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<1>
Accession Number
2011206419
Authors
Van Mieghem N.M. Nuis R.-J. Piazza N. Tzikas A. Ligthart J. Schultz C. De
Jaegere P.P. Serruys P.W.
Institution
(Van Mieghem, Nuis, Piazza, Tzikas, Ligthart, Schultz, De Jaegere,
Serruys) Department of Cardiology, Thoraxcentre, Erasmus Medical Centre,
Rotterdam, Netherlands
Title
Vascular complications with transcatheter aortic valve implantation using
the 18 Fr Medtronic CoreValve System: The Rotterdam experience.
Source
EuroIntervention. 5 (6) (pp 673-679), 2010. Date of Publication: January
2010.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Transcatheter aortic valve implantation (TAVI) requires large bore
catheters. Access site complications, therefore, can be a concern. The aim
of this study is to present the 30-day incidence of major and minor
vascular complications in patients treated with the third generation 18 Fr
Medtronic CoreValve System. Methods and results: We prospectively
evaluated the vascular complications occurring in all patients treated
with the 18 Fr Medtronic CoreValve System between October 2006 and October
2009 in the Thoraxcenter using various proposed definitions. Ninety-nine
consecutive patients were treated with TAVI using the 18 Fr Medtronic
CoreValve System. Vascular events were encountered in 13 patients (13%),
seven of these cases (54%) were related to incomplete arteriotomy closure
with the Prostar device which is the default access closure technique in
our centre. Depending on how major vascular complications were defined,
the incidence varied from 4 to 13%. Blood transfusions in combination with
surgical or percutaneous intervention were required in eight cases.
Conclusions: Transcatheter aortic valve implantation with the 18 Fr
Medtronic CoreValve System has a 4 to 13% vascular complications' rate.
More than half of the vascular events were due to incomplete Prostar
arteriotomy closure, despite its use by experienced operators. Current
percutaneous closure devices for these large arteriotomies seems
suboptimal. Uniformity in how to define TAVI related vascular
complications is needed. Europa Edition. All rights reserved.

<2>
Accession Number
2011210250
Authors
Piscione F. Piccolo R. Cassese S. Galasso G. De Rosa R. D'Andrea C.
Chiariello M.
Institution
(Piscione, Piccolo, Cassese, Galasso, De Rosa, D'Andrea, Chiariello)
Department of Clinical Medicine, Cardiovascular Sciences and Immunology,
Federico II University, Naples, Italy
Title
Effect of drug-eluting stents in patients with acute ST-segment elevation
myocardial infarction undergoing percutaneous coronary intervention: A
meta-analysis of randomised trials and an adjusted indirect comparison.
Source
EuroIntervention. 5 (7) (pp 853-860), 2010. Date of Publication:
February 2010.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The role of drug-eluting stent (DES) remains an unsettled issue in
patients with ST-segment elevation myocardial infarction (STEMI).
Therefore, we performed a meta-analysis of randomised trials to evaluate
the clinical outcome of DES as compared with bare-metal stent (BMS) after
percutaneous coronary intervention (PCI). Methods and results: We
undertook a literature search until July 2009. Thirteen clinical trials
met inclusion criteria, with 7,244 patients enrolled. Up to 1-year,
patients treated with DES as compared with BMS experienced less
target-vessel revascularisation (TVR) (5.11% versus 11.19% respectively,
p<0.00001) and recurrent myocardial infarction rates (3.03% versus 3.70%
respectively, p=0.02). In addition, no significant differences were found
in terms of cardiac death (2.80% versus 3.52%, p=0.21) and stent
thrombosis (2.65% versus 2.76%, p=0.37). Using the adjusted indirect
comparison, a significant difference between sirolimus- and
paclitaxel-eluting stent was found when TVR was evaluated (OR [95% CI]
=0.59 [0.40-0.89], p=0.01), without differences in other clinical
outcomes. Conclusions: In patients undergoing PCI for STEMI, treatment
with DES is associated with decreased TVR and myocardial infarction rates,
without increasing cardiac death or stent thrombosis occurrence.
Sirolimus-eluting stent is associated with a greater TVR reduction as
compared to paclitaxel-eluting stent. Europa Edition. All rights
reserved.

<3>
Accession Number
2011160247
Authors
Trouillet J.-L. Luyt C.-E. Guiguet M. Ouattara A. Vaissier E. Makri R.
Nieszkowska A. Leprince P. Pavie A. Chastre J. Combes A.
Institution
(Trouillet, Luyt, Nieszkowska, Chastre, Combes) Service de Reanimation,
Institut de Cardiologie, Groupe Hospitalier Pitie-Salpetriere, 47,
boulevard de l'Hopital, 75651 Paris Cedex 13, France
(Guiguet) Institut National de la Sante et de la Recherche Medicale U943,
Universite Pierre et Marie Curie Unite Mixte de Recherche en Sante-943, 56
boulevard Vincent Auriol, Paris F75013, France
(Ouattara) Service d'Anesthesie-Reanimation II, Hopital du Haut- Leveque,
Avenue Magellan, 33600 Pessac, France
(Vaissier, Makri) Departement d'Anesthesie et Reanimation, Institut de
Cardiologie, Groupe Hospitalier Pitie-Salpetriere, 47, boulevard de
l'Hopital, 75651 Paris Cedex 13, France
(Leprince, Pavie) Service de Chirurgie Thoracique et Cardiovasculaire,
Institut de Cardiologie, Groupe Hospitalier Pitie-Salpetriere, 47,
boulevard de l'Hopital, 75651 Paris Cedex 13, France
Title
Early percutaneous tracheotomy versus prolonged intubation of mechanically
ventilated patients after cardiac surgery: A Randomized Trial.
Source
Annals of Internal Medicine. 154 (6) (pp 373-383), 2011. Date of
Publication: March 2011.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Whether early percutaneous tracheotomy in patients who require
prolonged mechanical ventilation can shorten mechanical ventilation
duration and lower mortality remains controversial. Objective: To compare
the outcomes of severely ill patients who require prolonged mechanical
ventilation randomly assigned to early percutaneous tracheotomy or
prolonged intubation. Design: Prospective, randomized, controlled,
single-center trial (ClinicalTrials.gov registration number: NCT00347321).
Setting: Academic center. Patients: 216 adults requiring mechanical
ventilation 4 or more days after cardiac surgery. Intervention: Immediate
early percutaneous tracheotomy or prolonged intubation with tracheotomy 15
days after randomization. Measurements: The primary end point was the
number of ventilator-free days during the first 60 days after
randomization. Secondary outcomes included 28-, 60-, or 90-day mortality
rates; durations of mechanical ventilation, intensive care unit stay, and
hospitalization; sedative, analgesic, and neuroleptic use;
ventilatorassociated pneumonia rate; unscheduled extubations; comfort and
ease of care; and long-term health-related quality of life (HRQoL) and
psychosocial evaluations. Results: There was no difference in
ventilator-free days during the first 60 days after randomization between
early percutaneous tracheotomy and prolonged intubation groups (mean, 30.4
days [SD, 22.4] vs. 28.3 days [SD, 23.7], respectively; absolute
difference, 2.1 days [95% CI, -4.1 to 8.3 days]) nor in 28-, 60-, or
90-day mortality rates (16% vs. 21%, 26% vs. 28%, and 30% vs. 30%,
respectively). The durations of mechanical ventilation and
hospitalization, as well as frequencies of ventilator-associated pneumonia
and other severe infections, were also similar. However, early
percutaneous tracheotomy was associated with less intravenous sedation;
less time of heavy sedation; less haloperidol use for agitation, delirium,
or both; fewer unscheduled extubations; better comfort and ease of care;
and earlier resumption of oral nutrition. After a median follow-up of 873
days, between-group survival, psychosocial evaluations, and HRQoL were
similar. Limitation: The prolonged intubation group had more
ventilatorfree days during days 1 to 60 than what was hypothesized (mean,
23.0 days [SD, 17.0]). Conclusion: Early tracheotomy provided no benefit
in terms of mechanical ventilation and length of hospital stay, rates of
mortality or infectious complications, and long-term HRQoL for patients
who require prolonged mechanical ventilation after cardiac surgery.
However, the well-tolerated procedure was associated with less sedation,
better comfort, and earlier resumption of autonomy. Primary Funding
Source: French Ministry of Health. 2011 American College of Physicians.

