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<1>
Accession Number
2011280044
Authors
Zahid I. Sharif S. Routledge T. Scarcib M.
Institution
(Zahid, Sharif) Imperial College London, South Kensington Campus, London
SW7 2AZ, United Kingdom
(Routledge, Scarcib) Department of Thoracic Surgery, Guy's Hospital, Great
Maze Pond, London SE1 9RT, United Kingdom
Title
Is pleurectomy and decortication superior to palliative care in the
treatment of malignant pleural mesothelioma?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (5) (pp 812-817),
2011. Date of Publication: May 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether pleurectomyy
decortication (PyD) is superior to palliative care in the treatment of
patients with malignant pleural mesothelioma (MPM). Overall 80 papers were
found using the reported search, of which 11 represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results are tabulated. We conclude that PyD may lead to superior survival
rates but at the expense of higher morbidity rates to palliative
treatment. Six studies reported patient outcomes after use of radical PyD
to treat patients with MPM. Radical PyD leads to a higher median survival
than supportive care (14.5 vs. 4.5 months) and non-radical decortication
(15.3 vs. 7.1 months, P-0.000). However, radical PyD had a complication
rate of 30%, hospital stay of 12 days with an operative mortality rate of
9.1%. One-year survival rate was 65% but this fell to 0-24% at three
years. Three studies highlighted the use of palliative chemotherapy to
manage patients with MPM. Median survival (14 vs. 10 months) was higher in
patients who received chemotherapy early compared to those on a delayed
protocol. Early chemotherapy had a longer time to disease progression (25
vs. 11 weeks, Ps0.1) and greater one-year survival (66% vs. 36%) than the
delayed group. Active symptom control (ASC) alone had lower symptom
control rates than the combination of ASC plus MVP
(mitomycinqvinblastineqcisplatin) (7% vs. 11%, Ps0.0017) and ASC plus
vinorelbine (4% vs. 7%, Ps0.047). Three studies reported results of
palliative surgery in patients with known MPM. Median survival period was
213 days with a 30-day mortality rate of 7.8%. Survival rates reduced from
70.6% at three months to 25.5% at one-year post-surgery. Prolonged
air-leak and postoperative empyema complicated 9.8% and 4% of patients,
respectively. PyD is a morbid operation that is associated with
significant perioperative mortality and complication rates. Although a
number of retrospective studies have shown a small benefit in survival
with PyD, the heavily documented similarity in patient outcomes between
PyD and extrapleural pneumonectomy along with the results of the
Mesothelioma and Radical Surgery trial, should induce the surgical
community to consider the use of PyD only in patients with malignant
mesothelioma enrolled in prospective trials. 2011 Published by European
Association for Cardio-Thoracic Surgery. All rights reserved.

<2>
Accession Number
2011280040
Authors
Nagendran M. Maruthappua M. Sugand K.
Institution
(Nagendran, Maruthappua) Green Templeton College, University of Oxford,
Woodstock OX2 6HG, United Kingdom
(Sugand) Department of Surgery, Kingston Hospital, Kingston upon Thames,
Surrey KT2 7QB and St George's London Healthcare Trust, London, United
Kingdom
Title
Should double lung transplant be performed with or without cardiopulmonary
bypass?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (5) (pp 799-804),
2011. Date of Publication: May 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether double lung
transplantation should be performed with or without cardiopulmonary bypass
(CPB) in order to improve postoperative clinical outcomes. Altogether 386
papers were found using the reported search, of which 14 represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. All 14 papers assessed
a range of postoperative outcomes and broadly speaking, six papers found
significantly worse outcomes with CPB use, six found no difference and two
found a mixture of both depending on the specific outcomes assessed.
Dalibon et al. wJ Cardiothorac Vasc Anesth 2006;20:668-672x found that
mortality was significantly worse in the CPB group at 48 h, one month and
one year wPs0.001, odds ratio (OR)s246.1; Ps0.083, ORs2.6; Ps0.001,
ORs5.3, respectivelyx. Other papers revealed poor outcomes in the CPB
group in a range of measures including diffuse alveolar damage (Ps0.009),
chest radiograph infiltrate score (Ps0.005), longer intubation time
(Ps0.002), longer intensive care unit stay (Ps0.05), and greater incidence
of pulmonary reimplantation response (Ps0.03). However, Myles et al. wJ
Cardiothorac Vasc Anesth 1997;11:177-183x found that only acute
postoperative outcomes were significantly worse in their CPB group
(P-0.001); medium- and long-term survival outcomes were not significantly
different (Ps0.055). de Boer et al. wTransplantation 2002;73:1621-1627x
even found that there was an improved one-year survival rate with CPB use
(ORs0.25, Ps0.038) and that the number of human leukocyte antigen DR
(HLA-DR) mismatches influenced this effect. Those papers suggesting no
deleterious effects of CPB generally measured similar postoperative
outcomes to those mentioned above, with one study also assessing incidence
of primary graft failure, which was not significantly different (Ps0.37).
We conclude that CPB should continue to be used where clinically indicated
for a specific reason (for example, where there is pulmonary hypertension
or a requirement for concomitant cardiac repair). However, given that the
evidence for using CPB for all elective cases is relatively weak, and the
fact that there are strong arguments in the literature for both methods,
either approach would be clinically acceptable. 2011 Published by
European Association for Cardio-Thoracic Surgery. All rights reserved.

