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<1>
Accession Number
2011298711
Authors
Lu J. Luo L. Guo Y. Long D. Wei L. Shan J. Feng L. Li S. Yang X. Lu Y.
Krams S. Li Y.
Institution
(Lu, Luo, Guo, Long, Shan, Feng, Li, Li) Key Laboratory of Transplant
Engineering and Immunology, West China Hospital, Sichuan University,
Chengdu 610041, China
(Yang, Li) Chinese Evidence-Based Medicine Center, Chengdu 610041, China
(Lu) Transplantation Institute, West China Hospital, Sichuan University,
Chengdu 610041, China
(Wei, Krams) Transplant Immunobiology Laboratory, Department of Surgery,
Stanford University School of Medicine, Stanford, United States
Title
The effect of MICA antigens on transplant outcomes: A systematic review.
Source
Journal of Evidence-Based Medicine. 4 (2) (pp 106-121), 2011. Date of
Publication: May 2011.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Background and Objective: Human major histocompatibility complex class
I-related gene A (MICA) is reportedly associated with poor transplant
outcomes and a high risk of acute and chronic rejection in solid organ
transplantation. However, studies on these risks have found conflicting
results. In order to identify areas in which additional research is
needed, we have undertaken the first systematic review of evidence
concerning the risk of anti-MICA antibodies in recipients' sera. Methods:
We searched MEDLINE, EMBASE, and the Cochrane Library for original reports
of clinical studies involving detection of MICA abs in transplant
recipients' sera which used survival rate, acute rejection, and/or chronic
rejection as outcome measures. RevMan 5.0.15 was used to calculate
relative risk (RR), odds ratios (ORs), and 95% confidence intervals
(95%CIs). Results: We found 18 relevant articles, with a total of 6,607
recipients. Follow-up duration ranged from 1 to 15 years. In studies with
more than 2 years of follow-up, anti-MICA abs positive in kidney
recipients' post-transplant sera was associated with a lower graft
survival rate (4 years: RR = 2.04, 95%CI 1.30 to 3.22; 3 years: OR = 3.56,
95%CI 1.47 to 8.62; 2 years: RR = 2.17, 95%CI 1.09 to 4.31) and a higher
acute rejection rate (RR = 1.92, 95%CI 1.27 to 2.91), but there was no
clear association with chronic rejection. Similar conclusions could not be
drawn for heart or liver transplantation due to possible confounding by
anti-HLA abs and the small sample sizes of the available studies.
Conclusion: Anti-MICA antibodies in recipients' sera may associated with
poor graft survival rates and high risk of acute and chronic rejection in
solid organ transplantation, but more rigorous studies are needed to
confirm or refute this relationship. Current immunosuppressive therapy may
fail to suppress the harmful effect of MICA antigens. 2011 Blackwell
Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital
of Sichuan University.

<2>
Accession Number
2011291784
Authors
Memmo A. Carozzo A. Landoni G. Fano G. Sottocorna O. Bignami E. Giacchi V.
Corno L. Magrin S. Zangrillo A.
Institution
(Landoni) Department of Cardiothoracic, Anesthesia and Intensive Care
Istituto Scientifico San Raffaele Milano, Italia Via Olgettina 60, 20132
Milano, Italy
(Memmo, Carozzo, Fano, Sottocorna, Bignami, Giacchi, Corno, Magrin,
Zangrillo) Universita Vita-Salute San Raffaele, Istituto Scientifico San
Raffaele Milano, Milano, Italy
Title
Perioperative fenoldopam for the prevention of acute renal failure in
non-cardiac surgery, randomized clinical trial.
Source
Signa Vitae. 6 (1) (pp 14-19), 2011. Date of Publication: 2011.
Publisher
Pharmamed Mado Ltd (Zatisje 8 g, Zabreb 10000, Croatia)
Abstract
Purpose. Acute renal failure is a serious complication of surgery causing
morbidity and mortality. The aim of this study was to evaluate the
efficacy of fenoldopam, a selective dopamine-1 receptor agonist, in
patients at high risk of perioperative renal dysfunction. Methods. In this
prospective single-center randomized double-blind trial we enrolled 64
patients undergoing major surgery. Patients received either fenoldopam at
a dosage of 0.05 mcg/kg/min or dopamine at a dosage of 2.5 mcg/kg/min
after anesthesia induction for a 12-hour period. The primary endpoint was
defined as 25% serum creatinine increase from baseline after surgery.
