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<1>
Accession Number
21558517
Authors
Najjar S.S. Rao S.V. Melloni C. Raman S.V. Povsic T.J. Melton L. Barsness
G.W. Prather K. Heitner J.F. Kilaru R. Gruberg L. Hasselblad V. Greenbaum
A.B. Patel M. Kim R.J. Talan M. Ferrucci L. Longo D.L. Lakatta E.G.
Harrington R.A. REVEAL Investigators
Institution
(Najjar) Intramural Research Program, National Institute on Aging,
National Institutes of Health, Baltimore, Maryland, USA.
Title
Intravenous erythropoietin in patients with ST-segment elevation
myocardial infarction: REVEAL: a randomized controlled trial.
Source
JAMA : the journal of the American Medical Association. 305 (18) (pp
1863-1872), 2011. Date of Publication: 11 May 2011.
Abstract
Acute ST-segment elevation myocardial infarction (STEMI) is a leading
cause of morbidity and mortality. In experimental models of MI,
erythropoietin reduces infarct size and improves left ventricular (LV)
function. To evaluate the safety and efficacy of a single intravenous
bolus of epoetin alfa in patients with STEMI. A prospective, randomized,
double-blind, placebo-controlled trial with a dose-escalation safety phase
and a single dose (60,000 U of epoetin alfa) efficacy phase; the Reduction
of Infarct Expansion and Ventricular Remodeling With Erythropoietin After
Large Myocardial Infarction (REVEAL) trial was conducted at 28 US sites
between October 2006 and February 2010, and included 222 patients with
STEMI who underwent successful percutaneous coronary intervention (PCI) as
a primary or rescue reperfusion strategy. Participants were randomly
assigned to treatment with intravenous epoetin alfa or matching saline
placebo administered within 4 hours of reperfusion. Infarct size,
expressed as percentage of LV mass, assessed by cardiac magnetic resonance
(CMR) imaging performed 2 to 6 days after study medication administration
(first CMR) and again 12 +/- 2 weeks later (second CMR). In the efficacy
cohort, the infarct size did not differ between groups on either the first
CMR scan (n = 136; 15.8% LV mass [95% confidence interval {CI}, 13.3-18.2%
LV mass] for the epoetin alfa group vs 15.0% LV mass [95% CI, 12.6-17.3%
LV mass] for the placebo group; P = .67) or on the second CMR scan (n =
124; 10.6% LV mass [95% CI, 8.4-12.8% LV mass] vs 10.4% LV mass [95% CI,
8.5-12.3% LV mass], respectively; P = .89). In a prespecified analysis of
patients aged 70 years or older (n = 21), the mean infarct size within the
first week (first CMR) was larger in the epoetin alfa group (19.9% LV
mass; 95% CI, 14.0-25.7% LV mass) than in the placebo group (11.7% LV
mass; 95% CI, 7.2-16.1% LV mass) (P = .03). In the safety cohort, of the
125 patients who received epoetin alfa, the composite outcome of death,
MI, stroke, or stent thrombosis occurred in 5 (4.0%; 95% CI, 1.31%-9.09%)
but in none of the 97 who received placebo (P = .04). In patients with
STEMI who had successful reperfusion with primary or rescue PCI, a single
intravenous bolus of epoetin alfa within 4 hours of PCI did not reduce
infarct size and was associated with higher rates of adverse
cardiovascular events. Subgroup analyses raised concerns about an increase
in infarct size among older patients. clinicaltrials.gov Identifier:
NCT00378352.

<2>
Accession Number
2011249174
Authors
Stehouwer M.C. Boers C. de Vroege R. Kelder J.C. Yilmaz A. Bruins P.
Institution
(Stehouwer, Boers) Department of Extracorporeal Circulation, St Antonius
Hospital, Nieuwegein, Netherlands
(de Vroege) Department of Extracorporeal Circulation, HAGA Hospital, The
Hague, Netherlands
(Kelder) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Yilmaz) Department of Cardiothoracic Surgery, St Antonius Hospital,
Nieuwegein, Netherlands
(Bruins) Department of Anesthesiology, Intensive Care and Pain Management,
St Antonius Hospital, Nieuwegein, Netherlands
Title
Clinical evaluation of the air removal characteristics of an oxygenator
with integrated arterial filter in a minimized extracorporeal circuit.
Source
International Journal of Artificial Organs. 34 (4) (pp 374-382), 2011.
Date of Publication: April 2011.
Publisher
Wichtig Editore s.r.l. (Via Friuli 72/74, Milan 20135, Italy)
Abstract
The use of minimized extracorporeal circuits (MECC) in cardiac surgery is
an important measure to increase the biocompatibility of cardiopulmonary
bypass during coronary artery bypass grafting (CABG). These circuits
eliminate volume storage reservoirs and bubble traps to minimize the
circuit. However, the reduction in volume may increase the risk of gaseous
microemboli (GME). The MECC system as used by our group consists of a
venous bubble trap, centrifugal pump, and an oxygenator. To further reduce
the risk of introducing GME, an oxygenator with an integrated arterial
filter was developed based on the concept of minimal volume and foreign
surface. We studied the air removal characteristics of this oxygenator
with and without integrated arterial filter. The quantity and volume of
GME were measured with precision at both the inlet and outlet of the
devices. Our results showed that integration of an arterial filter into
this oxygenator increased GME reducing capacity from 69.2% to 92%.
Moreover, we were able to obtain data on the impact of an arterial filter
on the exact size-distribution of GME entering the arterial line. The
present study demonstrates that an MECC system and oxygenator with
integrated arterial filter significantly reduces the volume and size of
GME. The use of an integrated arterial filter in an MECC system may
protect the patient from the deleterious effects of CPB and may further
improve patient safety. 2011 Wichtig Editore.

<3>
Accession Number
2011238783
Authors
Bonow R.O. Maurer G. Lee K.L. Holly T.A. Binkley P.F. Desvigne-Nickens P.
Drozdz J. Farsky P.S. Feldman A.M. Doenst T. Michler R.E. Berman D.S.
Nicolau J.C. Pellikka P.A. Wrobel K. Alotti N. Asch F.M. Favaloro L.E. She
L. Velazquez E.J. Jones R.H. Panza J.A.
Institution
(Bonow, Holly) Center for Cardiovascular Innovation, Northwestern
University, Feinberg School of Medicine, 645 N. Michigan Ave., Chicago, IL
60611, United States
(Maurer) Medical University of Vienna, Vienna, Austria
(Lee, She, Velazquez, Jones) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Binkley) Ohio State University Medical Center, Columbus, United States
(Desvigne-Nickens) National Heart, Lung and Blood Institute, Bethesda,
United States
(Drozdz) Medical University of Lodz, Lodz, Poland
(Wrobel) John Paul II Hospital, Krakow, Poland
(Farsky) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Nicolau) Instituto Do Coracao-Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Feldman) Jefferson Medical College, Philadelphia, United States
(Doenst) Heart Center, University of Leipzig, Leipzig, Germany
(Michler) Montefiore Medical Center, Albert Einstein College of Medicine,
New York, United States
(Berman) Cedars-Sinai Medical Center, Los Angeles, United States
(Pellikka) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Alotti) Zala County Hospital, Zalaegerszeg, Hungary
(Asch, Panza) Washington Hospital Center, Washington, DC, United States
(Favaloro) University Hospital Favaloro Foundation, Buenos Aires,
Argentina
Title
Myocardial viability and survival in ischemic left ventricular
dysfunction.
Source
New England Journal of Medicine. 364 (17) (pp 1617-1625), 2011. Date of
Publication: 28 Apr 2011.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
Background: The assessment of myocardial viability has been used to
identify patients with coronary artery disease and left ventricular
dysfunction in whom coronary-artery bypass grafting (CABG) will provide a
survival benefit. However, the efficacy of this approach is uncertain.
methods: In a substudy of patients with coronary artery disease and left
ventricular dysfunction who were enrolled in a randomized trial of medical
therapy with or without CABG, we used single-photon-emission computed
tomography (SPECT), dobutamine echocardiography, or both to assess
myocardial viability on the basis of prespecified thresholds. results:
Among the 1212 patients enrolled in the randomized trial, 601 underwent
assessment of myocardial viability. Of these patients, we randomly
assigned 298 to receive medical therapy plus CABG and 303 to receive
medical therapy alone. A total of 178 of 487 patients with viable
myocardium (37%) and 58 of 114 patients without viable myocardium (51%)
died (hazard ratio for death among patients with viable myocardium, 0.64;
95% confidence interval [CI], 0.48 to 0.86; P = 0.003). However, after
adjustment for other baseline variables, this association with mortality
was not significant (P=0.21). There was no significant interaction between
viability status and treatment assignment with respect to mortality (P =
0.53). conclusions: The presence of viable myocardium was associated with
a greater likelihood of survival in patients with coronary artery disease
and left ventricular dysfunction, but this relationship was not
significant after adjustment for other baseline variables. The assessment
of myocardial viability did not identify patients with a differential
survival benefit from CABG, as compared with medical therapy alone.
Copyright 2011 Massachusetts Medical Society. All rights reserved.