<4>
Accession Number
2011160275
Authors
Bhatt D.L.
Institution
(Bhatt) VA Boston Healthcare System, Boston, MA, United States
Title
Adding omeprazole to clopidogrel reduced GI events and did not increase CV
events.
Source
Annals of Internal Medicine. 154 (6) (pp JC3-7), 2011. Date of
Publication: March 2011.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<5>
Accession Number
2011205568
Authors
Piazza N. Van Gameren M. Juni P. Wenaweser P. Carrel T. Onuma Y. Gahl B.
Hellige G. Otten A. Kappetein A.-P. Takkenberg J.J.M. Van Domburg R. De
Jaegere P. Serruys P.W. Windecker S.
Institution
(Piazza, Onuma, Otten, De Jaegere, Serruys) Department of Cardiology,
Erasmus Medical Center, Thoraxcenter, Ba 583, 's-Gravendijkwal 230, 3015
CE Rotterdam, Netherlands
(Van Gameren, Kappetein, Takkenberg) Department of Cardiac Surgery,
Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Juni) Division of Clinical Epidemiology and Biostatistics, Institute of
Social and Preventive Medicine, University of Bern, Bern, Switzerland
(Juni, Windecker) CTU Bern, Bern University Hospital, Bern, Switzerland
(Wenaweser, Hellige, Windecker) Department of Cardiology, Bern University
Hospital, Bern, Switzerland
(Carrel, Gahl) Department of Cardiac Surgery, University of Bern Hospital,
Bern, Switzerland
(Takkenberg, Van Domburg) Department of Biostatistics and Epidemiology,
Erasmus Medical Center, Rotterdam, Netherlands
Title
A comparison of patient characteristics and 30-day mortality outcomes
after transcatheter aortic valve implantation and surgical aortic valve
replacement for the treatment of aortic stenosis: A two-centre study.
Source
EuroIntervention. 5 (5) (pp 580-588), 2009. Date of Publication:
November 2009.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: It is unclear whether transcatheter aortic valve implantation (TAVI)
addresses an unmet clinical need for those currently rejected for surgical
aortic valve replacement (SAVR) and whether there is a subgroup of
high-risk patients benefiting more from TAVI compared to SAVR. In this
two-centre, prospective cohort study, we compared baseline characteristics
and 30-day mortality between TAVI and SAVR in consecutive patients
undergoing invasive treatment for aortic stenosis. Methods and results: We
pre-specified different adjustment methods to examine the effect of TAVI
as compared with SAVR on overall 30-day mortality: crude univariable
logistic regression analysis, multivariable analysis adjusted for baseline
characteristics, analysis adjusted for propensity scores, propensity score
matched analysis, and weighted analysis using the inverse probability of
treatment (IPT) as weights. A total of 1,122 patients were included in the
study: 114 undergoing TAVI and 1,008 patients undergoing SAVR. The crude
mortality rate was greater in the TAVI group (9.6% vs. 2.3%) yielding an
odds ratio [OR] of 4.57 (95%-CI 2.17-9.65). Compared to patients
undergoing SAVR, patients with TAVI were older, more likely to be in NYHA
class III and IV, and had a considerably higher logistic EuroSCORE and
more comorbid conditions. Adjusted OR depended on the method used to
control for confounding and ranged from 0.60 (0.11-3.36) to 7.57
(0.91-63.0). We examined the distribution of propensity scores and found
scores to overlap sufficiently only in a narrow range. In patients with
sufficient overlap of propensity scores, adjusted OR ranged from 0.35
(0.04-2.72) to 3.17 (0.31 to 31.9). In patients with insufficient overlap,
we consistently found increased odds of death associated with TAVI
compared with SAVR irrespective of the method used to control confounding,
with adjusted OR ranging from 5.88 (0.67-51.8) to 25.7 (0.88-750).
Approximately one third of patients undergoing TAVI were found to be
potentially eligible for a randomised comparison of TAVI versus SAVR.
Conclusions: Both measured and unmeasured confounding limit the
conclusions that can be drawn from observational comparisons of TAVI
versus SAVR. Our study indicates that TAVI could be associated with either
substantial benefits or harms. Randomised comparisons of TAVI versus SAVR
are warranted. Europa Edition. All rights reserved.

<6>
Accession Number
70399394
Authors
Tindle H.A. Belnap B.H. Hum B. Houck P.R. Mazumdar S. Scheier M. Matthews
K.A. Rollman B.L.
Institution
(Tindle, Belnap, Hum, Rollman) Internal Medicine, University of
Pittsburgh, Pittsburgh, PA, United States
(Houck, Mazumdar) Biostatistics, University of Pittsburgh, Pittsburgh, PA,
United States
(Scheier) Psychology, Carnegie Mellon University, Pittsburgh, PA, United
States
(Matthews) Psychiatry, United States
Source
Psychosomatic Medicine. Conference: 69th Annual Meeting of the American
Psychosomatic Society San Antonio, TX United States. Conference Start:
20110309 Conference End: 20110312. Conference Publication: (var.pagings).
73 (3) (pp A49), 2011. Date of Publication: 01 Apr 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Optimism, or the expectation that good things will happen, has
been associated with favorable Cardiov ascular disease (CVD) outcomes,
including lower risk of subclinical CVD progression and of
re-hospitalization following coronary artery bypass graft (CABG) surgery.
Depressive symptoms are common following CABG surgery and are associated
with worse clinical outcomes. Little is known about how optimism may
affect treatment for depression after CABG. We examined this question
using data from the Bypassing the Blues randomized controlled trial of
collaborative care for post-CABG depression. Methods: Exploratory post-hoc
analysis of 284 depressed post-CABG patients (2-week post-hospitalization
PHQ-9 score>=10) and 146 non-depressed controls who completed the Life
Orientation Test-Revised (LOT-R) to assess level of optimism. We
classified those who scored in the top quartile on the LOT-R as optimists
and those who scored in the bottom quartile as pessimists. Over 8 months
we assessed health-related quality of life (HRQoL, SF-36), mood symptoms
(Hamilton Rating Scale for Depression, HRS-D) and re-hospitalization for
any reason (adjudication). We defined depression remission as a>=50%
decline in HRS-D score from baseline. Results: Among all 430 post-CABG
patients, 19% were classified as optimists and 30% as pessimists. At
baseline, optimists were more likely than pessimists to report higher
levels of education (66% vs. 47%), mental (SF-36 MCS: 55 vs. 43) and
physical (SF-36 PCS: 35 vs. 32) HRQoL, and lower mean HRS-D scores (8 vs.
15) (all p < .05). Among all 284 depressed patients, optimists' mood
symptoms were more likely to remit than pessimists' at 8 months (62% vs.
29%, p < .05: HR 3.67; 95% CI 1.41-9.57). Furthermore, we observed a
similar pattern among depressed subjects randomized to UC (HR 8.54
(1.80-40.59) but not among those randomized to the study intervention (HR
2.25 (0.82-6.20)). Conclusions: Optimistic post-CABG patients recover from
depression at higher rates, particularly among patients receiving UC.
Further research should explore the impact of optimism on long-term
post-CABG outcomes.

<7>
Accession Number
70400813
Authors
Athappan G. Kanagalingam S. Patvardhan E. Faisal Khan M.
Institution
(Athappan, Kanagalingam, Patvardhan, Faisal Khan) Caritas St. Elizabeth,
Tufts School of Medicine, Brighton, MA, United States
Source
Journal of the American College of Cardiology. Conference: 60th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.11 New Orleans, LA United States.
Conference Start: 20110402 Conference End: 20110405. Conference
Publication: (var.pagings). 57 (14 SUPPL. 1) (pp E1136), 2011. Date of
Publication: 05 Apr 2011.
Publisher
Elsevier USA
Abstract
Background: With advances in medical and PCI related therapies, the
superiority of CABG over PCI as the revascularization strategy of choice
in diabetics with multivessel disease (MVD) is being questioned. We
performed a systematic review to compare the safety and efficacy of PCI to
CABG in diabetic patients with MVD. Methods: All comparative studies
published on PCI with drug eluting stents (DES) vs. CABG for MVD in
diabetic patients until 2010 were identified using an electronic search
and reviewed using a random effects model. Endpoints evaluated were all
cause mortality, MI, stroke, TVR and MACE, which was defined as a
composite of the other end points. Results: 12 studies comprising 9520
patients were included in the analysis. 4598 patients underwent PCI with
DES. There was no significant difference between the two groups in the
incidence of all cause mortality (OR:0.87, 95% CI:0.74-1.02, p=0.08) or MI
(OR:1.37, 0.93-2.01, p=0.11). Whereas TVR occurred significantly more
frequently in patients undergoing PCI (OR:4.2, 3.0-5.88, p<0.001), stroke
occurred significantly less (OR:0.43, 0.25-0.74, p=0.002). Overall, MACE
rates were higher in patients undergoing PCI (OR:1.86,1.47-2.4, p<0.001).
Conclusions: We conclude that in diabetics undergoing revascularization
for MVD, PCI with DES is comparable to CABG in terms of mortality. CABG
leads to reduced repeat revascularization but increased stroke. A tailored
approach to each patient's anatomy and stroke risk may lead to the optimal
management strategy. (Table presented).

<8>
Accession Number
70400850
Authors
Rajpurohit N. Garg N. Choudhary A. Aggarwal K.B. Dellsperger K.C. Alpert
M.
Institution
(Rajpurohit, Garg, Choudhary, Aggarwal, Dellsperger, Alpert) University of
Missouri, Columbia, MO, United States
Source
Journal of the American College of Cardiology. Conference: 60th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.11 New Orleans, LA United States.
Conference Start: 20110402 Conference End: 20110405. Conference
Publication: (var.pagings). 57 (14 SUPPL. 1) (pp E1173), 2011. Date of
Publication: 05 Apr 2011.
Publisher
Elsevier USA
Abstract
Background: Studies indicate that an early invasive strategy is favorable
over a selective invasive strategy for Non-ST segment elevation acute
coronary syndromes (NSTE-ACS). However, there is no general consensus on
precisely how early should the revascularization be performed. Randomized
controlled trials (RCTs) performed to compare the outcomes of
revascularization less than 24 hours of presentation (group A) versus
between 24 hours and seven days after presentation (group B) for NSTE-ACS
show conflicting results. Methods: MEDLINE, PubMed and abstracts from
major cardiology conferences were searched. RCTs comparing the composite
of death or myocardial infarctions (MI) between group A and group B within
30 days of revascularisation were included. The effects of both methods
were analyzed by calculating pooled estimates for death, MI, repeat
revascularisation, bleeding and composite of death or MI. Separate
analyses were performed for each outcome by using odds ratio (OR) by fixed
and random effects models. Publication bias was assessed by funnel plots.
All were graded by jaded score. Heterogeneity among studies was assessed
by calculating |x measure of inconsistency. Results: Seven studies with a
total of 13,762 patients met our inclusion criteria. The incidence of the
composite of death or MI was not different between group A [607/7710
(7.9%)] compared to group B [823/6052(13.6%)], (OR 0.83, 95% CI 0.62-1.10,
P=0.20). Similar results were obtained for death (OR 0.58, 95% CI
0.24-1.39, P=0.22) and MI (OR 0.93, 95% CI 0.64-1.34, P=0.69) separately.
In group A there was a decrease (OR 1.33 (95% CI 1.13-1.56, p=0.0004) in
the incidence of repeat revascularization [405/7398(5.5%)] as compared to
group B [337/5734(5.9%)]. Group A experienced lower incidence of bleeding
5.3% (293 in 5497) as compared to 6.9% (232/3376) in group B (OR-0.76, 95%
CI, 0.63-0.91, P=0.003). Conclusions: Coronary artery revascularization
within 24 hours of presentation does not reduce death and MI at 30 days in
NSTE-ACS as compared to intervention after 24 hours. Early intervention
groups had significantly lower rate of repeat revascularization and
bleeding as compared to the delayed intervention group.