Results. All the patients included were at high risk of perioperative
renal dysfunction and underwent major surgery. The two groups (fenoldopam
versus dopamine) were homogenous cohorts and no difference in outcome was
observed. The incidence of acute renal failure was similar: 11/32 (34%) in
the fenoldopam group and 14/32 (44%) in the dopamine group (p=0.6). The
postoperative serum creatinine peak was also similar in the two groups. No
in-hospital death was observed. Conclusion. Despite an increasing number
of reports suggesting renal protective properties of fenoldopam, we
observed no difference in clinical outcome compared to dopamine in a
high-risk population undergoing major surgery.

<3>
Accession Number
21310897
Authors
Olper L. Cervi P. De Santi F. Meloni C. Gatti R.
Institution
(Olper) Rehabilitation Department, San Raffaele Hospital, Via Olgettina
60, 20132 Milan, Italy.
Title
Validation of the treadmill Six-Minute Walk Test in people following
cardiac surgery.
Source
Physical therapy. 91 (4) (pp 566-576), 2011. Date of Publication: Apr
2011.
Abstract
The Six-Minute Walk Test (6MWT) often is used to measure exercise capacity
in people with cardiopulmonary diseases but has some disadvantages. The
6MWT administered on a treadmill (Tr6MWT) requires less physical space and
allows for easier monitoring of vital parameters than the traditional
6MWT. The objectives of this study were: (1) to analyze the validity of
the Tr6MWT in people who underwent cardiac surgery; (2) to compare the
reliability, responsiveness, and people's tolerance of the Tr6MWT with
those of the 6MWT; and (3) to evaluate the agreement between the 2 tests.
This study was designed to assess reliability and validity. Twenty-six
participants who were inpatients were assessed before a 2-week
rehabilitation program. Twenty of them also were assessed after
rehabilitation. All participants performed 3 Tr6MWT trials and 3 6MWT
trials that were randomly assigned on 2 consecutive days. The Pearson r
correlation coefficient between the Tr6MWT and the 6MWT was .72,
indicating satisfactory concurrent validity. The Tr6MWT was as well
tolerated as the 6MWT. The Tr6MWT produced reproducible results after 2
practice tests, whereas the 6MWT did so after only 1 practice test. Both
tests showed high test-retest reliability (intraclass correlation
coefficient of >.94; standard errors of measurement of 23 m for the Tr6MWT
and 18.5 m for the 6MWT). The Tr6MWT showed better responsiveness than the
6MWT (effect sizes of 0.9 for the Tr6MWT and 0.6 for the 6MWT). The
distance covered during the Tr6MWT was significantly shorter (X=62 m,
SD=91) before rehabilitation but not after rehabilitation. A crossover
randomized procedure could have improved the reliability of the Tr6MWT in
people who performed the 6MWT first. The Tr6MWT appears to be an
instrument with adequate concurrent validity and to be tolerable,
reliable, and responsive for the evaluation of exercise capacity in people
after cardiac surgery even though it is not interchangeable with the 6MWT.

<4>
Accession Number
2011307224
Authors
Mitchell A.J. Lawrence D.
Institution
(Mitchell) Department of Liaison Psychiatry, Leicestershire Partnership
Trust, Leicester, United Kingdom
(Mitchell) Department of Cancer Studies and Molecular Medicine, Leicester
Royal Infirmary, Leicester, United Kingdom
(Lawrence) Telethon Institute for Child Health Research, Centre for Child
Health Resaerch, University of Western Australia, Perth, WA, Australia
Title
Revascularisation and mortality rates following acute coronary syndromes
in people with severe mental illness: Comparative meta-analysis.
Source
British Journal of Psychiatry. 198 (6) (pp 434-441), 2011. Date of
Publication: June 2011.
Publisher
Royal College of Psychiatrists (17 Belgrave Square, London SW1X 8PG,
United Kingdom)
Abstract
Background: High levels of comorbid physical illness and excess mortality
rates have been previously documented in people with severe mental
illness, but outcomes following myocardial infarction and other acute
coronary syndromes are less clear. Aims: To examine inequalities in the
provision of invasive coronary procedures (revascularisation, angiography,
angioplasty and bypass grafting) and subsequent mortality in people with
mental illness and in those with schizophrenia, compared with those
without mental ill health. Method: Systematic search and random effects
meta-analysis were used according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses guidelines. Studies of mental health
and cardiovascular procedures following cardiac events were eligible but
we required a minimum of three independent studies to warrant pooling by
procedure type. We searched Medline/PubMed and EMBASE abstract databases
and ScienceDirect, Ingenta Select, SpringerLink and Online Wiley Library
full text databases. Results: We identified 22 analyses of possible
inequalities in coronary procedures in those with defined mental disorder,
of which 10 also reported results in schizophrenia or related psychosis.