<4>
Accession Number
2011237413
Authors
Abdel-Salam Z. Nammas W.
Institution
(Abdel-Salam, Nammas) Cardiology Department, Faculty of Medicine, Ain
Shams University, Cairo, Egypt
Title
Predictors of viability in patients with negative low-dose dobutamine
stress echocardiography.
Source
Arquivos Brasileiros de Cardiologia. 96 (3) (pp 188-194), 2011. Date of
Publication: Mar. 2011.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Background: Low-dose dobutamine stress echocardiography is specific for
predicting reversible contractility dysfunction, but its sensitivity is
lower than ideal. Objective: We sought to explore the predictors of
myocardial contractile recovery following revascularization, in patients
with no viability by low-dose dobutamine stress echocardiography. Methods:
We prospectively enrolled 30 consecutive patients with significant
coronary stenosis/occlusion amenable for revascularization, regional wall
motion abnormality in the distribution of the affected artery and absence
of viability by low-dose dobutamine stress echocardiography. They
underwent resting ^99mTc-sestamibi imaging study, and then
underwent successful coronary revascularization. Follow-up
echocardiography was performed 3 months later. Patients were classified
into 2 groups: group 1: with evidence of myocardial contractile recovery
after revascularization at follow up echocardiography and group 2: with no
such evidence of recovery. The two groups were compared with respect to
patients' clinical, echocardiographic and scintigraphic data. Results: The
mean age was 52.3 +/- 5.9 years, with 97% being males. The percentage of
total ^99mTc-sestamibi uptake was significantly higher in group
1 as compared to group 2 (p < 0.01), and it was the strongest independent
predictor of myocardial contractile recovery at 3-month follow-up by
multivariate regression analysis. Receiver operating characteristics curve
revealed that a cutoff value of the percentage of total
^99mTc-sestamibi uptake of 72% best predicted myocardial
contractile recovery, with a sensitivity of 100% and specificity of 95.7%.
Conclusion: In patients with no viability by low-dose dobutamine stress
echocardiography, the percentage of total 99mTcsestamibi uptake
independently predicted myocardial contractile recovery following coronary
revascularization.

<5>
Accession Number
2011248802
Authors
Vamvakas E.C.
Institution
(Vamvakas) Department of Pathology, Laboratory Medicine, Cedars-Sinai
Medical Center, Los Angeles, CA, United States
Title
Purported deleterious effects of "old" versus "fresh" red blood cells: An
updated meta-analysis.
Source
Transfusion. 51 (5) (pp 1122-1123), 2011. Date of Publication: May 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)

<6>
Accession Number
2011247146
Authors
Huang Z. Zhong X. Irwin M.G. Ji S. Wong G.T. Liu Y. Xia Z.-Y. Finegan B.A.
Xia Z.
Institution
(Huang, Ji) Department of Anesthesia, Sun Yat-Sen Cardiovascular Hospital,
Shenzhen, China
(Huang, Irwin, Wong, Liu, Xia) Department of Anesthesiology, University of
Hong Kong, Hong Kong SAR, China
(Huang, Xia, Xia) Anesthesiology Research Laboratory, Department of
Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
(Zhong) Zhongshan Ophthalmic Center, State Key Laboratory of
Ophthalmology, Sun Yat-sen University, Guangzhou, China
(Finegan) Department of Anesthesiology and Pain Medicine, University of
Alberta, Edmonton, AB, Canada
Title
Synergy of isoflurane preconditioning and propofol postconditioning
reduces myocardial reperfusion injury in patients.
Source
Clinical Science. 121 (2) (pp 57-69), 2011. Date of Publication: July
2011.
Publisher
Portland Press Ltd (59 Portland Place, London W1N 3AJ, United Kingdom)
Abstract
Either isoflurane preconditioning or high-dose propofol treatment has been
shown to attenuate myocardial IRI (ischaemia/reperfusion injury) in
patients undergoing CABG (coronary artery bypass graft) surgery. It is
unknown whether isoflurane and propofol may synergistically attenuate
myocardial injury in patients. The present study investigated the efficacy
of IsoPC (isoflurane preconditioning), propofol treatment
(postconditioning) and their synergy in attenuating postischaemic
myocardial injury in patients undergoing CABG surgery using CPB
(cardiopulmonary bypass). Patients (n = 120) selected for CABG surgery
were randomly assigned to one of four groups (n = 30 each). After
induction, anaesthesia was maintained either with fentanyl and midazolam
(control; group C); with propofol at 100 mug kg^-1 of body
weight min^-1 before and during CPB followed by propofol at 60
mug kg^-1 of body weight min^-1 for 15 min after
aortic declamping (group P); with isoflurane 1-1.5 % end tidal throughout
the surgery (group I) or with isoflurane 1-1.5 % end tidal before CPB and
switching to propofol at 100 mug kg^-1 of body weight
min^-1 during CPB followed by propofol at 60 mug
kg^-1 of body weight min^-1 for 15 min after aortic
declamping (group IP, i.e. IsoPC plus propofol postconditioning). A joint
isoflurane and propofol anaesthesia regimen synergistically reduced plasma
levels of cTnI (cardiac troponin I) and CK-MB (creatine kinase MB) and
f-FABP (heart-type fatty acid-binding protein) (all P < 0.05 compared with
control, group P or group I) and facilitated postoperative myocardial
functional recovery. During reperfusion, myocardial tissue eNOS
(endothelial NO synthase) protein expression in group IP was significantly
higher, whereas nitrotyrosine protein expression was lower than those in
the control group. In conclusion, a joint isoflurane preconditioning and
propofol anaesthesia regimen synergistically attenuated myocardial
reperfusion injury in patients. The Authors Journal compilation. 2011
Biochemical Society.

<7>
Accession Number
2011232420
Authors
Kragten H.A. Siebenga J. Hoppener P.F. Verburg R. Visker N.
Institution
(Kragten, Hoppener, Visker) Department of Cardiology, Atrium Medical
Centre Parkstad Heerlen, Henri Dunantstreet 5, 6419PC Heerlen, Netherlands
(Siebenga, Hoppener) Department of Surgery, Atrium Medical Centre Parkstad
Heerlen, Henri Dunantstreet 5, 6419PC Heerlen, Netherlands
(Verburg) Department of Anaesthesiology, Atrium Medical Centre Parkstad
Heerlen, Henri Dunantstreet 5, 6419PC Heerlen, Netherlands
Title
Symptomatic pectus excavatum in seniors (SPES): A cardiovascular problem?:
A prospective cardiological study of 42 senior patients with a symptomatic
pectus excavatum.
Source
Netherlands Heart Journal. 19 (2) (pp 73-78), 2011. Date of Publication:
February 2011.
Publisher
Bohn Stafleu van Loghum (P.O. Box 246, Houten 3990 GA, Netherlands)
Abstract
Objectives There is no consensus among physicians as to whether or not
pectus excavatum can produce symptoms sometimes even severe enough to
justify a surgical procedure. The aim of this study was to assess the
prevalence and severity of complaints and symptoms of senior patients with
a pectus excavatum and to evaluate the results of surgical correction of
the chest deformation. Design This is a prospective clinical study, case
series. Participants The participants are 42 senior patients with a pectus
excavatum and somatic complaints. Methods Cardiological screening included
medical history taking, physical examination, electrocardiography,
transtho- racic echocardiography and treadmill cardiography. Com- plaints,
symptoms and test results were arranged in a clinical score. Indication
for a therapeutic surgical correction by a modified Ravitch operation was
a high clinical score in combination with radiological evidence of cardiac
compression on CT or MRI. Results The clinical picture of the 42 senior
patients with a pectus excavatum showed complaints of fatigue and low
exercise tolerance, shortness of breath, palpitations, inspiratory
obstruction and sometimes chest discomfort or pain. The serious and
sometimes invalidating complaints of 19 patients (45%) had started only in
their fourth or fifth decade of life and were labelled in 12 patients
(63%) as 'Unexplained cardiovascular complaints'. To date, 11 patients
have undergone surgical procedures. Symptoms were reduced substantially or
had disappeared completely. All patients indicated that their health-
related quality of life was significantly improved. Conclusion Recognising
the clinical picture of SPES is relevant because surgical reconstruction
of the chest can provide substantial relief of symptoms. Springer
Media/Bohn Stafleu van Loghum 2011.