<9>
Accession Number
70401186
Authors
Alreja G. Chandrasekaran D. Trikalinos T. Rothberg M.
Institution
(Alreja, Chandrasekaran, Trikalinos, Rothberg) Baystate Medical Center,
Tufts University, Springfield, MA, United States
Source
Journal of the American College of Cardiology. Conference: 60th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.11 New Orleans, LA United States.
Conference Start: 20110402 Conference End: 20110405. Conference
Publication: (var.pagings). 57 (14 SUPPL. 1) (pp E1509), 2011. Date of
Publication: 05 Apr 2011.
Publisher
Elsevier USA
Abstract
Background: Secondary prophylaxis of stroke without atrial fibrillation or
artificial heart valves remains challenging. Multiple randomized control
trials evaluating warfarin with or without aspirin after the first
incidence of coronary artery disease (CAD) or cerebrovascular disease
(CVD) have yielded mixed results. Methods: Meta-analysis of the literature
(MEDLINE - 1980 to August 2010) was performed to determine pooled
estimates of benefits (reduced incidence of stroke) and risks (mortality,
intracranial bleeds, major and minor bleeds) of warfarin (with and without
aspirin) in patients with CAD and CVD. 24 trials (32827 patients) were
stratified based on the intensity of the therapeutic international
normalized ratio (INR): low (INR3.0). Results: In patients with CAD,
intermediate intensity warfarin with aspirin when compared to aspirin
alone, significantly reduced risk of secondary strokes [relative risk (RR)
0.48, confidence interval (CI) 95% 0.29-0.80], increased the risk of
intracranial (RR 3.03 CI 95% 0.48-19.20) and major bleed (RR 2.54, CI 95%
1.70-3.79) and did not reduce mortality (RR 1.00, CI 95% 0.80-1.25).
Intermediate intensity warfarin without aspirin did not reduce stroke
compared to aspirin alone (RR 1.16, CI 95% 0.46-2.93). In patients with
CVD, intermediate intensity warfarin without aspirin although did reduce
stroke, but did not reach statistical significance (RR 0.78, CI 95%
0.55-1.11) and modestly increased the risk of intracranial (RR 1.81, CI
95% 0.87-3.77) and major (RR 2.27, CI 95% 1.52-3.37) bleed. There are no
studies of intermediate intensity warfarin plus aspirin in this
population. Low intensity warfarin did not confer any additional benefit
with previous CVD. High intensity warfarin increased intracranial (RR
14.30, CI 95% 1.89-108.44) bleed substantially. Conclusions: In CAD
patients, use of intermediate intensity warfarin with aspirin reduces the
risk of stroke at the price of increased bleeding. In CVD patients,
intermediate intensity warfarin without aspirin also reduced stroke.
Intermediate intensity warfarin plus aspirin might be particularly
effective for secondary prevention in CVD patients.

<10>
Accession Number
70401514
Authors
Kim Y.-H. Kim H.-S. Park D.-W. Cheong S.-S. Lee K. Lee N.-H. Lee S.-G. Lee
C.H. Hwang K.W. Park G.-M. Kim Y.-G. Ahn J.-M. Song H.G. Lee J.-Y. Kang
S.-J. Lee S.-W. Lee C.W. Park S.-W. Park S.-J.
Institution
(Kim, Kim, Park, Cheong, Lee, Lee, Lee, Lee, Lee, Hwang, Park, Kim, Ahn,
Song, Lee, Kang, Lee, Lee, Park, Park) Division of Cardiology, University
of Ulsan, Asan Medical Center, Seoul, South Korea
Source
Journal of the American College of Cardiology. Conference: 60th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.11 New Orleans, LA United States.
Conference Start: 20110402 Conference End: 20110405. Conference
Publication: (var.pagings). 57 (14 SUPPL. 1) (pp E1837), 2011. Date of
Publication: 05 Apr 2011.
Publisher
Elsevier USA
Abstract
Background: Currently, it is now time for the development of the next
generation of drug-eluting stents (DES) to guarantee more safe and
efficient profile as compared to the first generation of DES. We compared
the efficacy and safety of the new paclitaxel-eluting stents (Coroflex
Please), compared with first-generation paclitaxel-eluting stents for
coronary revascularization. Methods: We performed a single-blind,
multicenter, prospective randomized trial to compare the safety and
efficacy of the Coroflex Please stent and TAXUS stent in patients with de
novo coronary disease. The primary end point was an in-segment late
luminal loss at 9-month follow-up angiography. Clinical events were also
monitored for at least 12 months. Results: A total of 319 patients were
randomized 1:1 to received Coroflex Please stent (n=159) and
paclitaxel-eluting stent (n=160). At 9 month, the primary end-point of
in-segment late loss was similar in patients receiving Coroflex Please
stent and in those receiving Taxus stent (0.40+/-0.38 and 0.39+/-0.38,
P=0.98). The rate of angiographic in-segment restenosis was also similar
between 2 groups (22.2% and 18.8%, P=0.48). There were no significant
between-group differences in the rate of death from cardiac causes, any
myocardial infarction, or revascularization. The rate of definite or
probable stent thrombosis was 0.6% in the Coroflex Please stent group and
1.3% in the Taxus stent group (P>0.99). Conclusions: During 1 year of
follow-up, the newer-generation paclitaxel-eluting Coroflex Please stent
was found to be noninferior to early generation paclitaxel-eluting stent
for coronary revascularization.

<11>
Accession Number
70401572
Authors
Stub D. Chan W. Andrianopoulos N. Butler M. Clark D.J. Ajani A.E. Brennan
A. Newcomb A.E. Smith J.A. Naidu P. Dart A.M. Dinh D.T. Duffy S.J.
Institution
(Stub, Chan, Andrianopoulos, Butler, Clark, Ajani, Brennan, Newcomb,
Smith, Naidu, Dart, Dinh, Duffy) Monash Centre of Cardiovascular Research
and Education in Therapeutics (CCRE), Monash University, Melbourne,
Australia
(Stub, Chan, Andrianopoulos, Butler, Clark, Ajani, Brennan, Newcomb,
Smith, Naidu, Dart, Dinh, Duffy) Heart Centre Alfred Hospital, Australia
Source
Journal of the American College of Cardiology. Conference: 60th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.11 New Orleans, LA United States.
Conference Start: 20110402 Conference End: 20110405. Conference
Publication: (var.pagings). 57 (14 SUPPL. 1) (pp E1895), 2011. Date of
Publication: 05 Apr 2011.
Publisher
Elsevier USA
Abstract
Introduction: Sub-group analyses of several randomised controlled trials
of percutaneous coronary intervention (PCI) versus coronary artery bypass
grafting (CABG) suggest that diabetics with multivessel coronary artery
disease (CAD) have improved event-free survival with CABG. Method: We
compared clinical characteristics and long-term mortality using National
Death Index data in 3455 patients with diabetes who underwent PCI (n=1112;
32%) or CABG (n=2343; 68%) in two large, parallel, multi-centre registries
from April 2004 to October 2008. Cardiogenic shock, acute myocardial
infarction (MI) <24 hours, previous CABG, associated valve surgery or
prior PCI were exclusions. Predictors of long-term mortality were
determined using Cox proportional hazard modelling. Results: Both PCI and
CABG groups had similar age, ejection fraction and BMI. Patients
undergoing CABG were more likely to be males, dyslipidaemic, hypertensive,
have cerebrovascular, and peripheral arterial disease, prior MI, heart
failure, higher intra-aortic balloon pump use, and multivessel CAD (all
p<0.0001). By contrast, more PCI patients had recent MI (1-7 days prior),
NYHA class IV symptoms, creatinine >200mumol/L, and were current smokers
(all p<=0.02). Over 2.2 years of follow up, mortality was similar between
the CABG and PCI cohorts (6.0% vs. 5.4%, p=0.47). significant multivariate
predictors of mortality included age (HR 1.05 per year; 95% CI 1.03-1.06,
p<0.0001), creatinine (4.3; 2.9-6.4, p<0.0001), IABP use (3.0; 1.7-5.3,
p<0.0001) and prior MI (1.5; 1.1-2.1, p=0.01), but not the mode of
revascularisation (0.99; 0.7-1.5, p=0.94). Conclusion: In this
multi-centre, real world registry of patients with diabetes requiring
revascularization, CABG and PCI provide comparable mortality benefit.

<12>
Accession Number
70401736
Source
Journal of the American College of Cardiology. Conference: 60th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.11 New Orleans, LA United States.
Conference Start: 20110402 Conference End: 20110405. Conference
Publication: (var.pagings). 57 (14 SUPPL. 1) , 2011. Date of
Publication: 05 Apr 2011.
Publisher
Elsevier USA
Abstract
The proceedings contain 2058 papers. The topics discussed include: does
gender mismatch increase the risk of antibody-mediated rejection?; effect
of testosterone supplementation on exercise capacity in heart failure
patients: a systematic review and meta-analysis; aging impairs dobutamine
augmentation of early diastolic intraventricular pressure gradient;
comprehensive 6-year follow-up of stent implantation for aortic
coarctation; executive functioning, gross motor ability and mood are key
drivers of poorer quality of life in child and adolescent survivors with
complex congenital heart disease; should concomitant tricuspid
regurgitation be addressed during adult congenital heart surgery?; impact
of multiple risk factor intervention on progression of coronary
atherosclerosis in patients with type 2 diabetes mellitus; and a decade of
LDL-C goal achievement in high risk adults: findings from the national
health and nutrition surveys 1999-2008.

<13>
Accession Number
70401792
Authors
Zhang S. Yao K. Qian J. Ge J.
Institution
(Zhang, Yao, Qian, Ge) Zhongshan Hospital, Fudan University Shanghai,
Shanghai, China
Source
American Journal of Cardiology. Conference: 16th Annual Interventional
Vascular Therapeutics Angioplasty Summit-Transcatheter Cardiovascular
Therapeutics Asia Pacific Symposium, TCTAP 2011 Seoul South Korea.
Conference Start: 20110427 Conference End: 20110429. Conference
Publication: (var.pagings). 107 (8 SUPPL. 1) (pp 34A), 2011. Date of
Publication: April 2011.
Publisher
Elsevier Inc.
Abstract
Background: Until now the optimal timing of coronary revascularization for
non-ST-segment elevation acute coronary syndrome (NSTEACS) patients
remains uncertain.We investigated the optimal timing (early or deferred)
of coronary revascularization in patients who present with NSTE-ACS.
Methods: We systematically searched Medline, ISI Web of Science, Central
Register of Controlled Trials, and Cochrane Database of Systematic
Reviews.We included all randomized controlled trials comparing early
coronary revascularization with deferred intervention in NSTE-ACS
patients. Two reviewers independently performed quality assessment and
extracted the data on the number of major clinical outcomes, including
all-cause death, recurrent myocardial infarction (MI), repeat
intervention, refractory ischemia, and major bleeding events from the
eligible trials. Results: A total of five trials with 4155 patients were
included for analysis. The fixed-effect meta-analysis showed that an early
revascularization had no significant differences in the incidence of death
(risk ratios [RR] = 0.88, 95% CI, 0.61-1.26; p= 0.47), recurrent MI (RR =
0.92, 95% CI, 0.70-1.22; p=0.58), and repeat revascularization compared
with a deferred intervention. However, a significant reduction in
refractory ischemia was observed in early intervention group (RR =0.47,
95%CI, 0.32-0.68; p < 0.01), and the procedure also showed a tendency
towards decreasing major bleeding events (RR = 0.77, 95% CI, 0.57-1.03; p
= 0.08). According to the stratification based on intervention era, the
extent of revascularization, and the time of revascularization, subgroup
analysis did not show the between-group differences in all-cause
mortality, recurrent MI, and major bleeding events. Also sensitivity
analysis by alternatively using random-effect model did not find any
relevant influence on the overall results in direction and magnitude.
Conclusion: Early coronary revascularization is feasible and safe for the
patients with NSTE-ACS. And the early procedure might markedly reduce the
incidence of refractory ischemia and appeared to have a lower bleeding
risk.

