderbilt Children's Hospital, Nashville, TN, United States
(Butrous, Oakes, Dilleen) Pfizer Global Research and Development,
Sandwich, United Kingdom
(Wessel) Children's National Medical Center, 111 Michigan Ave, NW,
Washington, DC 20010, United States
Title
Intravenous sildenafil for postoperative pulmonary hypertension in
children with congenital heart disease.
Source
Intensive Care Medicine. 37 (3) (pp 502-509), 2011. Date of Publication:
March 2011.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: To evaluate the efficacy and safety of intravenous sildenafil for
immediate postoperative pulmonary hypertension (PH) in pediatric patients
undergoing congenital heart surgery. Methods: A double-blind, multicenter,
placebo-controlled, dose-ranging, parallel-group trial was conducted.
Patients were randomized to one of three doses of intravenous sildenafil,
or placebo, for a minimum of 24 h. Results: The study was heavily
underpowered. Whereas enrollment of 228 patients (57 per treatment arm)
was required to achieve the sample size estimate to detect difference
between arms, the sponsor terminated the study after 15 months owing to
slow patient accrual. Seventeen patients (median age 5 months)
experiencing postoperative PH were randomized and treated, five with
placebo and four each with low-, medium-, and high-dose sildenafil. In the
first 24 h, 40% of placebo and 17% of sildenafil patients required
additional therapy (p = 0.330). Median time to extubation (3 versus 8
days, p = 0.023) and intensive care unit stay (6 versus 15 days, p =
0.008) were shorter for sildenafil patients. Mean +/- standard deviation
systolic pulmonary artery pressure was reduced with sildenafil (46 +/- 11
to 35 +/- 6 mmHg, p = 0.027 versus placebo). No adverse events or systemic
hypotension were attributed to sildenafil. Conclusion: Intravenous
sildenafil reduced pulmonary artery pressure and shortened time to
extubation and intensive care unit stay in children with postoperative PH.
2010 Copyright jointly held by Springer and ESICM.

<36>
Accession Number
2011196759
Authors
Diercks D.B. Pollack Jr. C.V. Hollander J.E. Blomkalns A.L. Emerman C.L.
Rokos I.C. Larson D.M. Hoekstra J.W. Mehran R. Stone G.W.
Institution
(Diercks) Department of Emergency Medicine, University of California-Davis
Medical Center, Ste 2100 PSSB, 2315 Stockton Blvd, Sacramento, CA 95817,
United States
(Pollack Jr.) Pennsylvania Hospital, University of Pennsylvania Health
System, Philadelphia, PA, United States
(Hollander) University of Pennsylvania, Philadelphia, PA, United States
(Blomkalns) University of Cincinnati, Cincinnati, OH, United States
(Emerman) Metro Health Hospital, Cleveland, OH, United States
(Rokos) University of California Los Angeles Medical Center, Los Angeles,
CA, United States
(Larson) University of Minneapolis, Minneapolis, MN, United States
(Hoekstra) Wake Forest University Hospital, Wake Forest, NC, United States
(Mehran, Stone) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, NY, United States
Title
The time dependence of antithrombin initiation in patients with
non-ST-segment elevation acute coronary syndromes: Subgroup analysis from
the ACUITY trial.
Source
Annals of Emergency Medicine. 57 (3) (pp 204-212.e1-e6), 2011. Date of
Publication: March 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Study objective: Antithrombins are among standard treatment agents for
patients with non-ST-segment elevation acute coronary syndromes. We aimed
to determine the association between time from emergency department (ED)
presentation to treatment with an antithrombin and adverse cardiac events.
Methods: The study cohort was a subgroup of the Acute Catheterization and
Urgent Intervention Triage Strategy (ACUITY) trial, enrolled from March 1,
2005, to December 5, 2005. The ACUITY trial enrolled patients with
moderate- and high-risk non-ST-segment elevation acute coronary syndromes
and who were undergoing an early invasive strategy (<72 hours from
randomization). All patients received an antithrombin (unfractionated
heparin, low-molecular-weight heparin, or bivalirudin), in addition to
other agents. A formal ED case report form was introduced in March 2005.
Time from presentation to antithrombin initiation was evaluated as a
continuous variable in hours. The endpoints were defined as major ischemic
events (death, myocardial infarction, unplanned revascularization) or
major bleeding within 30 days, or inhospital major bleeding. Logistic
regression was used to adjust for demographics, severity of disease,
comorbidities, and treatment differences. Results: Of the 2,722 patients
enrolled with an ED case report form, complete time data were available in
2,632 (96%). Median time to antithrombin administration was 4.87 hours
(interquartile range 2.67 to 9.83). After multivariable analysis, there
was no association of major ischemic events with log time (hours) to
antithrombin treatment (adjusted odds ratio [OR] 0.99; 95% confidence
interval [CI] 0.97 to 1.01). There was an increase in major bleeding at 30
days and inhospital major bleeding complications with longer log time
(hours) to antithrombin initiation (adjusted OR 1.44, 95% CI 1.15 to 1.80;
OR 1.43, 95% CI 1.13 to 1.83, respectively). Conclusion: In this study of
patients with non-ST-segment elevation acute coronary syndromes who were
undergoing an early invasive management strategy, we were unable to
demonstrate an association between adverse ischemic outcomes with the
timing of antithrombin administration. However, there was an increase in
bleeding outcomes as time to antithrombin administration increased. 2010
American College of Emergency Physicians.