<8>
[Use Link to view the full text]
Accession Number
21216835
Authors
Baran D.A. Zucker M.J. Arroyo L.H. Camacho M. Goldschmidt M.E. Nicholls
S.J. Prevost-Fernandez J. Carr C. Adams L. Pardi S. Hou V. Binetti M.
McCahill J. Chichetti J. Viloria V. Sanagustin M.G. Ebuenga-Smith J. Mele
L. Martin A. Blicharz D. Wolski K. Olesnicky L. Qian F. Gass A.L. Cohen M.
Institution
(Baran) Newark Beth Israel Medical Center, Newark, NJ 07112, USA.
Title
A prospective, randomized trial of single-drug versus dual-drug
immunosuppression in heart transplantation: the tacrolimus in combination,
tacrolimus alone compared (TICTAC) trial.
Source
Circulation. Heart failure. 4 (2) (pp 129-137), 2011. Date of
Publication: 1 Mar 2011.
Abstract
Cardiac transplantation, a procedure nearly abandoned in the 1970s, has
evolved into the standard of care for appropriate patients with end-stage
heart failure. Much of this success has been due to improvements in
immunosuppression, including the introduction of a triple-drug regimen.
Retrospective reports suggested that single-drug immunosuppression with
tacrolimus was feasible. As such, a prospective, randomized trial was
conducted to test this approach. One hundred fifty adult de novo heart
transplant recipients were enrolled in a prospective, randomized,
controlled, open-label trial comparing tacrolimus monotherapy (MONO) with
tacrolimus and mycophenolate mofetil therapy (COMBO). Corticosteroids were
used in the early postoperative period but discontinued in all patients
over 8 to 9 weeks. The primary end point was the composite biopsy score at
6 months after transplant. Patients were followed for 1 to 5 years. The
composite biopsy score was similar between groups at 6 and 12 months:
6-month MONO, 0.70 +/- 0.44 (95% confidence interval, 0.60 to 0.80) versus
COMBO, 0.65 +/- 0.40 (95% confidence interval, 0.55 to 0.74; P=0.44).
Allograft vasculopathy was assessed by angiography and intravascular
ultrasound, with no significant differences noted. Three-year survival was
also similar (92.4% MONO versus 97% COMBO; P=0.58, log-rank). Addition of
mycophenolate to single-agent immunosuppression did not provide an
advantage over single-agent immunosuppression in terms of rejection,
allograft vasculopathy, or 3-year survival. Corticosteroids, which have
traditionally been a mainstay of therapy, were successfully discontinued
in all patients. These conclusions are tempered by the limited statistical
power associated with a sample size of only 150 patients. Clinical Trial
Registration- URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00299221.

<9>
[Use Link to view the full text]
Accession Number
2011238343
Authors
Patti G. Cannon C.P. Murphy S.A. Mega S. Pasceri V. Briguori C. Colombo A.
Yun K.H. Jeong M.H. Kim J.-S. Choi D. Bozbas H. Kinoshita M. Fukuda K. Jia
X.-W. Hara H. Cay S. Di Sciascio G.
Institution
(Patti, Mega, Di Sciascio) Department of Cardiovascular Sciences, Campus
Bio-Medico University of Rome, University of Rome, Via Alvaro del
Portillo, 200, 00128 Rome, Italy
(Cannon, Murphy) Cardiovascular Division, Department of Medicine, Brigham
and Women's Hospital, Boston, MA, United States
(Pasceri) Interventional Cardiology Unit, San Filippo Neri Hospital, Rome,
Italy
(Briguori) Laboratory of Interventional Cardiology, Department of
Cardiology, Clinica Mediterranea, Naples, Italy
(Colombo) Laboratory of Interventional Cardiology, Vita e Salute
University School of Medicine, San Raffaele Scientific Institute, Milan,
Italy
(Yun) Department of Cardiovascular Medicine, Wonkwang University Hospital,
Iksan, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Kim, Choi) Yonsei University College of Medicine, Seoul, South Korea
(Bozbas) Department of Cardiology, Baskent University, Ankara, Turkey
(Kinoshita, Fukuda) Keio University School of Medicine, Tokyo, Japan
(Jia) Department of Cardiovascular Disease, Second Hospital of Hebei
Medical University, Shijiazhuang, Hebei, China
(Hara) Division of Cardiovascular Medicine, Toho University Ohashi Medical
Center, Tokyo, Japan
(Cay) Department of Cardiology, Yuksek Ihtisas Heart-Education and
Research Hospital, Ankara, Turkey
Title
Clinical benefit of statin pretreatment in patients undergoing
percutaneous coronary intervention: A collaborative patient-level
meta-analysis of 13 randomized studies.
Source
Circulation. 123 (15) (pp 1622-1632), 2011. Date of Publication: 19 Apr
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Previous studies suggested that statin pretreatment reduces
cardiac events in patients undergoing percutaneous coronary intervention.
However, most data were observational, and single randomized trials
included limited numbers of patients. Methods and results-: We performed a
collaborative meta-analysis using individual patient data from 13
randomized studies in which 3341 patients received either high-dose statin
(n=1692) or no statin/low-dose statin (n=1649) before percutaneous
coronary intervention, with all patients receiving statin therapy after
intervention. Occurrence of periprocedural myocardial infarction, defined
as postintervention creatine kinase-MB increase a1 3 times the upper limit
of normal, and 30-day major adverse cardiac events (death, myocardial
infarction, target-vessel revascularization) was evaluated. Incidence of
periprocedural myocardial infarction was 7.0% in the high-dose statin
versus 11.9% in the control group, which corresponds to a 44% risk
reduction in the active-treatment arm (odds ratio by fixed-effects model
0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major
adverse cardiac events at 30 days was significantly lower in the high-dose
statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and
1-month major adverse cardiac events, excluding periprocedural events,
were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose
statins was realized irrespective of clinical presentation (P for
interaction=0.43) and was maintained across various subgroups but appeared
greater in the subgroup with elevated baseline C-reactive protein levels
(n=734; 68% risk reduction for periprocedural myocardial infarction versus
31% in those 1861 patients with normal CRP; P for quantitative
interaction=0.025). Conclusions-: High-dose statin pretreatment leads to a
significant reduction in periprocedural myocardial infarction and 30-day
adverse events in patients undergoing percutaneous coronary intervention.
This strategy should be considered in all patients with planned
percutaneous coronary intervention. 2011 American Heart Association, Inc.

<10>
Accession Number
21463149
Authors
Park S.J. Kim Y.H. Park D.W. Yun S.C. Ahn J.M. Song H.G. Lee J.Y. Kim W.J.
Kang S.J. Lee S.W. Lee C.W. Park S.W. Chung C.H. Lee J.W. Lim D.S. Rha
S.W. Lee S.G. Gwon H.C. Kim H.S. Chae I.H. Jang Y. Jeong M.H. Tahk S.J.
Seung K.B.
Institution
(Park) Heart Institute, Center for Medical Research and Information,
University of Ulsan College of Medicine, Asan Medical Center, Seoul, South
Korea.
Title
Randomized trial of stents versus bypass surgery for left main coronary
artery disease.
Source
The New England journal of medicine. 364 (18) (pp 1718-1727), 2011. Date
of Publication: 5 May 2011.
Abstract
Percutaneous coronary intervention (PCI) is increasingly used to treat
unprotected left main coronary artery stenosis, although coronary-artery
bypass grafting (CABG) has been considered to be the treatment of choice.
We randomly assigned patients with unprotected left main coronary artery
stenosis to undergo CABG (300 patients) or PCI with sirolimus-eluting
stents (300 patients). Using a wide margin for noninferiority, we compared
the groups with respect to the primary composite end point of major
adverse cardiac or cerebrovascular events (death from any cause,
myocardial infarction, stroke, or ischemia-driven target-vessel
revascularization) at 1 year. Event rates at 2 years were also compared
between the two groups. The primary end point occurred in 26 patients
assigned to PCI as compared with 20 patients assigned to CABG (cumulative
event rate, 8.7% vs. 6.7%; absolute risk difference, 2.0 percentage
points; 95% confidence interval [CI], -1.6 to 5.6; P=0.01 for
noninferiority). By 2 years, the primary end point had occurred in 36
patients in the PCI group as compared with 24 in the CABG group
(cumulative event rate, 12.2% vs. 8.1%; hazard ratio with PCI, 1.50; 95%
CI, 0.90 to 2.52; P=0.12). The composite rate of death, myocardial
infarction, or stroke at 2 years occurred in 13 and 14 patients in the two
groups, respectively (cumulative event rate, 4.4% and 4.7%, respectively;
hazard ratio, 0.92; 95% CI, 0.43 to 1.96; P=0.83). Ischemia-driven
target-vessel revascularization occurred in 26 patients in the PCI group
as compared with 12 patients in the CABG group (cumulative event rate,
9.0% vs. 4.2%; hazard ratio, 2.18; 95% CI, 1.10 to 4.32; P=0.02). In this
randomized trial involving patients with unprotected left main coronary
artery stenosis, PCI with sirolimus-eluting stents was shown to be
noninferior to CABG with respect to major adverse cardiac or
cerebrovascular events. However, the noninferiority margin was wide, and
the results cannot be considered clinically directive. (Funded by the
Cardiovascular Research Foundation, Seoul, Korea, and others; PRECOMBAT
ClinicalTrials.gov number, NCT00422968.).