All studies following acute coronary syndrome originated in the USA. The
total sample size was 825 754 individuals. Those with mental disorders
received 0.86 (relative risk, RR: 95% CI 0.80-0.92, P<0.0001) of
comparable procedures with significantly lower receipt of coronary artery
bypass graft (CABG; RR = 0.85, 95% CI 0.72-1.00), cardiac catheterisation
(RR = 0.85, 95% CI 0.76-0.95) and percutaneous transluminal coronary
angioplasty or percutaneous coronary intervention (PTCA/PCI; RR = 0.87,
95% CI 0.72-1.05). People with a diagnosis of schizophrenia received only
0.53 (95% CI 0.44-0.64, P<0.0001) of the usual procedure rate with
significantly lower receipt of CABG (RR = 0.69, 95% CI 0.55-0.85) and
PTCA/PCI (RR = 0.50, 95% CI 0.34-0.75). We identified 6 related studies
examining mortality following cardiac events: for those with mental
illness there was a 1.11 relative risk of mortality up to 1 year (95% CI
1.00-1.24, P = 0.05) but there was insufficient evidence to examine
mortality rates in schizophrenia alone. Conclusions: Following cardiac
events, individuals with mental illness experience a 14% lower rate of
invasive coronary interventions (47% in the case of schizophrenia) and
they have an 11% increased mortality rate. Further work is required to
explore whether these factors are causally linked and whether improvements
in medical care might improve survival in those with mental ill health.
2011 The Royal College of Psychiatrists.

<5>
Accession Number
2011305540
Authors
Jacomo A.D.N. Carmona F. Matsuno A.K. Manso P.H. Carlotti A.P.C.P.
Institution
(Jacomo, Carmona, Matsuno, Manso, Carlotti) Department of Pediatrics,
Hospital das Clinicas, Faculty of Medicine of Ribeirao Preto, University
of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
Title
Effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence
of nosocomial pneumonia in children undergoing cardiac surgery.
Source
Infection Control and Hospital Epidemiology. 32 (6) (pp 591-596), 2011.
Date of Publication: June 2011.
Publisher
University of Chicago Press (1427 E. 60th Street, Chicago IL 60637-2954,
United States)
Abstract
Objective. To evaluate the effect of oral hygiene with 0.12% chlorhexidine
gluconate on the incidence of nosocomial pneumonia and
ventilator-associated pneumonia (VAP) in children undergoing cardiac
surgery. design. Prospective, randomized, double-blind, placebo-controlled
trial. setting. Pediatric intensive care unit (PICU) at a tertiary care
hospital. patients. One hundred sixty children undergoing surgery for
congenital heart disease, randomized into 2 groups: chlorhexidine (n = 87)
and control (n = 73). interventions. Oral hygiene with 0.12% chlorhexidine
gluconate or placebo preoperatively and twice a day postoperatively until
PICU discharge or death. results. Patients in experimental and control
groups had similar ages (median, 12.2 vs 10.8 months; P =.72) and risk
adjustment for congenital heart surgery 1 score distribution (66% in
category 1 or 2 in both groups; P =.17). The incidence of nosocomial
pneumonia was 29.8% versus 24.6% (P =.46) and the incidence of VAP was
18.3% versus 15% (P =.57) in the chlorhexidine and the control group,
respectively. There was no difference in intubation time (P =.34), need
for reintubation (P =.37), time interval between hospitalization and
nosocomial pneumonia diagnosis (P =.63), time interval between surgery and
nosocomial pneumonia diagnosis (P =.10), and time on antibiotics (P =.77)
and vasoactive drugs (P =.16) between groups. Median length of PICU stay
(3 vs 4 days; P =.53), median length of hospital stay (12 vs 11 days; P
=.67), and 28-day mortality (5.7% vs 6.8%; P =.77) were also similar in
the chlorhexidine and the control group. conclusions. Oral hygiene with
0.12% chlorhexidine gluconate did not reduce the incidence of nosocomial
pneumonia and VAP in children undergoing cardiac surgery. 2011 by The
Society for Healthcare Epidemiology of America. All rights reserved.