<37>
[Use Link to view the full text]
Accession Number
2011196941
Authors
Jildenstal P.K. Hallen J.L. Rawal N. Gupta A. Berggren L.
Institution
(Jildenstal, Hallen, Rawal, Gupta, Berggren) Department of Anaesthesiology
and Intensive Care, University Hospital, Orebro, Sweden
(Gupta) Department of Anaesthesiology, Linkoping University, Linkoping,
Sweden
(Berggren) Centre for Assessment of Medical Technology, Orebro (LB),
Sweden
(Jildenstal) Department of Anaesthesiology and Intensive Care, University
Hospital, 701 85 Orebro, Sweden
Title
Effect of auditory evoked potential-guided anaesthesia on consumption of
anaesthetics and early postoperative cognitive dysfunction: A randomised
controlled trial.
Source
European Journal of Anaesthesiology. 28 (3) (pp 213-219), 2011. Date of
Publication: March 2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Background Post-operative cognitive dysfunction (POCD) after non-cardiac
surgery is a well known problem in some categories of patients. This study
aims to evaluate the influence of auditory evoked potential (AEP)-guided
anaesthesia on the requirement for anaesthetic drugs and their influence
on POCD. Methods Four hundred and fifty patients aged between 18 and 92
years scheduled for ophthalmic surgery under general anaesthesia were
assigned randomly to one of two groups. In group A (AEP group), the depth
of anaesthesia (DoA) was aimed at an AEP index (AAI) between 15 and 25. In
group C (control group), DoA was guided by clinical signs. Hypotension was
treated with fluids and vasopressors using a standardised algorithm. A
mini-mental test and the Cognitive Failure Questionnaire were used to
evaluate cognitive function. Results Anaesthetic drug requirements were
significantly lower in group A than in group C: propofol 92.5+/-26.5 vs.
103.8+/-39.5mg (P=<0.001) and desflurane end-tidal concentration
2.5+/-0.58 vs. 3.3+/-0.79% (P<0.001). In group A, 36 patients (16%)
received additional fluids and vasopressors compared to 65 patients (29%)
in group C (P<0.01). AAI values differed significantly between the groups:
18 (11-21) in group A vs. 12 (10-19) in group C (P<0.001). The number of
patients with POCD was 16 in group C compared to two in group A (P<0.001)
at day 1 post-operation. Conclusion AEP monitoring allows dose reduction
of anaesthetic agents, leading to better cardiovascular stability and
decreased requirements for intra-operative fluids and vasopressors.
Cognitive decline seen following minor ophthalmic surgery, even when
anaesthesia is assessed clinically, is short-lived with no long-term
sequelae. 2011 Copyright European Society of Anaesthesiology.

<38>
Accession Number
70389668
Authors
Rivard A.L. Bianco R.W. Gallego R.P.
Institution
(Rivard, Bianco) University of Minnesota, Minneapolis, MN, United States
(Gallego) Brigham and Women's Hospital, Boston, MA, United States
Source
Journal of Extra-Corporeal Technology. Conference: 48th International
Conference of the American Society of ExtraCorporeal Technology, AMSECT
Reno, NV United States. Conference Start: 20100428 Conference End:
20100501. Conference Publication: (var.pagings). 42 (1) (pp A5), 2010.
Date of Publication: March 2010.
Publisher
American Society of Extra-Corporeal Technology
Abstract
Purpose: As a consequence of technology improvements and refinement,
perfusion of the donor heart has moved from the research lab to clinical
studies. A persistent problem with the donor heart is the high metabolism
relative to other organs; depletion of ATP leads rapidly to acidosis and
necrosis of the myocardium without preservation. This review examines
relevant regarding donor heart preservation focusing on myocardial
pathophysiology and the analytical techniques of pre-clinical evaluation
necessary for regulatory approval. Methods: A systematic review of English
language Medline literature from 1966 to the 2008 used the key words:
donor, heart, and perfusion. Potentially relevant citations were screened
and studies using only a single flush of cardioplegia and duplicate data
were excluded resulting in 35 studies. Journal articles were then
retrieved reviewed either online or print. Results: Two techniques used in
the studies included normothermic and hypothermic perfusion for a total of
245 animals. The average perfusion pressure was 36 cm H20 (range 9-82, n =
20) and temperature of 12degreeC +/- 7 (range 1-37degreeC, n = 27) for a
preservation time between 3-24 hours. Functional data obtained included
HR, CVP, LVEDP, CO, dP/dt. Most studies used some type of a biochemical
method (n = 27) for evaluation including: % water weight, lactate (pH),
ATP, or pNMR. Conclusions: Effective implementation of donor heart
preservation devices in clinical trials is dependent upon well-structured
preclinical studies continuing functional, biochemical and histological
data.