<11>
Accession Number
2011235344
Authors
Song J.W. Jo Y.Y. Jun N.H. Kim H.K. Kwak Y.L.
Institution
(Song, Jo, Jun, Kim, Kwak) Department of Anesthesiology and Pain Medicine,
Yonsei University College of Medicine, Seoul, South Korea
(Song, Jo, Jun, Kwak) Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
Title
The effect of milrinone on the intraoperative hemodynamics during off-pump
coronary bypass surgery in patients with an elevated echocardiographic
index of the ventricular filling pressure.
Source
Korean Journal of Anesthesiology. 60 (3) (pp 185-191), 2011. Date of
Publication: March 2011.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: Hemodynamic derangement during off-pump coronary artery bypass
surgery (OPCAB) is mainly attributed to impaired filling and diastolic
dysfunction. An elevated ratio of the mitral velocity to the
early-diastolic velocity of the mitral annulus (E/e' > 15) is a relatively
new indicator of diastolic function, and this was reported to be
associated with impaired hemodynamics during OPCAB. We investigated the
efficacy of milrinone on the perioperative hemodynamics and short term
outcomes of patients with an E/e' > 15 and who underwent OPCAB. Methods:
The patients were randomly allocated into either group C (control, n = 31)
or group M (n = 31) and they were treated with the same amount of either
normal saline or milrinone (0.5 mug/kg/min) without bolus loading after
completion of internal mammary artery harvest until the end of operation.
Hemodynamic measurements were recorded after the induction of anesthesia
(T1), 5 min after starting each distal anastomosis of the left anterior
descending artery (T2), left circumflex artery (T3) and right coronary
artery (T4), and 5 min after sternum closure (T5). Results: The mixed
venous oxygen saturation (SvO2) was lower through T2-T4 compared to the
baseline value in both groups, while the degree of the decrease was
significantly less in group M than that in group C. The other hemodynamic
variables, the operative data and the postoperative outcomes were similar
between the two groups. Conclusions: Intraoperative infusion of milrinone
did not significantly improve the perioperative hemodynamics and the
subsequent short term outcomes for the patients with preexisting diastolic
dysfunction as represented by an elevated E/e' value, although it reduced
the degree of decrease of the SvO₂ during OPCAB. the Korean
Society of Anesthesiologists, 2011.

<12>
Accession Number
2011239180
Authors
Liu W. Ma C.-S. Kang J.-P. Du X. Chen F. Zhou Y.-J. Lu S.-Z. Huang F.-J.
Gu C.-X. Zhu X.-L.
Institution
(Liu, Ma, Kang, Du, Chen, Zhou, Lu, Zhu) Department of Cardiology, Beijing
Anzhen Hospital, Capital Medical University, Beijing 100029, China
(Huang, Gu) Department of Cardiac Surgery, Beijing Anzhen Hospital,
Capital Medical University, Beijing 100029, China
Title
Comparison of drug eluting stent implantation with coronary artery bypass
surgery in the treatment of patients with chronic total occlusion and
multiple vessel disease.
Source
Chinese Medical Journal. 124 (8) (pp 1169-1174), 2011. Date of
Publication: April 2011.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background In patients with chronic total occlusion (CTO) and multivessel
coronary artery disease, the comparison of surgical and the percutaneous
revascularization strategies has rarely been conducted. The aim of this
study was to compare long term clinical outcomes of drug eluting stent
(DES) implantation with coronary artery bypass surgery (CABG) in the
patients with CTO and multivessel disease. Methods From a prospective
registry of 6000 patients in our institution, we included patients with
CTO and multivessel coronary artery disease who underwent either CABG
(n=679) or DES (n=267) treatment. Their propensity risk score was used for
adjusting baseline differences. Results At a median follow-up of three
years, propensity score adjusted Cox regression analysis showed that the
rate of major adverse cardiac cerebrovascular events (MACCE) was lower in
CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95% CI 1.219-3.179,
P=0.006) mainly due to lower rate of target vessel revascularization in
CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95% CI
5.739-45.391, P <0.001). The incidence of cardiac death or myocardial
infarction (composite end point) was not significantly different between
these two groups. On multivariate analysis, the significant predictors of
MACCE were only the type of revascularization. Age, left ventricular
ejection fraction (LVEF), and complete revascularization were identified
as significant predictors of composite end points. Conclusions Our study
shows that in patients with CTO and multivessel coronary disease, DES can
offer comparable long term outcomes in cardiac death and myocardial
infraction free survival in comparison with CABG. However, there is an
increased rate of MACCE which results from more repeat revascularizations.
Obtaining a complete revascularization is crucial for decreasing adverse
cardiac events.

<13>
[Use Link to view the full text]
Accession Number
2011243922
Authors
Cheng D.C.H. Martin J. Lal A. Diegeler A. Folliguet T.A. Nifong L.W.
Perier P. Raanani E. Smith J.M. Seeburger J. Falk V.
Institution
(Cheng, Martin, Lal) Department 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, London, ON, Canada
(Diegeler, Perier) Division of Cardiothoracic Surgery, Herz-und Gefasse
Klinik Bad Neustadt, Bad Neustadt, Germany
(Folliguet) Departement de Pathologie Cardiaque, L'Institut Mutualiste
Montsouris, Paris, France
(Nifong) Department of Cardiothoracic Surgery, East Carolina University
School of Medicine, Greenville, NC, United States
(Raanani) Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
(Smith) Cardiac, Vascular and Thoracic Surgeons, Inc., Cincinnati, OH,
United States
(Seeburger) Klinik fur Herzchirurgie, Herzzentrum der Universitat Leipzig,
Leipzig, Germany
(Falk) Klinik fur Herz- und Gefasschirurgie, Universitatsspital Zurich,
Zurich, Switzerland
(Cheng) LHSC-University Hospital, 339 Windermere Road, C3-172, London, ON
N6A 5A5, Canada
Title
Minimally invasive versus conventional open mitral valve surgery: A
meta-analysis and systematic review.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 6 (2) (pp 84-103), 2011. Date of Publication: March-April 2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Objective: This meta-analysis sought to determine whether minimally
invasive mitral valve surgery (mini-MVS) improves clinical outcomes and
resource utilization compared with conventional open mitral valve surgery
(conv-MVS) in patients undergoing mitral valve repair or replacement.
Methods: A comprehensive search of MEDLINE, Cochrane Library, EMBASE,
CTSnet, and databases of abstracts was undertaken to identify all
randomized and nonrandomized studies up to March 2010 of mini-MVS through
thoracotomy versus conv-MVS through median sternotomy for mitral valve
repair or replacement. Outcomes of interest included death, stroke,
myocardial infarction, aortic dissection, need for reintervention, and any
other reported clinically relevant outcomes or indicator of resource
utilization. Relative risk and weighted mean differences and their 95%
confidence intervals were analyzed as appropriate using the random effects
model. Heterogeneity was measured using the I statistic. Results:
Thirty-five studies met the inclusion criteria (two randomized controlled
trials and 33 nonrandomized studies). The mortality rate after mini-MVS
versus conv-MVS was similar at 30 days (1.2% vs 1.5%), 1 year (0.9% vs
1.3%), 3 years (0.5% vs 0.5%), and 9 years (0% vs 3.7%). A number of
clinical outcomes were significantly improved with mini-MVS versus
conv-MVS including atrial fibrillation (18% vs 22%), chest tube drainage
(578 vs 871 mL), transfusions, sternal infection (0.04% vs 0.27%), time to
return to normal activity, and patient scar satisfaction. However, the
30-day risk of stroke (2.1% vs 1.2%), aortic dissection/injury (0.2% vs
0%), groin infection (2% vs 0%), and phrenic nerve palsy (3% vs 0%) were
significantly increased for mini-MVS versus conv-MVS. Other clinical
outcomes were similar between groups. Cross-clamp time, cardiopulmonary
bypass time, and procedure time were significantly increased with
mini-MVS; however, ventilation time and length of stay in intensive care
unit and hospital were reduced. Conclusions: Current evidence suggests
that mini-MVS maybe associated with decreased bleeding, blood product
transfusion, atrial fibrillation, sternal wound infection, scar
dissatisfaction, ventilation time, intensive care unit stay, hospital
length of stay, and reduced time to return to normal activity, without
detected adverse impact on long-term need for valvular reintervention and
survival beyond 1 year. However, these potential benefits for mini-MVS may
come with an increased risk of stroke, aortic dissection or aortic injury,
phrenic nerve palsy, groin infections/ complications, and increased
cross-clamp, cardiopulmonary bypass, and procedure time. Available
evidence is largely limited to retrospective comparisons of small cohorts
comparing mini-MVS versus conv-MVS that provide only short-term outcomes.
Given these limitations, randomized controlled trials with adequate power
and duration of follow-up to measure clinically relevant outcomes are
recommended to determine the balance of benefits and risks. Copyright
2011 by the International Society for Minimally Invasive Cardiothoracic
Surgery.