<6>
Accession Number
2011304315
Authors
Storti F.C. Moffa P.J. Uchida A.H. Hueb W.A. Cesar L.A.M. Ferreira B.M.A.
de Camargo Jr. P.A. Chalela W.A.
Institution
(Storti, Moffa, Uchida, Hueb, Cesar, Ferreira, de Camargo Jr., Chalela)
Instituto do Coracao, HCFMUSP, Sao Paulo, SP, Brazil
Title
New prognostic score for stable coronary disease evaluation.
Source
Arquivos Brasileiros de Cardiologia. 96 (5) (pp 411-418), 2011. Date of
Publication: May 2011.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Background: The need to improve the exercise testing accuracy, pushed the
development of scores, whose applicability was already broadly recognized.
Objective: Prognostic evaluation of stable coronary disease through a new
simplified score. Methods: A new score was applied in 372 multivessel
coronary patients with preserved ventricular function, 71.8% male, age:
59.5 (+/- 9.07) years old, randomized to medical treatment, surgery (CABG)
or angioplasty (PTCA), with 5 years of follow-up. Cardiovascular death was
considered the primary endpoint. Non-fatal myocardial infarction, death
and re-intervention were considered for a combined secondary endpoint. The
score was based on an equation previously validated, resulting from a sum
of one point for: male gender, infarction history, angina, diabetes,
insulin use and one point for each decade of life after 40 years old.
Positive exercise testing summed one additional point. Results: Thirty six
deaths was observed (10 in group PTCA, 15 in CABG and 11 in the clinical
group), p = 0.61. We observed 93 combined events: 37 in PTCA group, 23 in
CABG and 33 in the clinical group (p = 0.058). 247 patients presented
clinical score >= 5 points and 216 >= 6 points. The cutoff point >= 5 or
>= 6 points identified higher risk, p = 0.015 and p = 0.012, respectively.
The survival curve showed a different death incidence after the
randomization when score reached 06 points or more (p = 0.07), and a
distinct incidence of combined events between the patients with score < 6
and >= 6 points (p = 0.02). Conclusion: The new score was consistent for
multiarterial stable coronary disease risk stratification.

<7>
Accession Number
2011299101
Authors
Atarashi H. Inoue H. Okumura K. Yamashita T. Kumagai N. Origasa H.
Institution
(Atarashi) Department of Internal Medicine, Nippon Medical School
Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
(Inoue) Department of Internal Medicine, University of Toyama, Graduat
School of Medicine, Toyama, Japan
(Okumura) Cardiology, Respiratory Medicine and Nephrology, Hirosaki
University Graduate School of Medicine, Aomori, Japan
(Yamashita) The Cardiovascular Institute, Tokyo, Japan
(Kumagai) Kochi Medical School Clinical Research Center, Kochi University,
Kochi, India
(Origasa) Division of Biostatistics and Clinical Epidemiology, University
of Toyama, Graduate School of Medicine, Toyama, Japan
Title
Present status of anticoagulation treatment in Japanese patients with
atrial fibrillation - A report from the J-RHYTHM registry -.
Source
Circulation Journal. 75 (6) (pp 1328-1333), 2011. Date of Publication:
June 2011.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Underuse and an inadequate range for the international
normalized ratio (INR) for warfarin use are still problems in the
management of the patients with atrial fibrillation (AF) in Japan. Methods
and Results: From January to July 2009, a total of 7,937 AF patients
[5,468 men (68.6+/-10.0 years) and 2,469 women (72.2+/-9.0 years)] were
registered from 158 institutions for the J-RHYTHM Registry. Overall, 34.2%
of the patients were over the age of 75. The associated cardiovascular
diagnoses were hypertension in 59.1%, coronary artery disease in 10.1%,
cardiomyopathy in 8.3%, valvular heart disease in 13.7% and artificial
cardiac valves in 3.1% of the patients. The type of AF was paroxysmal in
37.1%, persistent in 14.4%, and permanent in 48.5%. Overall, 87.3% of
patients were taking warfarin (2.9+/-1.2 mg/day), of whom 66.0% had an INR
between 1.6 and 2.6, and 35.4% were in the INR range from 2.0 to 3.0 at
the time of registration. Aspirin was prescribed in 22.3% of cases. The
CHADS2 score was 0 in 15.7% of patients, 1 in 34.0%, and >=2 in 50.3%.