<14>
Accession Number
2011181228
Authors
de Lima A.G. das-Neves-Pereira J.-C. de Campos J.R.M. Jatene F.B.
Institution
(de Lima) Heart Institute (InCor), Medicine School, State University of
Sao Paulo (USP), Sao Paulo, Brazil
(das-Neves-Pereira, de Campos, Jatene) Department of Thoracic Surgery,
Heart Institute (InCor), Medicine School, State University of Sao Paulo
(USP), Sao Paulo, Brazil
(de Lima) Department of Thoracic Surgery and Respiratory Endoscopy, Sumare
State Hospital, State University of Campinas (UNICAMP), Sao Paulo, Brazil
Title
Factors affecting long-term satisfaction after thoracic sympathectomy for
palmar and plantar hyperhidrosis. Is the sudomotor reflex the only
villain?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (4) (pp 554-557),
2011. Date of Publication: April 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
The main objective of this study was to determine if there are variations
in the level of improvement of the palmar and plantar hyperhidrotic
symptoms, as well as the incidence and intensity of the sudomotor reflex,
throughout the seasons of the year, after thoracic sympathectomy for
hyperhidrosis. The study also looks for the real impact of these variables
in the long-term satisfaction. A cohort of 75 patients was followed
through distinct seasons. A multivariate analysis was performed to
identify possible variables responsible for dissatisfaction. Both the
palmar (P=0.002) and plantar (P<0.001) symptoms and the presence and the
intensity of the sudomotor reflex varies significantly throughout the
seasons of the year. The sudomotor reflex was the main factor associated
with low satisfaction in our patients in the summer (P<0.025) and winter
(P<0.001) but in spring the lack of improvement in the hyperhidrosis in
the foot was the unique factor related to dissatisfaction (P<0.001). The
sudomotor reflex is the main negative factor in the summer and in the
winter, independent of its intensity. However, at least in spring, the
lack of removal of the plantar symptoms had a negative impact on
satisfaction. 2011 Published by European Association for Cardio-Thoracic
Surgery. All rights reserved.

<15>
Accession Number
2011181240
Authors
Nasso G. Costantini C. Petralia A. del Prete A. Lopriore V. Fattouch K.
Paterno C. Speziale G.
Institution
(Nasso, Costantini, Petralia, del Prete, Lopriore, Speziale) Division of
Cardiac Surgery, Anthea Hospital, GVM Hospitals of Care and Research,
Bari, Italy
(Fattouch, Paterno) Division of Cardiac Surgery, Villa Maria Cecilia
Hospital, Lugo, Italy
Title
A new extracorporeal vacuum-assisted device to optimize cardiopulmonary
bypass. Comparison with the conventional system.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (4) (pp 591-595),
2011. Date of Publication: April 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Miniaturized cardiopulmonary bypass (CPB) systems, though more
biocompatible, are limited by not being adaptable to all cardiac surgical
operations. We evaluate a versatile CPB system [extracorporeal
vacuum-assisted device optimized (EVADO)] based on the elimination of
roller pumps, separation of extracavitary suctioned blood and
state-of-the-art technology for oxygenator systems and digital control. We
randomized 165 patients to either EVADO or conventional CPB (cCPB).
Surgery could be completed in all cases without conversion to cCPB. The
use of EVADO significantly reduced the intraoperative haemolysis (lesser
increase in free hemoglobin, P<0.001 vs. control, and lesser decrease in
haptoglobin levels, P=0.001 vs. control). Among patients who were
submitted to EVADO, postoperative bleeding (P=0.004), transfusions
(P=0.046), rate of revision for bleeding (P=0.03), rate of postoperative
atrial fibrillation (P=0.007), time to extubation (P=0.02) and ICU stay
(P=0.04) were reduced. The clinical benefits associated with the EVADO may
be due to better end-organ perfusion, lesser impairment of the coagulation
and inflammatory reaction. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<16>
Accession Number
2011181243
Authors
Aal M.A. ElNahal N. Bakir B.M. Fouda M.
Institution
(Aal, ElNahal, Bakir, Fouda) King Fahad Cardiac Center, College of
Medicine, King Saud University, Riyadh, Saudi Arabia
Title
Mini-cardiopulmonary bypass impact on blood conservation strategy in
coronary artery bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (4) (pp 600-604),
2011. Date of Publication: April 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objective: Cardiopulmonary bypass (CPB) using a closed circuit system with
minimal priming volume can be a solution to ameliorate adverse effects of
CPB. We hypothesize that the use of mini-bypass in routine coronary artery
bypass grafting (CABG) reduces homologous blood product use and
postoperative bleeding. The study is designed to determine the differences
in blood loss and transfusion requirements associated with a minimized CPB
circuit vs. a standard bypass circuit. Methods: From February 2009 to
August 2009, 80 patients were prospectively randomized to undergo elective
CABG. Group A included 40 patients who had the minimized bypass circuit
(Medtronic Resting Heart Circuit). Group B had an equal number of patients
who had the standard CPB circuit (Stockert III, SEC.BM). Laboratory
parameters for hemoglobin, hematocrit and platelet count were measured at
baseline after initiation of CPB and after bypass. Blood usage was
controlled by study-specific protocol (transfusion for hemoglobin <8
g/dl). Records were kept for blood products. The chest and mediastinal
drainage was monitored for the first 24 postoperative hours. Ventilation
time, inotropic use and intensive care unit (ICU) stay was compared in
both groups. Results: There were no statistical differences in terms of
patients' demographics. Statistically significant differences were seen in
transfused red blood cells volume (1.47+/-1.13 units in group A vs.
2.05+/-1.19 in group B, P<0.05), fresh frozen plasma (2.5+/-1.62 unit vs.
3.55+/-2.58 units, P<0.001), platelets (1.95+/-2.95 units vs.
3.23+/-2.85), and postoperative drainage in 24 hours (531.62+/-220.12 ml
vs. 729+/-294.9 ml, P<0.05). The hematocrit was 33+/-5% in group A, and
27+/-1% in group B. There was statistical differences seen in the mean
hemoglobin level which was 10.19+/-0.65 g/dl in group A, and 9.4+/-0.68
g/dl in group B. There was statistical difference in the duration of
ventilation, length of ICU stay. The requirement of inotropic support was
lower in group A. Conclusions: The adoption of mini-bypass significantly
reduces morbidity including donor blood usage and postoperative bleeding
in routine CABG patients. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<17>
Accession Number
2011181246
Authors
Arnaoutoglou E. Kouvelos G. Milionis H. Mavridis A. Kolaitis N. Papa N.
Papadopoulos G. Matsagkas M.
Institution
(Arnaoutoglou, Papadopoulos) Department of Anesthesiology, School of
Medicine, University of Ioannina, Ioannina, Greece
(Kouvelos, Papa, Matsagkas) Department of Surgery - Vascular Surgery Unit,
School of Medicine, Ioannina University Campus, S. Niarchos Avenue, 45110
Ioannina, Greece
(Milionis) Department of Internal Medicine, School of Medicine, University
of Ioannina, Ioannina, Greece
(Mavridis) Laboratory of Immunology and Microbiology, School of Medicine,
University of Ioannina, Ioannina, Greece
(Kolaitis) Laboratory of Hematology, Ioannina University Hospital,
Ioannina, Greece
Title
Post-implantation syndrome following endovascular abdominal aortic
aneurysm repair: Preliminary data.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (4) (pp 609-614),
2011. Date of Publication: April 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: Endovascular aneurysm repair (EVAR), may elicit an unexpected
systemic inflammatory response, which has been named post-implantation
syndrome (PIS). The aim of this study was to prospectively evaluate the
association of PIS with clinical and laboratory parameters in patients who
underwent EVAR for abdominal aortic aneurysms (AAA). Methods: Forty
consecutive patients who underwent EVAR for AAA were studied. Complete
blood count, fibrinogen, high sensitivity C-reactive protein (hs-CRP),
interleukin (IL)-6, IL-1, tumor necrosis factor-alpha were determined
before and after surgery. Several parameters regarding the operation, as
well as the hospitalization days were recorded. Results: PIS was diagnosed
in 35% of the patients. Patients with PIS showed significant greater
changes of inflammation marker levels, including hs-CRP and IL-6, as
compared with the non-PIS group. PIS was associated with longer
hospitalization. Conclusion: PIS is a relatively common complication of
EVAR used to treat AAAs and it is associated with features of a systemic
inflammatory response and prolongation of hospitalization. Further studies
are necessary towards understanding the underlying pathophysiology and
evaluating effective preventive strategies. 2011 Published by European
Association for Cardio-Thoracic Surgery. All rights reserved.