<3>
Accession Number
2011280022
Authors
Alayouty H.D. Amin M.M. Aloukda A.W. Bafakeer S.S. Sulieman D.D.
Institution
(Alayouty, Amin) Department of Cardiothoracic Surgery, Suez Canal
University, Faculty of Medicine, Ismailia, Egypt
(Aloukda) Department of Pathology, Suez Canal University, Faculty of
Medicine, Ismailia, Egypt
(Bafakeer) Department of Pathology, Hadhramout University, Hadhramout,
Yemen
(Sulieman) Department of Surgery, Hadhramout University, Hadhramout, Yemen
Title
Should three slide-touch print cytology replace pleural lavage cytology
for detection of pleural micrometastases in cases of bronchogenic
carcinoma?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (5) (pp 728-732),
2011. Date of Publication: May 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A prospective study, including 112 patients, designed to estimate the
sensitivity and specificity of slide-touch and pleural lavage cytology for
diagnosis of pleural micrometastases in operable non-small cell lung
cancer (NSCLC). Histopathologically, excised tumors showed P0 in 22
patients (19%), P1 in 44 patients (39%), P2 in 32 patients (29%), P3 in 14
patients (13%). Cytological examination of the three slidetouch prints
from visceral pleura overlying the tumor (slide 1), parietal pleura facing
tumor (slide 2), parietal pleura in paravertebral gutter (slide 3)
resulted in: slide 1: positive in 60% (66y112) wthis included p0 (2 out of
22), p1 (22 out of 44), p2 (32 out of 32) and p3 (10 out of 14)x, slide 2:
positive in 13% (14y112); all of them had P3, and slide 3 positive in 8%
(9y112). Total positive slides 62% (70y112). Pleural lavage: positive in
19% (22y112), all of them were detected with slide 1 andyor slide 2.
During follow-up, patients with negative slides had no local or distant
metastases (truly negative), six recurrences among those with positive
slide 1, including four with positive lavage. Thus, slide touch print is
more sensitive than lavage cytology, both of prognostic significance.
Slide 1 is a highly sensitive detector of visceral pleural
micrometastases; slide 2 is a more sensitive detector of parietal pleural
invasion; slide 3 is the least. 2011 Published by European Association
for Cardio-Thoracic Surgery. All rights reserved.

<4>
Accession Number
2011278537
Authors
Talasaz A.H. Khalili H. Fahimi F. Mojtaba S.
Institution
(Talasaz, Fahimi) Department of Clinical Pharmacy, Shaheed Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Talasaz, Khalili) Department of Clinical Pharmacy, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Mojtaba) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Potential role of N-acetylcysteine in cardiovascular disorders.
Source
Therapy. 8 (3) (pp 237-245), 2011. Date of Publication: May 2011.
Publisher
Future Medicine Ltd. (2nd Albert Place, Finchley Central, London N3 1QB,
United Kingdom)
Abstract
Cardiovascular disorders are a common cause of mortality around the world.
The role of antioxidants is controversial in the prevention and treatment
of a wide variety of cardiovascular events. N-acetylcysteine (NAC) is an
antioxidant that is believed to have an adjunctive beneficial effect in
different medical conditions. We investigated all of the cardiovascular
disorders for which NAC was administered in order to find its possible
advantageous impact. We included clinical trials that were conducted in
patients with heart failure, myocardial infarction, hypertension,
atherosclerosis, ischemic heart disease or those who underwent
cardiothoracic surgery. However, to date there is no comprehensive review
on the potential impact of NAC in cardiovascular disorders. Therefore, we
conducted a systematic literature search in MEDLINE/PubMed. A search
strategy using medical subject headings and text keywords such as 'aN-
acetylcysteine, cardiology cardiac 'acute care cardiovascular
cardiothoracic heart failure myocardial infarction
hypertensionatherosclerosis andischemic heart disease was performed. After
a complete literature review, we arranged the data collected on this
subject and suggested some aspects for further research. 2011 Future
Medicine Ltd.

<5>
Accession Number
2011282569
Authors
Salvo F. Fourrier-Reglat A. Bazin F. Robinson P. Riera-Guardia N. Haag M.
Caputi A.P. Moore N. Sturkenboom M.C. Pariente A.
Institution
(Salvo, Fourrier-Reglat, Bazin, Robinson, Moore, Pariente) Departement de
Pharmacologie, Universite de Bordeaux, Bordeaux, France
(Salvo, Fourrier-Reglat, Bazin, Moore, Pariente) INSERM U657, Bordeaux,
France
(Salvo, Caputi) Dipartimento Clinico Sperimentale di Medicina e
Farmacologia, Universita di Messina, Messina, Italy
(Fourrier-Reglat, Moore, Pariente) CHU de Bordeaux, Bordeaux, France
(Fourrier-Reglat, Bazin, Robinson, Moore, Pariente) INSERM CIC 0005,
Bordeaux, France
(Riera-Guardia) RTI-Health Solutions, Barcelona, Spain
(Haag, Sturkenboom) Department of Medical Informatics, Erasmus University
Medical Centre, Rotterdam, Netherlands
Title
Cardiovascular and gastrointestinal safety of NSAIDs: A systematic review
of meta-analyses of randomized clinical trials.
Source
Clinical Pharmacology and Therapeutics. 89 (6) (pp 855-866), 2011. Date
of Publication: June 2011.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
As part of the Safety of Non-Steroidal Anti-Inflammatory Drugs (SOS)
Project, we reviewed the incidence of cardiovascular (CV) and
gastrointestinal (GI) events associated with the use of this category of
drugs. We collected data from published meta-analyses (MAs) of clinical
trials of nonsteroidal anti-inflammatory drugs (NSAIDs). The Medline,
Cochrane, ISI, and SCOPUS databases were systematically searched for MAs
of NSAID clinical trials that could potentially contain data on adverse
incidents such as myocardial infarction (MI), cerebrovascular events
(CeVs), stroke, thromboembolic events (ThEs), heart failure (HF),
gastrointestinal bleeding (GIB), and perforation, ulcer, and bleeding
(PUB). From 1,733 identified references, 29 MAs were selected for the
review. This allowed 109 estimations of incidence rates of CV adverse
events and 26 estimations of incidence rates for GI adverse events. No
data were found on hemorrhagic stroke or LGIB. Coxibs were studied in more
MAs than traditional NSAIDs were (21 MAs for coxibs vs. 7 for traditional
NSAIDs; one meta-analysis studied both). Many NSAIDs were not considered
in any of the MAs. Our systematic review of MAs included information on
the incidence of CV and GI events and identified important knowledge gaps
regarding, in particular, the CV safety of traditional NSAIDs. 2011
American Society for Clinical Pharmacology and Therapeutics.