<14>
[Use Link to view the full text]
Accession Number
2011243920
Authors
Falk V. Cheng D.C.H. Martin J. Diegeler A. Folliguet T.A. Nifong L.W.
Perier P. Raanani E. Smith J.M. Seeburger J.
Institution
(Falk) Klinik fur Herz- und Gefasschirurgie, Universitatsspital Zurich,
Ramistrasse 100, CH-8091 Zurich, Switzerland
(Cheng, Martin) Department 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, London, ON, Canada
(Diegeler, Perier) Klinik fur Kardiochirurgie, Herz- und Gefas-Klinik
GmbH, Bad Neustadt, Germany
(Folliguet) Departement de Pathologie Cardiaque, L'Institut Mutualiste
Montsouris, Paris, France
(Nifong) Department of Cardiothoracic Surgery, East Carolina University
School of Medicine, Greenville, NC, United States
(Raanani) Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
(Smith) Cardiac, Vascular and Thoracic Surgeons, Inc., Cincinnati, OH,
United States
(Seeburger) Klinik fur Herzchirurgie, Herzzentrum der Universitat Leipzig,
Leipzig, Germany
Title
Minimally invasive versus open mitral valve surgery: A consensus statement
of the international society of minimally invasive coronary surgery
(ISMICS) 2010.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 6 (2) (pp 66-76), 2011. Date of Publication: March-April 2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Objective: The purpose of this consensus conference was to deliberate the
evidence regarding whether minimally invasive mitral valve surgery via
thoracotomy improves clinical and resource outcomes compared with
conventional open mitral valve surgery via median sternotomy in adults who
require surgical intervention for mitral valve disease. Methods: Before
the consensus conference, the consensus panel reviewed the best available
evidence up to March 2010, whereby systematic reviews, randomized trials,
and nonrandomized trials were considered in descending order of validity
and importance. The accompanying meta-analysis article in this issue of
the Journal provides the systematic review of the evidence. Based on this
systematic review, evidence-based statements were created for prespecified
clinical questions, and consensus processes were used to derive
recommendations. The American Heart Association/American College of
Cardiology system was used to label the level of evidence and class of
each recommendation. Results and Conclusions: Considering the underlying
level of evidence, and notwithstanding the limitations of the evidence
base (retrospective studies with important differences in baseline patient
characteristics, which may produce bias in results of the evidence
syntheses), the consensus panel provided the following evidence-based
statements and overall recommendation:In patients with mitral valve
disease, minimally invasive surgery may be an alternative to conventional
mitral valve surgery (Class IIb), given that there was comparable
short-term and long-term mortality (level B), comparable in-hospital
morbidity (renal, pulmonary, cardiac complications, pain perception, and
readmissions) (level B), reduced sternal complications, transfusions,
postoperative atrial fibrillation, duration of ventilation, and intensive
care unit and hospital length of stay (level B). However, this should be
considered against the increased risk of stroke (2.1% vs 1.2%) (level B),
aortic dissection (0.2% vs 0%) (level B), phrenic nerve palsy (3% vs 0%)
(level B), groin infections/complications (2% vs 0%) (level B), and,
prolonged cross-clamp time, cardiopulmonary bypass time, and procedure
time (level B). The available evidence consists almost entirely of
observational studies and must not be considered definitive until future
adequately controlled randomized trials further address the risk of
stroke, aortic complications, phrenic nerve complications, pain, long-term
survival, need for reintervention, quality of life, and
cost-effectiveness. Copyright 2011 by the International Society for
Minimally Invasive Cardiothoracic Surgery.

<15>
Accession Number
2011243681
Authors
Yapici N. Coruh T. Kehlibar T. Yapici F. Tarhan A. Can Y. Ozler A. Aykac
Z.
Institution
(Yapici, Coruh, Aykac) Anesthesiology and Reanimation Clinic, Siyami Ersek
Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
(Kehlibar, Yapici, Tarhan, Ozler) Cardiovascular Surgery Clinic, Siyami
Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
(Can) Psychiatry Clinic, Bakirkoy Mental Disorders Hospital, Istanbul,
Turkey
Title
Dexmedetomidine in cardiac surgery patients who fail extubation and
present with a delirium state.
Source
Heart Surgery Forum. 14 (2) (pp E93-E98), 2011. Date of Publication:
April 2011.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: We evaluated the use of dexmedetomidine to facilitate the
weaning of delirious postoperative patients from mechanical ventilation.
Methods: We included 72 consecutive patients who underwent elective
cardiac surgery in this prospective observational study. Each patient had
failed at least 1 trial of continuous positive airway pressure (CPAP) and
had agitation. Patients were assessed with the Richmond Agitation-Sedation
Scale (RASS) and the Confusion Assessment Method for the Intensive Care
Unit (CAMICU) 12 to 18 hours after their admission to the ICU. Midazolam
and fentanyl were then given to all patients according to the sedation
protocol. At 36 hours in the ICU, patients who had agitation and an
inability to wean were randomly divided into 2 groups: group M, 34
patients who continued to follow the routine sedative protocol; and group
D, 38 patients who were given dexmedetomidine. Arterial blood gas
measurements, hemodynamic parameters, and time to extubation were
recorded. Statistical analysis was performed with GraphPad InStat (version
2.02 for DOS). Results: All patients tested positive in the CAM-ICU
assessment, and all had a delirium diagnosis. The 38 patients in group D
tolerated a spontaneous breathing trial with CPAP and were extubated after
a mean (+/-SD) of 49.619 +/- 6.96 hours. The 2 groups had signifi cantly
different extubation times (58.389 +/- 3.958 hours versus 49.619 +/- 6.96
hours). The 2 groups had signifi cantly different RASS scores at 48 and 60
hours and signifi cantly different heart rates and PO2 values at 12 and 24
hours. The 2 groups showed no signifi cant differences with regard to
hemodynamic parameters. Conclusions: Dexmedetomidine may help to eliminate
the emergence of agitation and can be a good treatment choice for the
delirium state after cardiac surgery. 2011 Forum Multimedia Publishing,
LLC.

<16>
Accession Number
2011244358
Authors
Pan M. Medina A. Romero M. Segura J. Martn P. Suarez De Lezo J. Hernandez
E. Mazuelos F. Moreno A. Pavlovic D. Ojeda S. Toledano F. Leon C.
Institution
(Pan, Suarez De Lezo, Romero, Segura, Suarez De Lezo, Mazuelos, Moreno,
Pavlovic, Ojeda, Toledano, Leon) Department of Cardiology, Reina Sofia
Hospital, University of Crdoba, Cordoba, Spain
(Medina, Martn, Hernandez) Department of Cardiology, Dr. Negrin Hospital,
University of Las, Palmas, Las Palmas de Gran Canaria, Spain
Title
Coronary bifurcation lesions treated with simple approach (from the
Cordoba & Las Palmas [CORPAL] kiss trial).
Source
American Journal of Cardiology. 107 (10) (pp 1460-1465), 2011. Date of
Publication: 15 May 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The present report compared the incidence of 1-year clinical events in
patients with bifurcation lesions that had been treated with a simple
approach who were randomized to either a simultaneous final kissing
balloon (KB) or an isolated side-branch (SB) balloon post-dilation. From
February 2007 to December 2008, 293 patients with all types of Medina
bifurcation lesions were enrolled in a prospective study. All patients
underwent implantation of a sirolimus- or everolimus-eluting stent across
the bifurcation and provisional SB stenting. Patients with no SB ostial
compromise or those needing a second stent were excluded from the present
study (n = 49). The eligible patients were randomly assigned to treatment
with final KB inflation (n = 124, KB group) or isolated balloon after
dilation (n = 120, non-KB group). No significant differences were found
between the patients from the KB and non-KB groups in terms of age, risk
factors, clinical status, or location of the bifurcation lesions. The
angiographic data and immediate results were also similar in both groups.
Four patients experienced a nonQ-wave acute myocardial infarction in the
hospital: three (2%) from the KB group and one (1%) from the non-KB group.
Two in-hospital deaths occurred in the non-KB group. Target lesion
revascularization was required in 7 patients (3%): 5 from the KB group and
2 from the non-KB group. Late mortality occurred in 3 patients from the KB
group and 2 patients from the non-KB group. The incidence of major events
at 1 year (death, target lesion revascularization, or acute myocardial
infarction) was similar in both groups: 11 (9%) from the KB group and 7
(6%) from the non-KB group (p = NS). In conclusion, no differences in the
clinical outcome at 1 year of follow-up were observed between the patients
with bifurcation lesions treated with a simple approach and either a
simultaneous final KB or an isolated SB balloon post-dilation. 2011
Elsevier Inc. All rights reserved.

<17>
Accession Number
2011247355
Authors
Girdauskas E. Borger M.A. Secknus M.-A. Girdauskas G. Kuntze T.
Institution
(Girdauskas, Kuntze) Department of Cardiac Surgery, Heart Center,
Zentralklinik Bad Berka, Germany
(Secknus) Department of Cardiology, Heart Center, Zentralklinik Bad Berka,
Germany
(Borger) Department of Cardiac Surgery, Heart Center Leipzig, Germany
(Girdauskas) Academy of Physical Education, Kaunas, Lithuania
Title
Is aortopathy in bicuspid aortic valve disease a congenital defect or a
result of abnormal hemodynamics? A critical reappraisal of a one-sided
argument.
Source
European Journal of Cardio-thoracic Surgery. 39 (6) (pp 809-814), 2011.
Date of Publication: June 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Although there is adequate evidence that bicuspid aortic valve (BAV) is an
inheritable disorder, there is a great controversy regarding the
pathogenesis of dilatation of the proximal aorta. The hemodynamic theory
was the first explanation for BAV aortopathy. The genetic theory, however,
has become increasingly popular over the last decade and can now be viewed
as the clearly dominant one. The widespread belief that BAV disease is a
congenital disorder of vascular connective tissue has led to more
aggressive treatment recommendations of the proximal aorta in such
patients, approaching aortic management recommendations for patients with
Marfan syndrome. There is emerging evidence that the 'clinically normal'
BAV is associated with abnormal flow patterns and asymmetrically increased
wall stress in the proximal aorta. Recent in vitro and in vivo studies on
BAV function provide a unique hemodynamic insight into the different
phenotypes of BAV disease and asymmetry of corresponding aortopathy even
in the presence of a 'clinically normal' BAV. On the other hand, there is
a subgroup of young male patients with BAV and a root dilatation
phenotype, who may present the predominantly genetic form of BAV disease.
In the face of these important findings, we feel that a critical review of
this clinical problem is timely and appropriate, as the prevailing
BAV-aortopathy theory undoubtedly affects the surgical approach to this
common clinical entity. Thorough analysis of the recent literature shows a
growing amount of evidence supporting the hemodynamic theory of aortopathy
in patients with BAV disease. Data from recent studies requires a
reevaluation of our overwhelming support of the genetic theory, and
obliges us to acknowledge that hemodynamics plays an important role in the
development of this disease process. Given the marked heterogeneity of BAV
disease, further studies are required in order to more precisely determine
which theory is the 'correct' one for explaining the obviously different
types of BAV-associated aortopathy. 2011 European Association for
Cardio-Thoracic Surgery.