<18>
Accession Number
2011198399
Authors
Moreno R. Garcia E. Teles R.C. Almeida M.S. Carvalho H.C. Sabate M.
Martin-Reyes R. Rumoroso J.R. Galeote G. Goicolea F.J. Moreu J. Mainar V.
Mauri J. Ferreira R. Valdes M. Perez De Prado A. Martin-Yuste V.
Jimenez-Valero S. Sanchez-Recalde A. Calvo L. Lopez De Sa E. Macaya C.
Lopez-Sendon J.-L.
Institution
(Moreno, Martin-Reyes, Galeote, Jimenez-Valero, Sanchez-Recalde, Calvo,
Lopez De Sa, Lopez-Sendon) University Hospital la Paz, Madrid 28046, Spain
(Garcia, Macaya) Hospital Clinico San Carlos, Madrid, Spain
(Teles, Almeida) Hospital Sta. Cruz, Lisboa, Portugal
(Carvalho) Hospital Sto. Antonio, Porto, Portugal
(Sabate) Hospital Clinic, Barcelona, Spain
(Rumoroso) Hospital de Galdakao, Bilbao, Spain
(Goicolea) Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
(Moreu) Hospital Virgen de la Salud, Toledo, Spain
(Mainar) Hospital General de Alicante, Spain
(Mauri) Hospital Santa Marta, Lisboa, Portugal
(Ferreira) Hospital Virgen de la Arrixaca, Murcia, Spain
(Valdes) Complejo Hospitalario de Leon, Spain
(Perez De Prado, Martin-Yuste) Hospital Santa Creu I Sant Pau, Barcelona,
Spain
Title
A randomised comparison between everolimus-eluting stent and
sirolimus-eluting stent in chronic coronary total occlusions. Rationale
and design of the CIBELES (non-acute Coronary occlusion treated by
EveroLimus-Eluting Stent) trial.
Source
EuroIntervention. 6 (1) (pp 112-116), 2010. Date of Publication: May
2010.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Chronic total coronary occlusions constitute a sub-group of lesions at
very high risk of restenosis after successful percutaneous coronary
intervention. The sirolimus-eluting coronary stent is the only drugeluting
stent that has demonstrated to reduce angiographic restenosis and the need
for new revascularisation procedures in comparison with bare-metal stents
in randomised clinical trials focusing on these lesions.
Everolimus-eluting stents have shown to offer optimal angiographic and
clinical outcomes in comparison with bare-metal stents and
paclitaxel-eluting stents, but no randomised trials have tested the device
in chronic total occlusions. The CIBELES (non-acute Coronary occlusIon
treated By EveroLimus-Eluting Stent) will randomise 208 patients with
chronic total coronary occlusions in 13 centres from Portugal and Spain to
receive everolimus- or sirolimus-eluting coronary stents. The primary
endpoint will be angiographic in-stent late loss. Europa Edition 2010.
All rights reserved.

<19>
Accession Number
2011204105
Authors
Tamhane U. Meier P. Chetcuti S. Chen K.-Y. Rha S.-W. Grossman M.P. Gurm H.
Institution
(Tamhane, Meier, Chetcuti, Grossman, Gurm) University of Michigan
Cardiovascular Medicine, VA Ann Arbor Health Care System, SPC 5869, 1500
E. Medical Center Drive, Ann Arbor, MI 48109-5869, United States
(Chen) Second Hospital of Tianjin Medical University, Cardiovascular
Center, Tianjin, China
(Rha) Cardiovascular Center, Korea University Guro Hospital, Seoul, South
Korea
Title
Efficacy of Cilostazol in reducing restenosis in patients undergoing
contemporary stent based PCI: A meta-analysis of randomised controlled
trials.
Source
EuroIntervention. 5 (3) (pp 384-393), 2009. Date of Publication: August
2009.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Cilostazol has been associated with reduction in restenosis in
patients undergoing coronary and peripheral arterial angioplasty. Our
objective was to evaluate the impact of cilostazol on restenosis in
patients undergoing contemporary PCI with bare metal (BMS) or drug eluting
stents (DES) and treated with aspirin and thienopyridine. Methods and
results: Ten randomised trials (n=2,809 patients) comparing triple
antiplatelet therapy (aspirin, thienopyridine and cilostazol) with
standard dual antiplatelet therapy were included. Summary risk ratios for
restenosis, late loss, target lesion revascularisation (TLR) and target
vessel revascularisation (TVR) were calculated using fixed-effects models.
Cilostazol was associated with a significant reduction in late loss in BMS
(mean difference 0.24 mm, 95% CI 0.15-0.33, p<0.001) and DES groups (mean
difference 0.12 mm, 95% CI 0.07-0.18, p<0.001). Cilostazol therapy was
associated with a significant reduction in angiographic restenosis (Odds
ratio [OR] 0.52, 95% CI 0.41- 0.66, p<0.001) with consistent benefits in
patients treated with BMS (OR 0.49, 95% CI 0.35-0.70, p<0.001) or DES (OR
0.54, 95% CI 0.38-0.76, p=0.001). Addition of cilostazol to dual
antiplatelet therapy was associated with a significant reduction in TLR
(OR 0.38, 95% CI 0.25-0.58, p<0.001), with no difference in subacute stent
thrombosis (OR 1.91, 95% CI 0.33-11.08, p=0.47), or major bleeding (OR
0.87, 95% CI 0.44-1.74, P=0.69) but with an increased risk of skin rash
(OR 3.67, 95% CI 1.86-7.24, p<0.001). Conclusions: Cilostazol in addition
to dual antiplatelet therapy is associated with a reduction in
angiographic restenosis in patients undergoing stent based PCI. This
inexpensive drug may be particularly beneficial in patients who are at
high risk of restenosis and it should undergo further evaluation in large,
definitive randomised controlled trials. Europa Edition. All rights
reserved.

<20>
Accession Number
2011205409
Authors
Fajadet J. Wijns W. Laarman G.-J. Kuck K.-H. Ormiston J. Baldus S.
Hauptmann K.E. Suttorp M.J. Drzewiecki J. Pieper M. Schultheiss H.-P.
Mauri L.
Institution
(Fajadet) Clinique Pasteur, 45, avenue de Lombez, 31300 Toulouse, France
(Wijns) Cardiovascular Center, Aalst, Belgium
(Laarman) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Kuck) Krankenhaus Sankt Georg, Hamburg, Germany
(Ormiston) Mercy Hospital, Auckland, New Zealand
(Baldus) Universitatsklinikum, Hamburg-Eppendorf, Germany
(Hauptmann) Krankenhaus der Barmherzigen Bruder, Trier, Germany
(Suttorp) St. Antonius Hospital, Nieuwegein, Netherlands
(Drzewiecki) Medical University of Silesia, Katowice, Poland
(Pieper) Herzzentrum Bodensee, Kreuzlingen, Switzerland
(Schultheiss) Universitatsklinikum Benjamin Franklin, Berlin, Germany
(Mauri) Brigham and Women's Hospital, Harvard Clinical Research Institute,
Boston, MA, United States
Title
Long-term follow-up of the randomised controlled trial to evaluate the
safety and efficacy of the zotarolimus-eluting driver coronary stent in de
novo native coronary artery lesions: Five year outcomes in the ENDEAVOR II
study.
Source
EuroIntervention. 6 (5) (pp 562-567), 2010. Date of Publication:
November 2010.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: We report here the final 5-year follow-up results from the ENDEAVOR
II trial, which was the first randomised trial evaluating the Endeavor
zotarolimus-eluting stent (ZES) compared with a bare metal stent (BMS) in
patients with single, de novo coronary artery lesions. Methods and
results: Eligible patients were randomised 1:1 to receive ZES or BMS and
were followed by telephone or clinic visit up to five years. We evaluated
TVF and its components (target vessel revascularisation [TVR], Q-wave or
non Q-wave myocardial infarction, or cardiac death attributed to the
target vessel) at five years. Additionally, we report rates of MACE, TLR,
and stent thrombosis (protocol- and ARC-defined) through five years.
ENDEAVOR II enrolled 1,197 patients (598 ZES, 599 BMS). At five years of
follow-up, the rates of TVF (15.4% vs 24.4%), TVR (10.7% vs 20.1%), MACE
(15.4% vs 24.6%), and TLR (7.5% vs 16.3%) remained significantly lower in
ZES patients compared with BMS patients. ARC definite and probable very
late (>1 year) stent thrombosis remained low (0.2% ZES and 0.3% BMS)
through five years. Conclusions: After five years of follow-up, ZES
demonstrated significantly improved clinical outcomes with sustained
safety compared with BMS in patients with obstructive coronary artery
disease. Europa Edition 2010. All rights reserved.

<21>
Accession Number
2011206214
Authors
Van Gaal W.J. Arnold J.R. Testa L. Karamitsos T. Lim C.C.S. Ponnuthurai
F.A. Petersen S. Francis J.M. Selvanayagam J. Sayeed R. West N. Westaby S.
Neubauer S. Banning A.P.
Institution
(Van Gaal, Testa, Lim, Ponnuthurai, Petersen, Sayeed, West, Westaby,
Banning) Oxford Heart Centre, John Radcliffe Hospital, Oxford, United
Kingdom
(Van Gaal, Ponnuthurai) Department of Cardiology, Northern Hospital, VIC,
Australia
(Van Gaal) University of Melbourne, VIC, Australia
(Arnold, Karamitsos, Francis, Selvanayagam, Neubauer) University of Oxford
Centre for Clinical Magnetic Resonance Research, Department of
Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
(Testa) Department of Interventional Cardiology, S. Ambrogio Clinical
Institute, Milan, Italy
Title
Myocardial Injury following Coronary Artery Surgery versus Angioplasty
(MICASA): A randomised trial using biochemical markers and cardiac
magnetic resonance imaging.
Source
EuroIntervention. 6 (6) (pp 703-710), 2011. Date of Publication: January
2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To compare the frequency and extent of Troponin I and late
gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) defined
injury following PCI compared with CABG in patients with multivessel
and/or left main coronary artery disease (CAD), and interpret these
finding in light of the new ESC/ACCF/AHA/WHF Task Force definitions for
necrosis and infarction. Methods and results: Prospective, registered,
single centre randomised controlled trial. Eighty patients with 3 vessel
CAD (>=50% stenoses), or 2 vessel CAD including a type C lesion in the
LAD, and/or left main disease were enrolled. Mean SYNTAX and EuroSCOREs
were similar for both groups. Forty patients underwent PCI with drug
eluting stents and 39 underwent CABG (one died prior to CABG). In the PCI
group 6/38 (15.8%) patients had LGE, compared with 9/32 (28.1%) CABG
patients (p=0.25). Using the new Task Force definitions, necrosis occurred
in 30/40 (75%) PCI patients and 35/35 (100%) CABG patients (p=0.001),
whilst infarction occurred in 30/40 (75%) PCI patients and 9/32 (28.1%)
CABG patients (p=0.0001). Conclusions: Periprocedural necrosis according
to the Task Force definition was significantly lower in the PCI group, and
universal in the CABG group. The incidence and extent of CMR defined
infarction following PCI did not differ compared with CABG. This
demonstrates that PCI can achieve revascularisation in complex patients
without increased procedural myocardial damage. Europa Edition 2011. All
rights reserved.