<6>
Accession Number
70433137
Authors
Giobbe D. Balducci A. Paglia G. Giobbe M.L. Scacciatella P. Alunni G.L.
Giorgi M. Marra S.
Institution
(Giobbe, Balducci, Paglia, Giobbe) Dipartimento di Neuroscienze Azienda
Ospedaliero, Universitaria San Giovanni Battista Torino, Turin, Italy
(Scacciatella, Alunni, Giorgi, Marra) Dipartimento Cardiotoracico Azienda
Ospedaliero, Universitaria San Giovanni Battista Torino, Turin, Italy
Title
Cryptogenic ischemic events and patent foramen ovale: Endovascular
treatment results in the turin san giovanni battista hospital registry.
Source
Cerebrovascular Diseases. Conference: 20th European Stroke Conference,
ESC 2011 Hamburg Germany. Conference Start: 20110524 Conference End:
20110527 Sponsor: Bayer, Boehringer, ev3, Allergan, Pfizer, et al..
Conference Publication: (var.pagings). 31 (pp 296), 2011. Date of
Publication: May 2011.
Publisher
S. Karger AG
Abstract
Background: In pts with cryptogenic cerebral ischemic events (CCIE) and
Patent Foramen Ovale (PFO) a higher rate of recurrencies is known to occur
if an interatrial septal aneurysm (ISA), or a hypercogulable state are
associated, or the ischemic events are multiple, or the shunt is large.
Methods: 90 such pts performed clinical and lab examinations,
neuroimaging, duplex scanner, transthoracic (TTE) and transesophageal
echocardiography (TEE). Antiplatelet agents were employed before closure.
The procedure had a 45' mean duration time. An Amplatzer PFO-occluder was
employed in 95% of cases. The follow up included a cardiological and
neurological re-evaluation at 1 and 6 months and subsequently every 6
months, a TTE at 1 month, a TEE at 6 months. Subsequently TEE was repeated
every year only if shunt persistence. The postprocedural treatment was ASA
+ Clopidogrel for 3 months, then ASA for 3 months. Afterward ASA was
continued if a residual shunt was present. Results: In the periprocedural
time a transient paroxistic atrial arrythmia was observed in 4 pts and 1
TIA occurred; no residual large shunts or hemorrhagic events were
identified. During the follow up (mean duration 27,2 months) 9 small and 8
severe residual shunts were identified (2 treated with a second
procedure), 1 stroke, 3 transient arrhythmias and an interatrial sept
erosion occurred, 2 pts underwent surgery. No major cardiac events were
observed. Conclusions: Mas (2001) reported a 4 year recurrence rate (RR)
of 19,2% for pts with CCIE +PFO+ ISA; Nedeltchev (2002) and Anzola (2003)
showed respectively an annual RR of 9,9% in pts with multiple ischemic
events and of 8,2% in pts with a large shunt; finally Almekhlafi's
metaanalysis indicates a 4% CCIE annual RR. In our group percutaneous
closure of PFO proved safe and effective in the short and middle time.
Also if the sample is still narrow it seems promising the annual
recurrence rate is considerably lower (0,6%) than reported in literature.

<7>
Accession Number
70431756
Authors
Klaseie M.E.
Institution
(Klaseie) Feiringklinikken, Eidsvoll, Norway
Title
Acute confusion in the postoperative cardiac patient.
Source
European Journal of Cardiovascular Nursing. Conference: 11th Annual
Spring Meeting on Cardiovascular Nursing Brussels Belgium. Conference
Start: 20110401 Conference End: 20110402. Conference Publication:
(var.pagings). 10 (pp S2), 2011. Date of Publication: April 2011.
Publisher
Elsevier
Abstract
How can the cardiology nurse reduce the possibility for development of
acute confusion after cardiac surgery by facilitating sleep? Acute
confusion in patients in intensive care units and wards is a known
phenomenon in cardiac patients after open heart surgery. As cardiac
nurses, we want to increase the focus on acute confusion in postoperative
cardiac patients, and contribute to its prevention by facilitating sleep.
Guidelines to prevent acute confusion and treatment for these patients are
missing. An increased focus on this topic creates an environment for
increased knowledge and improved practice. The background for this study
is based on a systematic review. Searching for information from all
pertinent research papers and relevant literature on the topic of heart
surgery, coronary artery bypass graft, acute confusion and sleep
disturbance. In addition, we also used clinical expert assessment of
colleagues and our own experience in this area. We found that the
strongest risk factors for acute confusion after open heart surgery are
personal history of cerebrovascular disease or atrial fibrillation and
older age. Expert opinion confirms that the environment for care of these
patients needs to be improved. The literature shows that there are several
contributing factors that can generate acute confusion including certain
medicines, infection, low oxygenation, urinary problems, electrolyte
disturbance, lack of sleep, monotony, and being in an unfamiliar place.
One review revealed that forty-eight percent of postoperative cardiac
patients have reported noise and interventions by health professionals as
the main reason for sleep disturbance. Another review indicated that the
measured noise level in an intensive care unit is almost double of what is
recommended during the day, and more than double in the evening. Patients
that develop acute confusion are hospitalized 11 days longer than those
who have no confusion. The cardiac nurses' knowledge and expertise is
vital in identifying the patient at risk for developing acute confusion
postoperatively. Checklists are a useful tool for clinicians to use
throughout the hospital stay. Patients at risk can be identified and the
nurse may, by means of simple measures, facilitate sleep through the
creation of a therapeutic environment, thereby preventing the development
of acute confusion. This may decrease length of stay. A therapeutic
environment that decreases noise level will produce better outcomes for
patients and can reduce hospital costs.