<18>
Accession Number
2011247360
Authors
Dalmau M.J. Gonzalez-Santos J.M. Blazquez J.A. Sastre J.A. Lopez-Rodriguez
J. Bueno M. Castano M. Arribas A.
Institution
(Dalmau, Gonzalez-Santos, Blazquez, Sastre, Lopez-Rodriguez, Bueno,
Castano, Arribas) Department of Cardiac Surgery, Salamanca University
Hospital, Paseo de San Vicente, N 58-182, 37007 Salamanca, Spain
Title
Hemodynamic performance of the Medtronic Mosaic and Perimount Magna aortic
bioprostheses: Five-year results of a prospectively randomized study.
Source
European Journal of Cardio-thoracic Surgery. 39 (6) (pp 844-852), 2011.
Date of Publication: June 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Clinical outcomes of patients undergoing aortic valve
replacement may be influenced by the presence of residual gradients and
patient-prosthesis mismatch. The aim of this study was to compare
hemodynamic performance and clinical outcomes at 5 years after
prospectively randomized porcine versus bovine aortic valve replacement.
We also aimed to determine the effects of valve hemodynamics on left
ventricular (LV) mass regression. Methods: A total of 108 patients
undergoing aortic valve replacement were randomized to receive either the
Medtronic Mosaic (MM) porcine (n=54) or the Edwards Perimount Magna (EPM)
bovine pericardial prosthesis (n=54). Clinical outcomes, mean gradients,
effective orifice area and LV mass regression were evaluated at 1 and 5
years after surgery. Follow-up echocardiograms were performed on 106 (98%)
and 87 (92%) patients, respectively. Results: Preoperative characteristics
were similar between groups. Mean aortic annulus diameter and mean implant
size were comparable in both groups. At 1 and 5 years, mean
transprosthetic gradients were lower in the EPM group: EPM 10.3+/-3.4mmHg
versus MM 16.3+/-7.6mmHg (p<0.0001) and EPM 9.6+/-3.5mmHg versus MM
16.8+/-8.7mmHg (p<0.0001), respectively. Similarly, indexed effective
orifice areas (IEOA) at 1 and 5 years were significantly greater in the
EPM group: EPM 1.10+/-0.22cm²m^-2 versus MM
0.96+/-0.22cm²m^-2 (p<0.004) and EPM
1.02+/-0.25cm²m^-2 versus MM
0.76+/-0.19cm²m^-2 (p<0.0001), respectively. At 5
years, the incidence of patient-prosthesis mismatch
(IEOA<=0.85cm²m^-2) was significantly lower in the
EPM group: EPM 22.9% vs MM 73.9% (p<0.0001). Such differences were similar
when analysis was stratified by surgically measured annular size and
implant valve size. During the first year after surgery, both groups
demonstrated similar regression of LV mass index (MM
-26.3+/-43gm² vs EPM -30.1+/-36gm^-2; p=0.8);
however, at 5 years, regression of LV mass index was significantly greater
in the EPM group: (EPM -47.4+/-35gm^-2 vs
-4.4+/-36gm^-2; p<0.0001). Five-year survival was 79.6+/-4.1% in
the MM group and 94.4+/-2.2% in the EPM group (p=0.03). Conclusions: At 5
years, the EPM valve was significantly superior to the MM prosthesis with
regard to hemodynamic performance, incidence of patient-prosthesis
mismatch and regression of LV mass index. The hemodynamic superiority of
the EPM prostheses in comparison to MM-prostheses demonstrated at 1 year,
increased significantly over time. 2010 European Association for
Cardio-Thoracic Surgery.

<19>
Accession Number
2011247366
Authors
Golab H.D. Scohy T.V. de Jong P.L. Kissler J. Takkenberg J.J.M. Bogers
A.J.J.C.
Institution
(Golab, Scohy, de Jong, Kissler, Takkenberg, Bogers) Department of
Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam,
's Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
Title
Relevance of colloid oncotic pressure regulation during neonatal and
infant cardiopulmonary bypass: A prospective randomized study.
Source
European Journal of Cardio-thoracic Surgery. 39 (6) (pp 886-891), 2011.
Date of Publication: June 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: In neonatal and infant cardiac surgery with cardiopulmonary
bypass (CPB), hemodilution with reduction of plasma albumin concentration
and low colloid oncotic pressure (COP) are the main factors associated
with tissue edema and postoperative weight gain. The aim of our study was
to evaluate the influence of two different COP regulatory strategies on
post-bypass body weight gain, fluid balance, and clinical outcomes.
Methods: Seventy elective patients with body weight<10kg underwent
first-time cardiac surgery with CPB and were randomized into two groups.
The standard COP group received 0.5gkg^-1 of human albumin in
the priming and, during CPB, albumin was added to maintain the COP>15mmHg.
In the high COP group, albumin concentration in the priming was 5% and,
during CPB, the COP was maintained above 18mmHg. All patients were
monitored before, during and until 24h postoperatively. Data were
collected on body weight gain, COP, albumin concentration, fluids
transfusion, blood loss, urine production and laboratory results. Results:
Patients' demographics and operative data were comparable. Although the
high COP group had perioperatively significantly higher COP and albumin
concentration than the standard COP group, no significant difference was
found in the body weight gain. There were also no significant differences
between the groups with respect to fluid balance, urine output and blood
loss. However, the high COP group had significantly shorter postoperative
duration of mechanical ventilation (10h vs 14h, p=0.02) and lower plasma
lactate concentration post operation (1.1mmoll^-1 vs
1.4mmoll^-1, p=0.046). Conclusions: The COP regulatory strategy
for neonatal and infant CPB, based upon the 5% concentration of albumin in
the priming and a COP target of 18mmHg during bypass, better preserves the
plasma albumin concentration within the physiological range and stabilizes
the colloid pressure than the standard strategy (0.5gkg^-1
albumin in the priming and bypass COP target at 15mmHg). Nevertheless,
only the lower postoperative plasma lactate concentration and the shorter
duration of mechanical ventilation in the high COP group indicated the
potential clinical benefit of this new strategy. 2010 European
Association for Cardio-Thoracic Surgery.

<20>
Accession Number
2011247385
Authors
Bolukbas S. Eberlein M. Eckhoff J. Schirren J.
Institution
(Bolukbas, Eckhoff, Schirren) Department of Thoracic Surgery,
Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany
(Eberlein) Division of Pulmonary and Critical Care Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Eberlein) Critical Care Medicine Department, National Institutes of
Health, Bethesda, MD, United States
Title
Short-term effects of inhalative tiotropium/formoterol/budenoside versus
tiotropium/formoterol in patients with newly diagnosed chronic obstructive
pulmonary disease requiring surgery for lung cancer: A prospective
randomized trial.
Source
European Journal of Cardio-thoracic Surgery. 39 (6) (pp 995-1000), 2011.
Date of Publication: June 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: A new diagnosis of chronic obstructive pulmonary disease (COPD)
is often made during the evaluation of patients requiring a surgical
intervention for lung cancer. Based on initial impaired lung function,
these untreated patients are often considered not fit for lung surgery.
There is limited information on the short-term effectiveness of
preoperative pharmacologic treatment strategies in patients with newly
diagnosed COPD before lung surgery. Methods: A prospective randomized
study was conducted comparing 1-week-treatment periods of
tiotropium/formoterol/budenoside (GR1) with tiotropium/formoterol (GR2) in
conjunction with smoking cessation and chest physiotherapy. No patients
had been previously treated for COPD. The primary end point was body
plethysmography (forced expiratory volume in 1. s (FEV1), forced vital
capacity (FVC), and airway resistance (RAW)) at the end of each treatment
period. Secondary end points were improvement of >=10% in FEV1 (%
predicted) and improvement of the severity of COPD after the 1-week
treatment, as well as the rate of pulmonary complications after surgery.
Results: A total of 46 patients were randomized in GR1 (n= 24) and GR2 (n=
22). Both groups were comparable with regard to age, height, weight,
smoking history, baseline body plethysmography (FVC, FEV1, and RAW), and
the severity of COPD according to the Global Initiative for Obstructive
Lung Disease (GOLD) staging, respectively. However, the short-term effects
of the treatment with regard to FEV1 (2.0 l vs 1.7 l; p= 0.031) and
increase of FEV1 (0.31 l vs 0.10 l; p= 0.02) were better in GR1. More
patients in GR1 had an improvement of >=10% in FEV1 (p= 0.004) and
improvement of the severity of COPD (p= 0.012) after the 1-week treatment.
Fewer pulmonary complications (11.1% vs 42.9%, p= 0.04) were observed in
GR1 after surgery. Conclusions: Both therapies resulted in an improvement
of lung function. There is benefit from adding inhalative budenoside to
tiotropium and formoterol in terms of an improvement in FEV1 and the
severity of COPD. These beneficial results might lead to less pulmonary
complications in the postoperative period. 2010 European Association for
Cardio-Thoracic Surgery.