<22>
Accession Number
2011206825
Authors
Feldman T. Foster E. Glower D.G. Kar S. Rinaldi M.J. Fail P.S. Smalling
R.W. Siegel R. Rose G.A. Engeron E. Loghin C. Trento A. Skipper E.R. Fudge
T. Letsou G.V. Massaro J.M. Mauri L.
Institution
(Feldman) Evanston Hospital, NorthShore University Health System, Evanston
IL, United States
(Foster) University of California at San Francisco, San Francisco, United
States
(Glower) Duke University Medical Center, Durham, United States
(Rinaldi, Rose, Skipper) Sanger Heart and Vascular Institute, Carolinas
Medical Center, Charlotte, United States
(Kar, Siegel, Trento) Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, United States
(Fail, Engeron, Fudge) Terrebonne General Medical Center, Houma, United
States
(Smalling, Loghin, Letsou) Memorial Hermann Heart and Vascular
Institute/UT Health, Houston, United States
(Massaro) Boston University School of Public Health, Harvard Clinical
Research Institute, Boston, United States
(Mauri) Brigham and Women's Hospital, Harvard Clinical Research Institute,
Harvard Medical School, Boston, United States
(Feldman) Evanston Hospital Cardiology Division-Walgreen Bldg., 3rd Fl.,
2650 Ridge Ave., Evanston, IL 60201, United States
Title
Percutaneous repair or surgery for mitral regurgitation.
Source
New England Journal of Medicine. 364 (15) (pp 1395-1406), 2011. Date of
Publication: 14 Apr 2011.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
Background Mitral-valve repair can be accomplished with an investigational
procedure that involves the percutaneous implantation of a clip that
grasps and approximates the edges of the mitral leaflets at the origin of
the regurgitant jet. Methods We randomly assigned 279 patients with
moderately severe or severe (grade 3+ or 4+) mitral regurgitation in a 2:1
ratio to undergo either percutaneous repair or conventional surgery for
repair or replacement of the mitral valve. The primary composite end point
for efficacy was freedom from death, from surgery for mitral-valve
dysfunction, and from grade 3+ or 4+ mitral regurgitation at 12 months.
The primary safety end point was a composite of major adverse events
within 30 days. Results At 12 months, the rates of the primary end point
for efficacy were 55% in the percutaneous- repair group and 73% in the
surgery group (P = 0.007). The respective rates of the components of the
primary end point were as follows: death, 6% in each group; surgery for
mitral-valve dysfunction, 20% versus 2%; and grade 3+ or 4+ mitral
regurgitation, 21% versus 20%. Major adverse events occurred in 15% of
patients in the percutaneous-repair group and 48% of patients in the
surgery group at 30 days (P<0.001). At 12 months, both groups had improved
left ventricular size, New York Heart Association functional class, and
quality-of-life measures, as compared with baseline. Conclusions Although
percutaneous repair was less effective at reducing mitral regurgitation
than conventional surgery, the procedure was associated with superior
safety and similar improvements in clinical outcomes. (Funded by Abbott
Vascular; EVEREST II ClinicalTrials.gov number, NCT00209274.) 2011
Massachusetts Medical Society.

<23>
[Use Link to view the full text]
Accession Number
2011212369
Authors
Dagenais G.R. Lu J. Faxon D.P. Kent K. Lago R.M. Lezama C. Hueb W. Weiss
M. Slater J. Frye R.L.
Institution
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
2725 Chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
(Lu) University of Pittsburgh, Pittsburgh, PA, United States
(Faxon) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Kent) Washington Hospital Center, Washington, DC, United States
(Lago) Cleveland Clinic, Cleveland, OH, United States
(Lezama) La Raza Medical Center, Mexico City, Mexico
(Hueb) Heart Institute, Medical School University of Sao Paulo, Sao Paulo,
Brazil
(Weiss) New York Medical College, New York, NY, United States
(Slater) New York University-Langone Medical Center, New York, NY, United
States
(Frye) Mayo Clinic, Rochester, MN, United States
Title
Effects of optimal medical treatment with or without coronary
revascularization on angina and subsequent revascularizations in patients
with type 2 diabetes mellitus and stable ischemic heart disease.
Source
Circulation. 123 (14) (pp 1492-1500), 2011. Date of Publication: 12 Apr
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background: In the Bypass Angioplasty Revascularization Investigation 2
Diabetes (BARI 2D) trial, an initial strategy of coronary
revascularization and optimal medical treatment (REV) compared with an
initial optimal medical treatment with the option of subsequent
revascularization (MED) did not reduce all-cause mortality or the
composite of cardiovascular death, myocardial infarction, and stroke in
patients with type 2 diabetes mellitus and stable ischemic heart disease.
In the same population, we tested whether the REV strategy was superior to
the MED strategy in preventing worsening and new angina and subsequent
coronary revascularizations. Methods and Results: Among the 2364 men and
women (mean age, 62.4 years) with type 2 diabetes mellitus, documented
coronary artery disease, and myocardial ischemia, 1191 were randomized to
the MED and 1173 to the REV strategy preselected in the percutaneous
coronary intervention (796) and coronary artery bypass graft (377) strata.
Compared with the MED strategy, the REV strategy at the 3-year follow-up
had a lower rate of worsening angina (8% versus 13%; P<0.001), new angina
(37% versus 51%; P=0.001), and subsequent coronary revascularizations (18%
versus 33%; P<0.001) and a higher rate of angina-free status (66% versus
58%; P=0.003). The coronary artery bypass graft stratum patients were at
higher risk than those in the percutaneous coronary intervention stratum,
and had the greatest benefits from REV. Conclusions: In these patients,
the REV strategy reduced the occurrence of worsening angina, new angina,
and subsequent coronary revascularizations more than the MED strategy. The
symptomatic benefits were observed particularly for high-risk patients.
2011 American Heart Association, Inc.

<24>
Accession Number
2011216289
Authors
Ciccarella Y. Balestra C. Valsamis J. Van Der Linden P.
Title
Increase in endogenous erythropoietin synthesis through the normobaric
oxygen paradox in cardiac surgery patients.
Source
British Journal of Anaesthesia. 106 (5) (pp 752-753), 2011. Date of
Publication: May 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)

<25>
Accession Number
2011181368
Authors
Kim H.K. Hong Y.J. Jeong M.H. Kim W. Kim S.S. Ko J.S. Lee M.G. Sim D.S.
Park K.H. Yoon N.S. Yoon H.J. Kim K.H. Park H.W. Kim J.H. Ahn Y. Cho J.G.
Park J.C. Kang J.C.
Institution
(Kim, Hong, Jeong, Kim, Ko, Lee, Sim, Park, Yoon, Yoon, Kim, Park, Kim,
Ahn, Cho, Park, Kang) Department of Internal Medicine, The Heart Center of
Chonnam National University Hospital, Gwangju, South Korea
(Kim) Cardiovascular Division, Department of Internal Medicine, Kyung Hee
University Medical Hospital, Seoul, South Korea
Title
Two-Year Clinical Outcome after Carvedilol-Loaded Stent Implantation in
Patients with Coronary Artery Disease.
Source
Korean Journal of Internal Medicine. 26 (1) (pp 42-46), 2011. Date of
Publication: March 2011.
Publisher
Korean Association of Internal Medicine (Korean Medical Association
Building, Seoul 140-031, South Korea)
Abstract
Background/Aims: Carvedilol is an antioxidant that inhibits smooth muscle
cell proliferation and migration. The aim of this study was to investigate
the beneficial effects of carvedilol-loaded stents on 2-year clinical
outcomes after stent implantation in patients with coronary artery
disease. Methods: We performed a prospective trial with male subjects to
compare the safety and effects of carvedilolloaded BiodivYsio stents
implanted into 20 patients with those of bare-metal BiodivYsio stents
implanted into 21 patients for de novo coronary lesions. The primary end
point was the degree of neointimal hyperplasia, which was measured by
intravascular ultrasound (IVUS) 6 months after the procedure; the
secondary end point was major adverse cardiac events (MACE) at 2 years
after implantation. All carvedilol and control stents were deployed
successfully. Results: A 2-year follow-up was completed for 19 patients
(95%) in the carvedilol stent group and 20 patients (95%) in the control
stent group. IVUS showed a trend toward a larger luminal area (6.86 +/-
2.59 vs. 5.47 +/- 1.52 mm², p = 0.267), smaller neointimal area
(1.34 +/- 0.70 vs. 2.40 +/- 1.73 mm², p = 0.18), and reduced
net decrease in luminal area (-0.78 +/- 0.97 vs. -1.89 +/- 1.78
mm², p = 0.106) in the carvedilol stent group compared with the
control stent group, respectively. There were no significant differences
in the incidence of MACE (10.5 vs. 30.0%, respectively, p = 0.132) between
the groups at 2 years after stent implantation. Stent thrombosis did not
occur in either group after 2 years. Conclusions: The carvedilol-loaded
stents tended to inhibit neointimal hyperplasia without the occurrence of
cardiac death, myocardial infarction, or stent thrombosis at 2-year
follow-up.

<26>
Accession Number
2011198398
Authors
Hermanides R.S. Ottervanger J.-P. Dambrink J.-H.E. De Boer M.-J. Hoorntje
J.C.A. Gosselink A.T.M. Suryapranata H. Van 't Hof A.W.J.
Institution
(Hermanides, Ottervanger, Dambrink, De Boer, Hoorntje, Gosselink,
Suryapranata, Van 't Hof) Isala Klinieken, Location Weezenlanden,
Department of Cardiology, Zwolle, Netherlands
Title
Incidence, predictors and prognostic importance of bleeding after primary
PCI for ST-elevation myocardial infarction.
Source
EuroIntervention. 6 (1) (pp 106-111), 2010. Date of Publication: May
2010.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To investigate incidence, predictors and prognosis of bleeding in ST
elevation myocardial infarction (STEMI) patients who underwent primary
percutaneous coronary intervention (PCI). Methods and results: A large
scale, prospective, observational study was performed between 1991 and
2004 in a single teaching hospital in The Netherlands including all
consecutive STEMI patients who underwent primary PCI. The independent
association between both major and minor bleeding and oneyear mortality
was evaluated using Cox proportional hazard models. A total of 5,030
patients were included, of whom 109 patients (2%) had cardiac surgery
within 48 hours. Data on bleeding <48 hours were available in 4,717
patients (96%). Of these, 80 (1.6%) had major bleeding, whereas minor
bleeding was observed in 266 patients (5.6%). Independent predictors of
minor bleeding were advanced age, multivessel disease, Killip class >=2 on
admission, anterior MI location and TIMI 0 flow before PCI. Killip class
>=2 on admission was an independent predictor of major bleeding. Major
bleeding (HR 3.5 [95% CI 2.3-5.4]) was associated with an increased risk
of death at one year. Conclusions: After primary PCI, the incidence of
major bleeding is less than 2%. Although relatively infrequent, major
bleeding complications are strongly and independently related to short-
and midterm mortality. Europa Edition 2010. All rights reserved.