<8>
Accession Number
2011288754
Authors
Saran T. Perkins G.D. Javed M.A. Annam V. Leong L. Gao F. Stedman R.
Institution
(Saran, Perkins, Javed, Annam, Leong, Gao, Stedman) Academic Department of
Anaesthesia, Critical Care and Pain, Heart, England NHS Foundation Trust,
Birmingham B9 5SS, United Kingdom
(Saran, Perkins, Gao) Warwick Medical School, University of Warwick,
Coventry CV4 7AL, United Kingdom
(Saran) Department of Anaesthesia, University Hospitals, Coventry and
Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
Title
Does the prophylactic administration of magnesium sulphate to patients
undergoing thoracotomy prevent postoperative supraventricular arrhythmias?
A randomized controlled trial.
Source
British Journal of Anaesthesia. 106 (6) (pp 785-791), 2011. Date of
Publication: June 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Supraventricular arrhythmias (SVA) are common after thoracic surgery and
are associated with increased morbidity and mortality. This prospective,
randomized, double-blind, placebo-controlled trial examined the effects of
perioperative magnesium on the development of postoperative SVA. Methods.
Two hundred patients undergoing thoracotomy for lobectomy, bi-lobectomy,
pneumonectomy, or oesophagectomy were recruited and randomly allocated
into two groups. The treatment group received magnesium (5 g daily)
intraoperatively, and on days 1 and 2 after operation, the control group
received placebo. The primary outcome of the study was the development of
SVA within the first 5 days after operation. Results. There were 100
patients in each arm of the study, with one withdrawal and three lost to
follow-up in the treatment group and four withdrawals in the control
group. Ninety-six patients received magnesium and 96 received placebo.
There was no difference in the incidence of SVA between the treatment and
control groups, 16.7 (16/96) vs 25 (24/96), P0.16. In the predefined
subgroup analysis, patients at highest risk of arrhythmias (those
undergoing pneumonectomy) had a significant reduction in the frequency of
SVA, 11.1 (2/18) vs 52.9 (9/17), P0.008. There were no differences in
hospital length of stay or mortality. Patients receiving i.v. magnesium
experienced a higher frequency of minor side-effects (stinging at
injection site). The treatment was otherwise well tolerated. Conclusion.
sOverall, prophylactic magnesium did not reduce the incidence of SVA in
patients undergoing thoracotomy. However, it reduced the incidence of SVA
in the high-risk cohort of patients undergoing pneumonectomy.
(ISRCTN22028180.) The Author [2011].

<9>
Accession Number
2011288752
Authors
Schoen J. Husemann L. Tiemeyer C. Lueloh A. Sedemund-Adib B. Berger K.-U.
Hueppe M. Heringlake M.
Institution
(Schoen, Husemann, Tiemeyer, Lueloh, Sedemund-Adib, Berger, Hueppe,
Heringlake) Department of Anesthesiology, University of Luebeck,
Ratzeburger Allee 160, D-23538 Luebeck, Germany
Title
Cognitive function after sevoflurane- vs propofol-based anaesthesia for
on-pump cardiac surgery: A randomized controlled trial.
Source
British Journal of Anaesthesia. 106 (6) (pp 840-850), 2011. Date of
Publication: June 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Cognitive dysfunction is a frequent complication after cardiac surgery and
has been found to be associated with decreases in cerebral oxygen
saturation measured with near-infrared spectroscopy. Sevoflurane has
neuroprotective properties in vitro and in animal models. This study was
designed to determine cognitive and clinical outcomes after sevoflurane-
compared with propofol-based anaesthesia for on-pump cardiac surgery and
the impact of decreases in under different anaesthesia regimens. Methods.
One hundred and twenty-eight patients were randomly assigned to either
i.v. anaesthesia with propofol- (PROP) or sevoflurane-based anaesthesia
(SEVO). An intraoperative was defined as desaturation. The Abbreviated
Mental Test, Stroop Test, Trail-Making Test, Word Lists, and
mood-assessment tests were performed before, 2, 4, and 6 days after
cardiac surgery. Markers of general outcome were obtained. Results. The
analysis groups had differences in baseline cognitive performance.
Analysis of variance for repeated measures (incorporating covariance of
baseline scores) showed that in three of four cognitive tests, patients
with cerebral desaturation showed worse results than patients without
desaturation. Patients assigned to sevoflurane-based anaesthesia showed
better results in all cognitive tests than patients after propofol.
Interactions between the anaesthetic regimen and desaturation were found
in all four cognitive tests. There were no differences in markers of organ
dysfunction or general clinical outcome. Conclusion. sPatients with
impaired cognitive performance before operation may be at particular risk
for intraoperative cerebral insult. A sevoflurane-based anaesthesia was
associated with better short-term postoperative cognitive performance than
propofol. The Author [2011].