<21>
Accession Number
2011247370
Authors
Chandrasekharan D.P. Taggart D.P.
Institution
(Chandrasekharan, Taggart) Nuffield Department of Surgery, Oxford
University, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
Title
Informed consent for interventions in stable coronary artery disease:
Problems, etiologies, and solutions.
Source
European Journal of Cardio-thoracic Surgery. 39 (6) (pp 912-917), 2011.
Date of Publication: June 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
The objective of this review was to determine whether patients undergoing
percutaneous coronary intervention (PCI) and coronary artery bypass
grafting (CABG) (1) understand the aims of the proposed intervention, and
(2) whether they are offered alternative and potentially more effective
therapies, as required for the process of informed consent. We performed a
systematic review of Medline for observational studies of patient
understanding and perceptions of coronary revascularization and of the
consent process. Data extraction was of patient perceptions of expected
symptomatic and prognostic benefits of PCI and CABG, and the proportion of
patients offered potential alternative treatments. Eight studies were
identified, of which seven were relevant to PCI and three to CABG. On
average, 55% of patients correctly believed that PCI would improve
symptoms, while 78% erroneously believed that PCI would extend life
expectancy and 71% erroneously believed PCI would prevent future
myocardial infarction. On average, over 80% of patients correctly
identified that CABG would improve symptoms, reduce the risk of myocardial
infarction and extend life expectancy. In the three studies that examined
whether alternative therapies were discussed, 68% of PCI patients and 59%
of CABG patients reported no such discussion. In conclusion, a large
proportion of patients undergoing coronary interventions do not appear to
understand the rationale for treatment and have erroneous perceptions
regarding expected benefits. Moreover, patients are frequently not offered
potentially more effective alternative therapies. This raises important
questions about the adequacy of the current informed consent process. We
recommend a multidisciplinary team approach as the most obvious way to
remedy current practice. 2010 European Association for Cardio-Thoracic
Surgery.

<22>
Accession Number
2011198465
Authors
Bertel O. Ramsay D. Wettstein T. Kurz D.J. Stettler I. Straumann E.
Frielingsdorf J. Maurer D. Naegeli B.
Institution
(Bertel, Straumann, Maurer, Naegeli) HerzGefassZentrum Zurich, Klinik im
Park, Seestrasse 247, CH-8027 Zurich, Switzerland
(Ramsay, Wettstein, Kurz, Stettler, Frielingsdorf) Division of Cardiology,
Department of Internal Medicine, Triemli Hospital, Zurich, Switzerland
Title
Intravenous enoxaparin versus unfractionated heparin in unselected
patients undergoing percutaneous coronary interventions: The Zurich
enoxaparin versus unfractionated heparin in PCI study (ZEUS).
Source
EuroIntervention. 6 (3) (pp 407-412), 2010. Date of Publication: August
2010.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To evaluate the efficacy and safety of intravenous enoxaparin as an
alternative to unfractionated heparin (UFH) as antithrombotic therapy in
unselected patients undergoing percutaneous coronary intervention (PCI).
Methods and results: Eight hundred and seventy-six (876) consecutive
eligible patients undergoing PCI were prospectively randomised to either
intravenous enoxaparin 0.75 mg/kg or dose-adjusted UFH in this open-label
study that was prematurely stopped due to slow recruitment. Randomisation
was stratified on elective PCI or PCI for acute coronary syndrome (ACS).
The primary endpoint was a combination of death, myocardial infarction,
unplanned target vessel revascularisation and major bleeding at 30 days.
Secondary endpoint was a composite of major and minor bleeding and
thrombocytopenia < 50x109. The primary endpoint of intravenous enoxaparin
did not differ from those of UFH (5.5% vs. 7.0%, p=ns) whereas safety
endpoints were reduced with enoxaparin compared to UFH (9.9% vs. 20.0%,
p<0.001). Among 229 (26%) patients presenting with ACS, the incidence of
both, the primary and secondary endpoints, was lower with enoxaparin as
compared to UFH (1.8% vs. 12.9% and 14.2% vs. 31%, p<0.001 and p=0.003,
respectively). Conclusions: Due to the premature halting of the study and
the low event rate, these data are observational only, and no definite
conclusion could be made concerning efficacy and safety of intravenous
enoxaparin as an alternative to UFH in unselected patients undergoing PCI.
Europa Edition 2010. All rights reserved.

<23>
Accession Number
2011198464
Authors
Ozaki Y. Lemos P.A. Yamaguchi T. Suzuki T. Nakamura M. Ismail T.F.
Kitayama M. Nishikawa H. Kato O. Serruys P.W.
Institution
(Ozaki) Division of Cardiology, Fujita Heath University Hospital, Post
Code 470-1192, 1-98 Dengaku, Kutsukake, Toyoake, Japan
(Lemos) Heart Institute, University of Sao Paulo Medical School, Sao
Paulo, Brazil
(Yamaguchi) Toranomon Hospital, Tokyo, Japan
(Suzuki, Kato) Toyohashi Heart Center, Toyohashi, Japan
(Nakamura) Toho University Medical Center, Ohashi Hospital, Tokyo, Japan
(Ismail) Charing Cross Hospital, London, United Kingdom
(Kitayama) Kanazawa Medical University, Uchinada, Japan
(Nishikawa) Mie Heart Center, Meiwa, Japan
(Serruys) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
Title
A quantitative coronary angiography-matched comparison between a
prospective randomised multicentre cutting balloon angioplasty and bare
metal stent trial (REDUCE III) and the Rapamycin-Eluting Stent Evaluation
at Rotterdam Cardiology Hospital (RESEARCH) study.
Source
EuroIntervention. 6 (3) (pp 400-406), 2010. Date of Publication: August
2010.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: There remains significant concern about the long-term safety of
drug-eluting stents (DES). However, bare metal stents (BMS) have been used
safely for over two decades. There is therefore a pressing need to explore
alternative strategies for reducing restenosis with BMS. This study was
designed to examine whether IVUS-guided cutting balloon angioplasty (CBA)
with BMS could convey similar restenosis rates to DES. Methods and
results: In the randomised REstenosis reDUction by Cutting balloon
angioplasty Evaluation (REDUCE III) study, 521 patients were divided into
four groups based on device and IVUS use before BMS (IVUS-CBA-BMS: 137
patients; Angio-CBA-BMS: 123; IVUS-BA-BMS: 142; and Angio-BA-BMS: 119). At
follow-up, the IVUS-CBA-BMS group had a significantly lower restenosis
rate (6.6%) than the other groups (p=0.016). We performed a quantitative
coronary angiography (QCA) based matched comparison between an IVUS-guided
CBA-BMS strategy (REDUCE III) and a DES strategy (Rapamycin-Eluting-Stent
Evaluation At Rotterdam Cardiology Hospital, the RESEARCH study). We
matched the presence of diabetes, vessel size, and lesion severity by QCA.
Restenosis (>50% diameter stenosis at follow-up) and target vessel
revascularisation (TVR) were examined. QCA-matched comparison resulted in
120-paired lesions. While acute gain was significantly greater in
IVUS-CBA-BMS than DES (1.65+/-0.41 mm vs. 1.28+/-0.57 mm, p=0.001), late
loss was significantly less with DES than with IVUS-CBA-BMS (0.03+/-0.42
mm vs. 0.80+/-0.47 mm, p=0.001). However, no difference was found in
restenosis rates (IVUS-CBA-BMS: 6.6% vs. DES: 5.0%, p=0.582) and TVR (6.6%
and 6.6%, respectively). Conclusions: An IVUS-guided CBA-BMS strategy
yielded restenosis rates similar to those achieved by DES and provided an
effective alternative to the use of DES. Europa Edition 2010. All rights
reserved.

<24>
Accession Number
2011198457
Authors
Reifart N. Hauptmann K.-E. Rabe A. Enayat D. Giokoglu K.
Institution
(Reifart, Rabe, Enayat, Giokoglu) Main Taunus Kliniken, Kronbergerstr. 36,
Bad Soden, 65812, Bad Soden, Germany
(Hauptmann) Krankenhaus Barmherzige Bruder, Trier, Germany
Title
Short and long term comparison (24 months) of an alternative
sirolimus-coated stent with bioabsorbable polymer and a bare metal stent
of similar design in chronic coronary occlusions: The CORACTO trial.
Source
EuroIntervention. 6 (3) (pp 356-360), 2010. Date of Publication: August
2010.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: We studied a novel sirolimus eluting stent with a bioabsorbable
coating (SES) in >3months old chronic total coronary occlusions (CTO).
Methods and results: Ninety-five patients were randomised to either BMS
(n=47) or SES (n=48). The primary endpoints were late lumen loss (LLL) and
in-segment restenosis (ISR) after six months. Secondary endpoints were
target vessel revascularisation after six and 24 months. Occlusion length
(37.6 mm), reference diameter (2.8 mm) as well as the stented segment
(45.5 mm) were similar in both groups. Up until six months no death,
myocardial infarction or stent thrombosis occurred in either group.
Angiographic follow-up (45BMS/46SES): LLL 1.8 mm/0.77 mm (p<0.0001), ISR
60%/17.4% (p<0.0001). In-segment re-occlusion 15.5%/0% and TVR 53.3%/10.8%
(p<0.0001). After 24 months: 1 BMS, 2 SES patients died; 0 BMS, 0 SES
infarction; 0 BMS, 0 SES stent thrombosis and 3 BMS, 0 SES TVR between six
and 24 months. Thus total TVR after 24 months was 60% for BMS and 10.8%
for SES (p<0.0001). Conclusions: The alternative sirolimus-coated stent
was shown to reduce the relative risk of restenosis after six months by
71%, and of TVR after 24 months by 82%. Between six and 24 months, neither
stent thrombosis occurred, nor repeat revascularisation was required in
patients who received a SES. Europa Edition 2010. All rights reserved.