<27>
Accession Number
2011198404
Authors
Sanchez-Recalde A. Valero S.J. Moreno R. Barreales L. Lozano I. Galeote G.
Reyes R.M. Calvo L. Lopez-Sendon J.L.
Institution
(Sanchez-Recalde, Valero, Moreno, Galeote, Reyes, Calvo, Lopez-Sendon)
Interventional Cardiology Unit, University Hospital la Paz, Paseo de la
Castellana, 261, 28046 Madrid, Spain
(Barreales) Division of Clinical Epidemiology, Department of Preventive
Medicine, Hospital Universitario Clinico San Carlos, Madrid, Spain
(Lozano) Interventional Cardiology Unit, Hospital Universitario Central de
Asturias, Spain
Title
Safety and efficacy of drug-eluting stents versus bare-metal stents in
saphenous vein grafts lesions: A meta-analysis.
Source
EuroIntervention. 6 (1) (pp 149-160), 2010. Date of Publication: May
2010.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Controversy exists about the safety and efficacy of drug-eluting
stents (DES) in saphenous vein bypass grafts (SVGs). The aim of this study
was to perform a meta-analysis of all published studies comparing DES and
bare-metal stents (BMS) in patients with SVGs disease. Methods and
results: We included 22 studies comparing DES versus BMS in 5,543 patients
with SVGs disease. The primary efficacy endpoint was target vessel
revascularisation (TVR). The primary safety endpoint was mortality. Other
outcomes of interest were cardiac mortality, myocardial infarction, target
lesion revascularisation (TLR), stent thrombosis and a combined of major
adverse cardiac events (MACE). DES significantly reduced the risk of TVR,
OR=0.56 (95% CI, 0.41-0.76, p=0.0003) and TLR, OR=0.58 (95% CI, 0.41-0.81;
p=0.001). Total mortality and cardiac mortality were significantly lower
in DES versus BMS, OR=0.69 (95% CI, 0.49-0.98, p=0.04) and OR=0.71 (95%
CI, 0.51-0.99; p=0.04), respectively. The overall risk of stent
thrombosis, and myocardial infarction were not significantly different for
patients receiving DES vs. BMS. Total MACE were significantly lower in
patients receiving DES, OR=0.55 (95% CI, 0.42-0.71; p<0.00001).
Conclusions: This meta-analysis suggests that the use of DES in patients
with SVG lesions is associated with a reduction of the need of
reintervention and mortality compared with BMS. Europa Edition 2010. All
rights reserved.

<28>
Accession Number
2011206645
Authors
Bangalore S. Kumar S. Poddar K.L. Ramasamy S. Rha S.-W. Faxon D.P.
Institution
(Bangalore) Department of Medicine, Division of Cardiology, New York
University School of Medicine, New York, NY, United States
(Kumar) University of Nebraska Medical Center, Omaha, NE, United States
(Poddar, Ramasamy, Rha) Korea University Guro Hospital, Guro-Gu, Seoul,
South Korea
(Faxon) Brigham and Women's Hospital, Boston, MA, United States
Title
Meta-analysis of multivessel coronary artery revascularization versus
culprit-only revascularization in patients with ST-segment elevation
myocardial infarction and multivessel disease.
Source
American Journal of Cardiology. 107 (9) (pp 1300-1310), 2011. Date of
Publication: 01 May 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
American College of Cardiology/American Heart Association guidelines for
management of patients with ST-segment elevation myocardial infarction
(STEMI) recommend culprit artery-only revascularization (CULPRIT) based on
safety concerns during noninfarct-related artery intervention. However,
the data to support this safety concern are scant. Searches were performed
in PubMed/EMBASE/CENTRAL for studies evaluating multivessel
revascularization versus CULPRIT in patients with STEMI and multivessel
disease (MVD). A multivessel revascularization strategy had to be
performed at the time of CULPRIT or during the same hospitalization. Early
(<=30-day) and long-term outcomes were evaluated. Among 19 studies (23
arms) that evaluated 61,764 subjects with STEMI and MVD, multivessel
revascularization was performed in a minority of patients (16%). For early
outcomes, there was no significant difference for outcomes of mortality,
MI, stroke, and target vessel revascularization, with a 44% decrease in
risk of repeat percutaneous coronary intervention and major adverse
cardiovascular events (odds ratio 0.68, 95% confidence interval 0.57 to
0.81) with multivessel revascularization compared to CULPRIT. Similarly,
for long-term outcomes (follow-up 2.0 +/- 1.1 years), there was no
difference for outcomes of MI, target vessel revascularization, and stent
thrombosis, with 33%, 43%, and 53% decreases in risk of mortality, repeat
percutaneous coronary intervention, coronary artery bypass grafting,
respectively, and major adverse cardiovascular events (odds ratio 0.60,
95% confidence interval 0.50 to 0.72) with multivessel revascularization
compared to CULPRIT. In conclusion, in patients with STEMI and MVD,
multivessel revascularization appears to be safe compared to culprit
artery-only revascularization. These findings support the need for a
large-scale randomized trial to evaluate revascularization strategies in
patients with STEMI and MVD. 2011 Elsevier Inc.

<29>
Accession Number
2011206666
Authors
Yan T.D. Padang R. Poh C. Cao C. Wilson M.K. Bannon P.G. Vallely M.P.
Institution
(Yan, Poh, Cao, Wilson, Bannon, Vallely) Baird Institute for Applied Heart
and Lung Surgical Research, Newtown, Australia
(Yan, Cao, Wilson, Bannon, Vallely) Department of Cardiothoracic Surgery,
University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia
(Padang) Department of Cardiology, University of Sydney, Royal Prince
Alfred Hospital, Sydney, Australia
Title
Drug-eluting stents versus coronary artery bypass grafting for the
treatment of coronary artery disease: A meta-analysis of randomized and
nonrandomized studies.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (5) (pp 1134-1144),
2011. Date of Publication: May 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: We performed the present systematic review and meta-analysis
of randomized and nonrandomized comparative studies in an attempt to
compare the safety and efficacy of drug-eluting stents with coronary
artery bypass grafting for patients with coronary artery disease. Methods:
Twenty-five eligible comparative studies (1 randomized and 24
nonrandomized) were assessed. Two reviewers independently appraised each
study. Meta-analysis was performed by combining the results of reported
incidence of morbidity, mortality, and repeat revascularization. The
relative risk was used as a summary statistic. Results: In these 25
studies 34,278 patients were compared, of whom 18,538 received
drug-eluting stents and 15,740 underwent coronary artery bypass grafting.
It must be acknowledged that this comparison represented a selected group
of patients who received drug-eluting stents or underwent coronary artery
bypass grafting. The accumulative incidences of all-cause mortality at 12
months (4.5% vs 4.0%, P = .92) and 24 months (6.2% vs 8.4%, P = .27) and
30-day myocardial infarction (1.4% vs 2.0%, P = .60) were similar,
respectively, between the drug-eluting stent and coronary artery bypass
grafting groups. Drug-eluting stents were associated with lower rates of
all-cause mortality at 30 days (0.9% vs 2.3%, P < .001), stroke (0.4% vs
1.7%, P < .001), and 30-day major adverse cardiac and cerebrovascular
events (3.6% vs 5.5%, P < .04). However, the coronary artery bypass
grafting group had a lower incidence of postprocedural myocardial
infarction (5.5% vs 4.7%, P = .03), repeat revascularization (22.2% vs
4.1%, P < .001), and 12-month major adverse cardiac and cerebrovascular
events (16.7% vs 10.5%, P < .001). Subgroup analysis of patients with
multivessel coronary artery disease showed similar results. Conclusions:
Drug-eluting stents are associated with less periprocedural risks but a
higher incidence of postprocedural myocardial infarction, repeat
revascularization, and 12-month major adverse cardiac and cerebrovascular
events compared with coronary artery bypass grafting. Copyright 2011 by
The American Association for Thoracic Surgery.

<30>
Accession Number
2011206670
Authors
Al-Rashidi F. Landenhed M. Blomquist S. Hoglund P. Karlsson P.-A. Pierre
L. Koul B.
Institution
(Al-Rashidi, Landenhed, Karlsson, Pierre, Koul) Department of
Cardiothoracic Surgery, Skane University Hospital in Lund, University of
Lund, A Block, 221 85 Lund, Sweden
(Blomquist) Department of Cardiothoracic Anesthesia and Intensive Care,
Skane University Hospital in Lund, University of Lund, Sweden
(Hoglund) Clinical Research and Competence Center, Skane University
Hospital in Lund, University of Lund, Sweden
Title
Comparison of the effectiveness and safety of a new de-airing technique
with a standardized carbon dioxide insufflation technique in open left
heart surgery: A randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (5) (pp 1128-1133),
2011. Date of Publication: May 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: We have compared the effectiveness, time required for
de-airing, and safety of a newly developed de-airing technique for open
left heart surgery (Lund technique) with a standardized carbon dioxide
insufflation technique. Methods: Twenty patients undergoing elective open
aortic valve surgery were randomized prospectively to the Lund technique
(Lund group, n = 10) or the carbon dioxide insufflation technique (carbon
dioxide group, n = 10). Both groups were monitored intraoperatively during
de-airing and for 10 minutes after weaning from cardiopulmonary bypass by
transesophageal echocardiography and online transcranial Doppler for the
severity and the number of gas emboli, respectively. The systemic arterial
partial pressure of carbon dioxide and pH were also monitored in both
groups before, during, and after cardiopulmonary bypass. Results: The
severity of gas emboli observed on transesophageal echocardiography and
the number of microembolic signals recorded by transcranial Doppler were
significantly lower in the Lund group during the de-airing procedure (P =
.00634) and in the first 10 minutes after weaning from cardiopulmonary
bypass (P = .000377). Furthermore, the de-airing time was significantly
shorter in the Lund group (9 vs 15 minutes, P = .001). The arterial pH
during the cooling phase of cardiopulmonary bypass was significantly lower
in the carbon dioxide group (P = .00351), corresponding to significantly
higher arterial partial pressure of carbon dioxide (P = .005196) despite
significantly higher gas flows (P = .0398) in the oxygenator throughout
the entire period of cardiopulmonary bypass. Conclusions: The Lund
de-airing technique is safer, simpler, and more effective compared with
the carbon dioxide insufflation technique. The technique is also more
cost-effective because the de-airing time is shorter and no extra expenses
are incurred. Copyright 2011 by The American Association for Thoracic
Surgery.