<10>
Accession Number
2011288748
Authors
Ruetzler K. Grubhofer G. Schmid W. Papp D. Nabecker S. Hutschala D. Lang
G. Hager H.
Institution
(Ruetzler, Grubhofer, Schmid, Papp, Nabecker, Hutschala, Hager) Department
of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine,
Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna,
Austria
(Lang) Department of Thoracic Surgery, Medical University of Vienna,
Waehringer Guertel 18-20, 1090 Vienna, Austria
Title
Randomized clinical trial comparing double-lumen tube and EZ-Blocker for
single-lung ventilation.
Source
British Journal of Anaesthesia. 106 (6) (pp 896-902), 2011. Date of
Publication: June 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
In several clinical situations, lung separation and single-lung
ventilation (SLV) is essential. In these cases, the double-lumen tube
(DLT) is the most widely used device. Bronchial blocker such as Univent or
Arndt Blocker serves as an alternative. The EZ-Blocker (EZ; AnaesthetIQ
B.V., Rotterdam, The Netherlands) is a new device promising to exceed
clinical performance of DLT. The aim of this study was to assess the
clinical performance of EZ in comparison with conventional left-sided DLT.
Methods. Forty adult patients undergoing elective thoracic surgery
requiring thoracotomy and SLV were included in this study. The patients
were randomly assigned to one of two groups: EZ (combined with
conventional 7.5 or 8.5 mm single-lumen tube) or DLT (37 or 39 Fr
left-sided DLT). Time for intubation procedure and time to verification of
the correct position of EZ or DLT using fibreoptic bronchoscopy (FOB) were
recorded. After surgery, a thoracic surgeon rated the quality of collapse
of the lung (13 on a three-level scale). Results. Time for intubation
using DLT 85.5 (54.8) s was significantly faster (P<0.001) than using EZ
192 (89.7) s, whereas time for bronchoscopy was not significantly
different (P0.556). Conditions of surgery were rated equally [DLT 1.3
(0.6) vs EZ 1.4 (0.6), P0.681]. Conclusion. sAlthough time for intubation
was longer with the EZ, the device proved to be an efficient and
easy-to-use device. The EZ is a valuable alternative device to
conventional DLT. Verification of the correct position of the EZ by FOB
seems to be obligatory.This study was registered at
http://www.clinicaltrials.gov (identifier: NCT01171560). The Author
[2011].

<11>
Accession Number
2011283438
Authors
Benedetto U. Melina G. Takkenberg J.J.M. Roscitano A. Angeloni E. Sinatra
R.
Institution
(Benedetto, Melina, Roscitano, Angeloni, Sinatra) Department of Cardiac
Surgery, University of Rome Sapienza, Policlinico S Andrea, Rome, Italy
(Takkenberg) Department of Cardio-Thoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
Title
Surgical management of aortic root disease in Marfan syndrome: A
systematic review and meta-analysis.
Source
Heart. 97 (12) (pp 955-958), 2011. Date of Publication: June 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Context: Surgical treatment of aortic root aneurysm in Marfan syndrome
(MFS) patients. Objective: To compare results of total root replacement
versus valve-sparing aortic root replacement in MFS patients. Data
Sources: PubMed, Embase and Cochrane library were searched from January
1966 until February 2010 looking for papers reporting on aortic root
operations in MFS patients. 530 studies were retrieved. Study Selection:
Finally, 11 publications were enrolled. Inclusion criteria were
observational studies reporting valve-related morbidity and mortality
after total root replacement (TTR) and/or valve-sparing root replacement
(VSRR) in patients with MFS and study size n>=30, reflecting the centre's
experience. Data Extraction: Data obtained from papers reporting both TRR
and VSRR cohorts were analysed separately. In case of multiple
publications, the most recent and complete report was selected. If the
total number of patient-years was not provided, we calculated it by
multiplying the number of hospital survivors with the mean follow-up
duration of that study. Results: Overall, 1385 patients were analysed (972
patients had TTR and 413 patients had VSRR). Reintervention rate was
0.3%/year (95% CI 0.1 to 0.5) versus 1.3%/year (95% CI 0.3 to 2.2)
(p=0.02) and thromboembolic events rate was 0.7%/year (95% CI 0.5 to 0.9)
versus 0.3%/year (95% CI 0.1 to 0.6) (p=0.01) after TRR and VSRR,
respectively. When composite valve-related events were compared, no
difference existed between the two surgical strategies (p=0.41). Among
patients undergoing VSRR, reimplantation was associated with a reduced
rate of reintervention compared with remodelling (0.7%/year vs 2.4%/year,
p=0.02). Conclusions: VSRR may represent a valuable option for patients
with MFS with aortic aneurysm. However, this technique should be used with
caution in patients with valve characteristics at risk for decreased
durability.