<25>
Accession Number
70413895
Authors
Alreja G. Bugano D. Lotfi A.
Institution
(Alreja, Lotfi) Tufts-Baystate Medical Center, Springfield, MA, United
States
(Bugano) Hospital das Clinicas da Universidade de Sao Paulo, Sao Paulo,
Brazil
Title
Effect of remote ischemic preconditioning on myocardial and renal injury
in patients undergoing cardiovascular interventions: A meta analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 34th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI Baltimore, MD United States. Conference Start:
20110504 Conference End: 20110507. Conference Publication: (var.pagings).
77 (pp S88), 2011. Date of Publication: 01 May 2011.
Publisher
Wiley-Liss Inc.
Abstract
Background: Clinical trials evaluating the effect of remote ischemic
preconditioning (RIPC) to prevent cardiac and renal injury during
cardiovascular interventions (coronary artery bypass grafting [CABG],
percutaneous coronary intervention, abdominal aortic aneurysm [AAA] repair
and carotid endarterectomy) have yielded inconsistent results. Methods:
Meta-analysis of prospective randomized clinical trials of patients
undergoing cardiovascular interventions who received RIPC versus control
was performed. 2 independent reviewers selected articles from databases
MEDLINE, EMBASE, SCOPUS, Cochrane, ISI Web of Science and BIREME.
Surrogate markers of myocardial (Troponin T or I and CK-MB) and renal
(serum creatinine) injury for primary outcomes were abstracted. Results:
Final pooled analysis from 18 clinical trials showed significant
heterogeneity of results and no relevant publication bias. When compared
to control, RIPC significantly reduced myocardial injury in patients
undergoing cardiovascular interventions (standard mean difference ([SMD]
-0.54 95% CI -1.01 to -0.08 p=0.02) especially in patients undergoing
Cardiac surgery (SMD -0.68, 95% CI -1.20 to -0.16, p=0.004). For patients
undergoing only CABG, RIPC showed a trend towards significance (SMD -0.50
95% CI -1.03 to 0.04, P= 0.07). In patients with AAA repair, RIPC when
compared to control also decreased renal injury (SMD: -0.51 95%CI: -0.78
to -0.23 p< 0.001, I2 = 0%). Trials reporting clinical outcomes were not
adequately powered to determine difference. Conclusions: RIPC is an
inexpensive and safe cardiac and renal protective strategy as determined
by surrogate markers for patients undergoing cardiovascular interventions.
Large trials should be conducted to establish the effect of remote
conditioning on clinical outcomes.[Table Represented].

<26>
Accession Number
70413866
Authors
Alam M. Huang H. Rogers P. Paniagua D. DeBakey M.E. Kar B. Jneid H.
Institution
(Alam, Huang, Rogers, Paniagua, Kar, Jneid) Baylor College of Medicine,
Houston, TX, United States
(DeBakey) Veterans Affair Medical Center, Houston, TX, United States
Title
Long-term outcomes of percutaneous coronary intervention with drug-eluting
stents versus coronary artery bypass graft surgery for unprotected left
main coronary artery stenosis.
Source
Catheterization and Cardiovascular Interventions. Conference: 34th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI Baltimore, MD United States. Conference Start:
20110504 Conference End: 20110507. Conference Publication: (var.pagings).
77 (pp S72-S73), 2011. Date of Publication: 01 May 2011.
Publisher
Wiley-Liss Inc.
Abstract
Background: Patients with unprotected left main coronary artery (ULMCA)
stenosis are increasingly treated with PCI using DESs. Its short- and
intermediate-term safety compared with CABG have been established in
select patient populations, albeit at the expense of increased repeat
revascularization. Longer follow-up data comparing PCI with DES vs. CABG
are largely lacking. Methods: We performed aggregate data meta-analyses of
clinical outcomes in studies comparing PCI with DESs vs. CABG for ULMCA
stenosis and reporting at least three years of follow-up. A search of
Medline and conference proceedings between 01/2000 and 10/2010 identified
8 studies enrolling 4,050 patients, of whom 1,899 and 2,151 underwent PCI
and CABG, respectively. Summary odds ratios & 95% confidence intervals
were calculated using the randomeffects model. Results: No major
inter-group differences in baseline socio-demographic and clinical
characteristics were observed. Compared with CABG, the PCI group had a
higher proportion of isolated ULMCA and ULMCA with single CAD, and a trend
towards shorter hospital stay. Following a median follow-up of 45 months,
patients in the PCI group had lower rates of stroke (OR= 0.39, 95% CI
0.19-0.76), lower composite endpoint of death/MI/stroke (OR= 0.57, 95% CI
0.37-0.89), and similar rates of death (OR= 0.82, 95% CI 0.64-1.05) and
non-fatal MI (OR= 1.26, 95% CI 0.56-2.83) compared with CABG. On the other
hand, the PCI group experienced increased risk of composite endpoint of
death/MI/stroke/repeat revascularization (MACCE; OR 1.25, 95% CI
1.02-1.52), which was driven predominantly by higher repeat
revascularization rates (OR 3.45, 95% CI= 2.33-5.12) (Figure 1).
Conclusions: In appropriately selected patients, PCI with DES for ULMCA
stenosis appears at least as safe as CABG, with lower stroke and
comparable mortality and MI rates, but is associated with increased rates
of repeat revascularization during long-term follow-up.

<27>
Accession Number
70413276
Authors
Ahmad S. Ali M. Kumar N. Guddati A.K. Taneja A. Kumar G.
Title
Outcomes of cardio-thoracic surgery in cirrhotic patients.
Source
Gastroenterology. Conference: Digestive Disease Week, DDW 2011 Chicago,
IL United States. Conference Start: 20110507 Conference End: 20110510.
Conference Publication: (var.pagings). 140 (5 SUPPL. 1) (pp S959), 2011.
Date of Publication: May 2011.
Publisher
W.B. Saunders
Abstract
Background: A recent meta-analysis reported poor outcomes in patients with
cirrhosis undergoing coronary artery bypass graft (CABG). Although
previous studies have reported higher mortality and morbidity in patients
with cirrhosis undergoing CABG, however studied patient populations have
been limited to data from academic and specialized centers. We analyzed
the outcomes of cardiothoracic surgery in cirrhotic patients on a national
inpatient sample. Methods: Using the Nationwide Inpatient Sample 2008,
patients older than 18 years, discharged with any diagnosis of cirrhosis
were identified through appropriate ICD- 9-CM codes. The patients with
major cardiac surgeries involving sternotomy or thoracotomy were similarly
identified using the ICD-9 procedure codes. The lung and heart transplant
patients were excluded from the study. Outcome variables included
frequency, in-hospital mortality and length of stay (LOS) of cardiac
surgeries in cirrhotic patients. Using the STATA software, multivariate
logistic regression was performed to adjust for age, sex, race and
Elixhauser co-morbidity index. Chi square test and T- test were used for
comparing categorical and continuous variable respectively. The outcomes
were also evaluated using Baveno classification of compensated (Class I &
II) and uncompensated cirrhosis (Class III & IV). Results: There were
438,306 estimated adult discharges with cirrhosis in 2008. The frequency
of admissions requiring cardiothoracic surgery was 0.33% in cirrhotics
when compared to 1.0% in non-cirrhotic hospitalization. Compensated
cirrhotics comprised 91% of the surgeries. Cirrhotic patients had higher
mortality rates when compared to non cirrhotic patient (10.3% vs. 3.1%,
p<0.001). After age and sex adjusted analysis, patients with cirrhosis had
3.9 times higher odds of dying when compared to non cirrhotics. The rates
of prolonged mechanical ventilation were significantly higher in the
cirrhotics (OR 2.0, 95%CI 1.4-2.7, p<0.001). Similarly the need for blood
and platelet transfusion was 1.3 times and 2 times higher respectively.
The LOS in cirrhosis patients undergoing cardio-thoracic surgeries was 2
days (Median LOS: 10 days vs. 8 days; p<0.001) longer than non cirrhosis
patients. Conclusion: This observational study confirms that
cardiothoracic surgery carries a significantly higher mortality even in
patients with compensated cirrhosis. In addition postoperative
complications like prolonged mechanical ventilation are common.
Identification of high risk patients and appropriate pre/post operative
management is of vital importance to reduce the mortality and morbidity of
patients with cirrhosis undergoing surgical procedures.