<31>
Accession Number
2011206683
Authors
Weber C.F. Jambor C. Strasser C. Moritz A. Papadopoulos N. Zacharowski K.
Meininger D.
Institution
(Weber, Strasser, Zacharowski, Meininger) Clinic for Anesthesiology,
Intensive Care Medicine and Pain Therapy, J.-W. Goethe University Hospital
Frankfurt, Theodor Stern Kai, 760590 Frankfurt, Germany
(Jambor) Clinic for Anesthesiology, University of Munich, Munich, Germany
(Moritz, Papadopoulos) Department of Thoracic and Cardiovascular Surgery,
J.-W. Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
Title
Normovolemic modified ultrafiltration is associated with better preserved
platelet function and less postoperative blood loss in patients undergoing
complex cardiac surgery: A randomized and controlled study.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (5) (pp 1298-1304),
2011. Date of Publication: May 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The purpose of the investigation was to study the impact of
normovolemic modified ultrafiltration (N-MUF) on hemostasis and
perioperative blood loss. Methods: Fifty patients scheduled for elective
complex cardiac surgery were enrolled in this prospective, randomized, and
controlled study. Patients were randomized into a control group (n = 25)
or an N-MUF group (n = 25). N-MUF was performed using a BC140plus Filter
(Maquet Cardiopulmonary AG, Hirrlingen, Germany) in the N-MUF group. Blood
samples were taken before (T1) and 30 minutes after (T2) N-MUF in the
N-MUF group and at corresponding time points in the control group.
Platelet function analyses (TRAPtest, ASPItest, ADPtest) using multiple
electrode aggregometry (Multiplate, Dynabyte, Munich, Germany),
thrombelastometry (ROTEM, Pentapharm GmbH, Munich, Germany), and
conventional laboratory coagulation analyses were performed at each time
point. Intraoperative and postoperative transfusion requirements,
hemostatic therapy, and blood loss were recorded. Results: There were no
significant group differences in demographic or surgical data. At T1,
platelet aggregation revealed no significant group differences in the
TRAPtest, ASPItest, or ADPtest. Platelet aggregation at T2 was
significantly higher in the N-MUF group compared with the control group in
the TRAPtest (65 [50/87] U vs 44 [28/51]; P < .001), the ASPItest (52
[36/69] U vs 22 [8/47] U; P = .001), or the ADPtest (39 [28/51] U vs 28
[19/39] U; P = .009). The postoperative chest tube blood loss was
significantly lower in the N-MUF at 24 hours (890 [500/1100] mL vs 1075
[800/1413] mL in the N-MUF group vs the control group; P = .039) and 48
hours (900 [550/1350] mL vs 1400 [900/1750] mL; P = .026) postoperatively.
Conventional laboratory coagulation analyses and thrombelastometric
parameters did not differ within the groups at T1 or T2. Conclusions:
N-MUF improved general platelet aggregation and reduced postoperative
blood loss in a significant manner. However, performing N-MUF did not
result in less postoperative transfusion requirements. Copyright 2011 by
The American Association for Thoracic Surgery.

<32>
Accession Number
2011206687
Authors
Kaw R. Hernandez A.V. Masood I. Gillinov A.M. Saliba W. Blackstone E.H.
Institution
(Kaw, Masood) Medicine Institute, Department of Hospital Medicine,
Cleveland Clinic, Cleveland, OH, United States
(Kaw) Department of Outcomes Research, Lerner Research Institute,
Cleveland Clinic, Cleveland, OH, United States
(Hernandez, Blackstone) Department of Quantitative Health Sciences, Heart
and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(Gillinov, Blackstone) Department of Thoracic and Cardiovascular Surgery,
Cleveland Clinic, Cleveland, OH, United States
(Saliba) Electrophysiology Laboratory, Cleveland Clinic, Cleveland, OH,
United States
(Kaw) Department of Hospital Medicine and Outcomes Research, Anesthesia.
Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH
44195, United States
Title
Short- and long-term mortality associated with new-onset atrial
fibrillation after coronary artery bypass grafting: A systematic review
and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (5) (pp 1305-1312),
2011. Date of Publication: May 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Our objectives were to evaluate short- and long-term mortality
associated with new-onset atrial fibrillation after coronary artery bypass
grafting and to identify preoperative and intraoperative patient
characteristics associated with new-onset atrial fibrillation. Methods:
Three independent investigators comprehensively reviewed the literature
using Medline from 1960, Web of Science from 1980, and Scopus from 1960.
All searches were done through December 2009. Selected cohort studies were
used to evaluate associations between new-onset atrial fibrillation after
coronary artery bypass grafting or coronary bypass plus valve and
short-term mortality (defined as 30-day or in-hospital mortality) and
long-term mortality (defined as mortality >= 6 months). We excluded
studies involving atrial flutter, off-pump coronary bypass, and isolated
valve surgery. Heterogeneity among studies was accounted for by
meta-analysis with random-effects models. Results: Eleven studies (n =
40,112) met our inclusion criteria. New-onset atrial fibrillation was
associated with higher short-term mortality (3.6% vs 1.9%; odds ratio
[OR], 2.29; 95% confidence interval [CI], 1.74-3.01; P < .00001;
heterogeneity of effects, P = .002). Mortality risks at 1 year and 4 years
were 2.56 (95% CI, 2.14-3.08) and 2.19 (95% CI, 1.97-2.45; P < .0001),
respectively. Older age, lower ejection fraction, history of hypertension,
heart failure, prior stroke, peripheral arterial disease, and longer
cardiopulmonary bypass and aortic clamp times were associated with
new-onset atrial fibrillation. Preoperative use of s-blockers reduced
occurrence of new-onset atrial fibrillation (OR, 0.94 [95% CI, 0.88-1.01;
P = .08]), whereas angiotensin-converting enzyme inhibitors increased it
(OR, 1.20 [95% CI, 1.11-1.29], P < .00001). Conclusions: New-onset atrial
fibrillation after coronary artery bypass grafting appears to increase
short- and long-term mortality. Preoperative use of s-blockers, avoidance
of angiotensin-converting enzyme inhibitors, and shorter cardiopulmonary
bypass and aortic clamp times potentially reduce occurrence of new-onset
atrial fibrillation. Copyright 2011 by The American Association for
Thoracic Surgery.

<33>
Accession Number
2011207256
Authors
Santarpino G. Rubino A.S. Onorati F. Curcio A. Torella D. Tucci L. Indolfi
C. Renzulli A.
Institution
(Santarpino, Rubino, Onorati, Renzulli) Cardiac Surgery Unit, Magna
Graecia University of Catanzaro, Viale Europa, Localita Germaneto, 88100
Catanzaro, Italy
(Curcio, Torella, Indolfi) Cardiology Unit, Magna Graecia University,
Catanzaro, Italy
(Tucci) Pathology Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
Title
Atrial fibrillation ablation induces reverse remodelling and impacts
cardiac function.
Source
Minerva Cardioangiologica. 59 (1) (pp 17-29), 2011. Date of Publication:
February 2011.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. Atrio-ventricular anatomo-functional response to successful surgical
atrial fibrillation (AF) ablation has been poorly investigated.
Determinants of AF recurrence following surgical ablation are still
debated. Methods. Sixty-nine patients underwent AF ablation during major
cardiac surgery. Main outcomes were clinical and echocardiographic results
after monopolar and/or bipolar ablation were recorded. Secondary outcomes
were freedom from AF, rehospitalization and congestive heart failure (CHF)
at follow-up. Predictors of AF-recurrence were evaluated. Results.
Fifty-three patients (76.8%) were in sinus rhythm (SR) at 31.4+/-10.6
months of mean follow-up. Overall freedom from AF-recurrence was
61.4+/-6.6%, from hospital readmission 89.9+/-3.6%, from CHF 91.9+/-5.05%.
Compared to AF-patients, SR-patients demonstrated better freedom from
re-hospitalization (98.1+/-1.9% vs. 62.5+/-12.1%; P=0.0001) and CHF
(94.7+/-5.1% vs. 77.8+/-13.9%; P=0.006). At follow-up SR-patients
demonstrated atrial (preoperative 5.9+/-1.2 cm vs. follow-up 5.2+/-1.0;
P=0.01) and ventricular reverse remodelling (preoperative LVDd 5.8+/-1.6cm
vs. follow-up 5.0+1.3 cm; P=0.002 - preoperative LVDs 4.2+/-1.8 cm vs.
follow-up 3.8+1.2 cm; P=0.045). E/A ratio was normal in 90.6% of
SR-patients (69.6% of the total population of the study). TDI at the level
of the left lateral annulus showed an improved left ventricular systole
(Sm), and diastole (Em, E/ Em) for SR-patients compared to AF-patients (Sm
9.30+/-1.66 vs. 7.81+/-1.41, P=0.001; Em: 10.55+/-1.87 vs. 7.44+/-0.40,
P=0.001; E/Em: 0.06+/-0.02 vs. 0.11+/-0.05, P=0.0001). Preoperative atrial
diameter (OR=23.9; P=0.002) and tricuspid insufficiency at follow-up
(OR=3.5; P=0.008) were independent predictors of AF-recurrence. Neither
etiology, nor duration of AF, nor even ablation technique influenced SR
recovery (P=NS for all measurement). Conclusion. Radiofrequency AF
ablation achieves 76.8% of SR recovery at follow-up. Maintenance of SR
improves clinical, haemodynamic and echocardiographic results.