<12>
Accession Number
2011280037
Authors
Muehling B.M. Ortlieb L. Oberhuber A. Orend K.H.
Institution
(Muehling, Ortlieb, Oberhuber, Orend) Department of Thoracic and Vascular
Surgery, University of Ulm, Steinhovelstrasse 9, 89075 Ulm, Germany
Title
Escvs article - aortic and aneurismal fast track management reduces the
systemic inflammatory response and organ failure following elective
infrarenal aortic aneurysm repair.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (5) (pp 784-788),
2011. Date of Publication: May 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: Systemic inflammatory response syndrome (SIRS) is common after
abdominal aortic aneurysm (AAA) repair. The aim of this study was to
analyze the impact of a multimodal fast track (FT) regimen on incidence
rates of SIRS after elective infrarenal AAA repair. Methods: Post hoc
analysis of a randomized controlled trial including 99 patients after
either traditional (TC) or FT care. Basic FT elements were no bowel
preparation, reduced preoperative fasting, patient controlled epidural
analgesia, enhanced postoperative feeding and mobilization. The presence
of SIRS, organ failure and mortality, length of stay (LOS) on intensive
care unit (ICU) were analyzed during the postoperative course. Results:
The incidence of SIRS in the FT treatment arm was significantly lower as
compared to TC: 28% vs. 50%, Ps0.04. The rate of any organ failure (AOF)
and multiple organ failure (MOF) was lower in the FT group: AOF: 16% vs.
36%, Ps0.039; MOF: 2% vs. 12%; Ps0.112. LOS on ICU showed a slight
advantage for FT care: 20 hours vs. 32 hours (Ps0.183). Conclusion: An
optimized patient care program in elective open AAA repair significantly
decreases the postoperative incidence of SIRS as well as rates of organ
failure. 2011 Published by European Association for Cardio-Thoracic
Surgery. All rights reserved.

<13>
Accession Number
2011280033
Authors
Bosmans J.M. Kefer J. De Bruyne B. Herijgers P. Dubois C. Legrand V.
Verheye S. Rodrigus I.
Institution
(Bosmans, Rodrigus) Department of Cardiology and Cardiac Surgery, Antwerp
University Hospital, Antwerp, Belgium
(Kefer) Department of Cardiology, UCLouvain, Brussel, Belgium
(De Bruyne) Department of Cardiology, OLV Ziekenhuis, Aalst, Belgium
(Herijgers) Department of Cardiac Surgery, University Hospital Leuven,
Leuven, Belgium
(Dubois) Department of Cardiology, University Hospital Leuven, Leuven,
Belgium
(Legrand) Department of Cardiology, CHU de Liege, Liege, Belgium
(Verheye) Department of Cardiology, Middelheim Ziekenhuis, Antwerp,
Belgium
Title
Procedural, 30-day and one year outcome following corevalve or edwards
transcatheter aortic valve implantation: Results of the belgian national
registry.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (5) (pp 762-767),
2011. Date of Publication: May 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
We report clinical outcomes following transcatheter aortic valve
implantation (TAVI), using the CoreValve revalving system (18 Fr
transfemoral or subclavian) or the Edwards Sapien valve (22 Fr
transfemoral or 24 Fr transapical) as part of a Belgian prospective
nonrandomized multicentre registry. All 15 Belgian centres performing TAVI
participated to this registry (seven exclusively Edwards Sapien, eight
exclusively CoreValve). All consecutive high-risk symptomatic patients
with severe aortic stenosis were evaluated by a heart team and screened
for eligibility for TAVI. Three hundred and twenty-eight patients
underwent TAVI with CoreValve (n=141; eight subclavian and 133
transfemoral) or Edwards Sapien (n=187; 99 transfemoral and 88
transapical) up to April 2010. Procedural success was 97%. Onemonth
survival was 88% for the Edwards and 89% for the CoreValve treated
patients. One-month mortality was both related to cardiac and non-cardiac
reasons. Overall one-year survival was 78% in the CoreValve transfemoral
treated patients, 100% in the CoreValve subclavian treated patients, 82%
in the Edwards transfemoral treated patients and 63% in the Edwards
transapical treated patients. This mid-term mortality was mainly related
to age-related, non-cardiac complications. 2011 Published by European
Association for Cardio-Thoracic Surgery. All rights reserved.

<14>
Accession Number
2011303392
Authors
Kim T.-Y. Kim D.-K. Yoon T.-G. Lim J.-A. Woo N.-S. Chee H.-K. Shin J.-K.
Song M.-G. Kim S.-H.
Institution
(Kim, Kim, Yoon, Lim, Woo, Chee, Shin, Song, Kim) Department of
Anaesthesiology and Pain Medicine, Konkuk University School of Medicine,
Hwayang-dong, Gwangjin-gu, Seoul 143-729, South Korea
(Chee) Department of Cardiovascular and Thoracic Surgery, South Korea
(Kim) Department of Anaesthesiology, South Korea
Title
Myocardial injury in remifentanil-based anaesthesia for off-pump coronary
artery bypass surgery: An equipotent dose of sevoflurane versus propofol.
Source
Anaesthesia and Intensive Care. 39 (3) (pp 418-425), 2011. Date of
Publication: May 2011.
Publisher
Australian Society of Anaesthetists (P.O. Box 600, Edgecliff NSW 2027,
Australia)
Abstract
This randomised controlled trial compared the effect of equipotent
anaesthetic doses of sevoflurane (S group) versus propofol (P group),
during remifentanil-based anaesthesia for off-pump coronary artery bypass
surgery, on myocardial injury. Either sevoflurane or propofol was titrated
to maintain bispectral index values between 40 and 50. In both groups, a
targeted concentration of remifentanil 20 ng.ml^-1 was
maintained during anaesthesia. The concentrations of creatine kinase MB
and troponin I were measured before the start of surgery, on admission to
the intensive care unit, and at 12 and 24 hours after intensive care unit
admission. The postoperative values of creatine kinase MB (S group:
15.08+/-18.97, 20.78+/-20.92, 12.76+/-12.82 vs 2.09+/-1.54
ng.ml^-1; P group: 10.99+/-13.15, 27.16+/-56.55, 11.88+/-18.80
vs 1.84+/-1.67 ng.ml^-1) and troponin I (S group: 3.56+/-5.19,
5.66+/-7.89, 3.35+/-4.55 vs 0.52+/-1.90 ng.ml^-1; P group:
2.42+/-3.33, 4.11+/-6.01, 3.04+/-5.31 vs 0.43+/-1.28 ng.ml^-1)
were significantly higher than preoperative values in both groups but
there were no significant differences between the two groups. There were
no significant differences in time to extubation (S group, 476+/-284
minutes; P group, 450+/-268 minutes) and intensive care unit length of
stay (S group, 2775+/-1449 minutes; P group, 2797+/-1534 minutes) between
the two groups. In conclusion, sevoflurane and propofol at equipotent
doses guided by bispectral index with remifentanil 20 ng.ml^-1
had similar creatine kinase MB and troponin I values.

<15>
Accession Number
2011296910
Authors
Tajstra M. Zembala M. Filipiak K. Knapik P. Hrapkowicz T. Gierlotka M.
Hawranek M. Polonski L. Gasior M.
Institution
(Zembala, Zembala, Filipiak, Hrapkowicz) Department of Cardiac Surgery and
Transplantology, Silesian Centre for Heart Diseases, Medical University of
Silesia, Zabrze, Poland
(Tajstra, Gierlotka, Hawranek, Polonski, Gasior) 3rd Department of
Cardiology, Silesian Centre for Heart Diseases, Medical University of
Silesia, Zabrze, Poland
(Knapik) Department of Cardiac Anaesthesia and Intensive Therapy, Silesian
Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
Title
Prospective randomised pilOt study evaLuating the safety and efficacy of
hybrid revascularisation in MultI-vessel coronary artery DisEaSe
(POLMIDES) - Study design.
Source
Kardiologia Polska. 69 (5) (pp 460-466), 2011. Date of Publication:
2011.
Publisher
Klinika Kardiologii CMKP (ul. Grenadierow 51/59, Warsaw 04-073, Poland)
Abstract
Background: Hybrid coronary artery revascularisation (HCR) is a
combination of minimally invasive left internal mammary artery bypass
grafting to the left anterior descending artery (LAD) and percutaneous
coronary interventions (PCI) with drug eluting stent implantation to other
coronary arteries. Due to the paucity of data from large, prospective
randomised trials comparing HCR to standard surgical revascularisation,
the POLMIDES study has been designed to assess the safety and efficacy of
HCR in patients with multivessel coronary artery disease (CAD) referred
for standard coronary artery bypass grafting (CABG). Aim: The primary
objective is evaluating the feasibility and safety of HCR. Methods:
Feasibility has been defined by means of the percentage of patients with a
complete hybrid procedure according to the study protocol and a percentage
of conversion to standard CABG. Safety has been defined as the occurrence
of major adverse cardiac events such as death, myocardial infarction,
stroke, repeat revascularisation and major bleeding within the 12 month
period after randomisation. All consecutive patients with angiographically
confirmed multivessel CAD involving LAD and a critical (> 70%) lesion in
at least one major epicardial vessel (except LAD) amenable to both PCI and
CABG referred for conventional surgical revascularisation, will be
randomised in a 1:1 fashion for HCR or standard surgical
revascularisation. Conclusions: The POLMIDES is a prospective, randomised
pilot trial designed to determine whether HCR in patients with multivessel
CAD referred for conventional CABG is safe, feasible and efficacious
(ClinicalTrials.gov number, NCT01035567). Copyright Polskie Towarzystwo
Kardiologiczne.

<16>
Accession Number
2011295812
Authors
Ghaffari S. Sohrabi B. Aslanabadi N. Mogadam A.R.S. Sepehrvand N.
Pourafkari L. Ghaffari R. Akbarzadeh F. Yaghoubi A.
Institution
(Ghaffari, Sohrabi, Aslanabadi, Mogadam, Sepehrvand, Pourafkari, Ghaffari,
Akbarzadeh, Yaghoubi) Cardiovascular Research Department, Madani Heart
Centre, Tabriz, Iran, Islamic Republic of
Title
Percutaneous transvenous mitral commissurotomy: With or without heparin? A
randomised double blind study.
Source
Kardiologia Polska. 69 (5) (pp 445-450), 2011. Date of Publication:
2011.
Publisher
Klinika Kardiologii CMKP (ul. Grenadierow 51/59, Warsaw 04-073, Poland)
Abstract
Background: Percutaneous transvenous mitral commissurotomy (PTMC) is an
alternative approach to open heart surgery in patients with symptomatic
mitral stenosis (MS). Aim: To compare the outcome of performing PTMC with
or without heparin administration. Methods: In this randomised clinical
trial, 480 patients with symptomatic MS were randomly allocated to one of
two groups, with or without heparin administration as part of the
procedure. Echocardiographic and clinical outcomes of PTMC assessed before
the procedure, during hospitalisation, and after the one-month follow-up,
were compared between the two groups. Results: Baseline demographic and
clinical characteristics were similar in the 240 patients with heparin
administration (the Hep [+] group) and the 240 patients without heparin
administration (the Hep [-] group) during the procedure. In the whole
study group mitral valve area (MVA) was 0.94 +/- 0.03 cm² prior
to PTMC, and increased to 1.85 +/- 0.06 cm ² after the
procedure (p = 0.0001). The mean increase in MVA was 0.85 +/- 0.27
cm² in the Hep (+) group and 0.88 +/- 0.2 cm ² in
the Hep (-) group (NS). During the procedure, or immediately after PTMC,
embolic events were recorded in two (0.83%) Hep (+) patients and one
(0.42%) Hep (-) patient (NS). The frequency of haematoma at puncture site
(three [1.25%] Hep [+] vs two [0.83%] Hep [-]), and the need for urgent
surgery (two [0.83%] Hep [+] vs five [2.1%] Hep [-]), were similar in both
groups. There were no embolic events after discharge or during the one
month follow-up period. Conclusions: Our study revealed that in high
volume centres and in selected patients without left atrial thrombus,
heparin administration during PTMC is not associated with any additional
protective effect against embolic events during short-term follow-up.
Copyright Polskie Towarzystwo Kardiologiczne.

<17>
Accession Number
70428810
Authors
Hansen M. Schmitdt H. Berg H.K. Jakobsen C.-J.
Institution
(Hansen, Schmitdt, Berg) Odense University Hospital, Odense, Denmark
(Jakobsen) Aarhus University Hospital, Skejby, Aarhus, Denmark
Title
Supplement of epidural analgesia seems to improve outcome in cardiac
surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 26th
Annual Meeting of the European Association of Cardiothoracic
Anaesthesiologists, EACTA 2011 Vienna Austria. Conference Start: 20110601
Conference End: 20110604. Conference Publication: (var.pagings). 25 (3
SUPPL. 1) (pp S31), 2011. Date of Publication: June 2011.
Publisher
W.B. Saunders
Abstract
Introduction. In a meta-analysis of 2,366 patients (33 trials) it was
concluded that epidural analgesia in combination with general anaesthesia
reduced the incidence of acute renal failure, the time on mechanical
ventilation and the composite endpoint of mortality and MI in patients
undergoing cadac surgery [1]. However, definitions of endpoints may vary
and no major single centre study has been published. Method. All
consecutive patients in 2008-10 were obtained from our database (n=1,747).
Patients with rare procedures, aortic surgery and TAVI were a priori
excluded, leaving 1,440 procedures. Epidural/No-epidural were matched for
age group, sex, residual EuroSCORE and operation type giving a cohort for
analysis of 1,078 procedures with exact match. All preoperative and
outcome data are registered prospectively in our database. Mortality is
checked daily against the Danish civil registration system. Result. As
shown in the table there was no difference between the groups in age, sex
and EuroSCORE between the matched groups. All outcome parameters showed a
lower tendency in the epidural group. However only the combined outcome
index was significant (P=0.008). The median ventilation time was lower
after epidural (P<0.001), while we found no difference in median ICU time
or in-hospital time. The lower ventilation time was a result of a policy
of extubation in the OR if possible. (Table presented) Conclusion. This
single centre study of 3 years' procedures suggest a lower incidence of
30-day mortality and postoperative MI, stroke and need for dialysis after
cardiac surgery combined with epidural analgesia.

<18>
Accession Number
70428797
Authors
Skhirtladze K. Linke S. Lassnigg A. Base E.
Institution
(Skhirtladze, Linke, Lassnigg, Base) Div. of Cardiothoracic and Vascular
Anaesthesia and Intensive Care, Medical University of Vienna, Vienna,
Austria
Title
Comparison of albumin 5%, hydroxyethyl starch 130/0.4 (6%) and
Ringer-Lactate for volume replacement during cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 26th
Annual Meeting of the European Association of Cardiothoracic
Anaesthesiologists, EACTA 2011 Vienna Austria. Conference Start: 20110601
Conference End: 20110604. Conference Publication: (var.pagings). 25 (3
SUPPL. 1) (pp S25-S26), 2011. Date of Publication: June 2011.
Publisher
W.B. Saunders
Abstract
Introduction. There is an ongoing debate about the optimal priming
solution for cardiopulmonary bypass (CPB). We compared hydroxyethyl starch
(HES) 130/0.4 (6%), Ringer-Lactate (RL) and human albumin (HA) 5% for
volume replacement during and after cardiac surgery. The effects on
postoperative blood loss and clot formation time (CFT-Intem) measured by
throm-boelastography were examined. Method. Two hundred and forty patients
were included in this double blind, randomized, controlled trial. They
were randomly assigned to either receive HES (n=80), HA 5% (n=80) or RL
(n= 80). Study solutions were administered in 250 mL bottles and blinding
was ensured through the use of specially prepared opaque masking sheets.
1.5 L of solution was used for CPB prime. Intra- and postoperative fluid
management was guided by central venous pressure and clinical judgement.
Patients received up to 50 ml kg-1 d-1 of the respective study solutions.
RL was administered for additional volume replacement. Statistical
analysis was performed using two-way analysis of variance. P<0.05 was
considered significant. Results. Cumulative blood loss over 24 hours after
surgery was equal between groups. Patients in the RL group received
significantly more study solution compared to HES and HA 5% patients
(P<0.0001). The 24 hour fluid balance was least positive in the HA 5%
group in relation to the other two groups (P<0.0001). On arrival in the
ICU, CFT-Intem values were significantly different (P<0.0001) between
groups with the highest values being detected in the HES group and the
lowest in the RL group. Twenty-four hours after surgery, the HA 5% group
showed significantly higher values than patients of the RL (P<0.0001) and
the HES group (P=0.0042). No significant difference was found between the
HES and the RL group (P>0.1929). Discussion. Both colloids induced
prolongation of CFT-Intem. However, 24 hours after surgery, it only
persisted in the HA 5% group. Thus, both colloids might negatively affect
coagulation. In contrast, RL did not influence coagulation parameters.