Conclusions: At present, warfarin is used extensively in patients with AF
whose stroke risk is relatively low (ie, in Japan) and half of them had
CHADS2 scores of 0 to 1 (UMIN Clinical Trials Registry UMIN000001569).

<8>
Accession Number
2011297058
Authors
Ranasinghe A.M. Quinn D.W. Richardson M. Freemantle N. Graham T.R. Mascaro
J. Rooney S.J. Wilson I.C. Pagano D. Bonser R.S.
Institution
(Ranasinghe, Pagano, Bonser) School of Clinical and Experimental Medicine,
University of Birmingham, Birmingham, United Kingdom
(Ranasinghe, Quinn, Graham, Mascaro, Rooney, Wilson, Pagano, Bonser)
Department of Cardiothoracic Surgery, University Hospital Birmingham,
Birmingham, United Kingdom
(Richardson, Freemantle) School of Health and Population Sciences,
University of Birmingham, Birmingham, United Kingdom
(Richardson, Freemantle, Pagano) Quality and Outcomes Research Unit
(QuORU), Birmingham, United Kingdom
Title
Which troponometric best predicts midterm outcome after coronary artery
bypass graft surgery?.
Source
Annals of Thoracic Surgery. 91 (6) (pp 1860-1867), 2011. Date of
Publication: June 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Various troponin I measurements (troponometrics) have been
used as surrogate markers of patient outcome after coronary artery bypass
grafting (CABG). Our aim was to define the postoperative troponometric
best able to predict in-hospital and late mortality. Methods: In 440
patients (seen from January 2000 to September 2004) undergoing isolated
on-pump CABG with standardized anesthesia, perfusion, cardioplegia, and
postoperative care, we followed all-cause mortality (census June 2009,
100% complete). Subjects underwent troponin I (cardiac troponin I [cTnI])
estimation at baseline and 6, 12, 24, 48, and 72 hours postoperatively,
and individual time-point cTnI (T6, T12, T24, T48, T72), peak cTnI
(C_max), increase in cTnI between 6 and 12 hours (T6-12) and 6
and 24 hours (T6-24), cumulative area under the curve cTnI (CAUC24,
CAUC48, and CAUC72), and cTnI < 13 ng mL^-1 at any time point
were each analyzed using univariate and multivariable Cox models to
identify the probability of in-hospital and late death. Logistic
EuroSCOREs and calculated creatinine clearance (CrCl) were also included.
The Akaike information criterion (AIC) was used to determine goodness of
fit. Results: There were 62 of 440 deaths after a median (interquartile
range) follow-up period of 7.0 (5.7 to 8.1) years. Univariate Cox analysis
demonstrated T12, T24, T48, T72, T6-12, T6-24, standardized CAUC24,
CAUC48, and CAUC72 each to be predictors of midterm mortality. On Cox
multivariable analysis in models incorporating both logistic EuroSCOREs
and CrCl, both T72 (hazard ratio [HR], 95% confidence interval [CI], 1.10
[1.06 to 1.14]; p < 0.001) and CAUC72 (1.45 [1.26 to 1.62], p < 0.001)
were identified as independent predictors of mortality. Of these, CAUC72
was superior based on the lowest AIC. Conclusions: In myocardial
protection studies, serial troponin I data should be collected until 72
hours postoperatively to calculate CAUC72, as this troponometric best
predicts midterm mortality. 2011 The Society of Thoracic Surgeons.

<9>
Accession Number
2011297006
Authors
Puskas J.D. Williams W.H. O'Donnell R. Patterson R.E. Sigman S.R. Smith
A.S. Baio K.T. Kilgo P.D. Guyton R.A.
Institution
(Puskas, Williams, Smith, Baio, Kilgo, Guyton) Clinical Research Unit,
Division of Cardiothoracic Surgery, Emory University School of Medicine,
Atlanta, GA, United States
(O'Donnell, Patterson, Sigman) Division of Cardiology, Emory University
School of Medicine, Atlanta, GA, United States
(Kilgo) Rollins School of Public Health, Emory University, Atlanta, GA,
United States
Title
Off-pump and on-pump coronary artery bypass grafting are associated with
similar graft patency, myocardial ischemia, and freedom from
reintervention: Long-term follow-up of a randomized trial.
Source
Annals of Thoracic Surgery. 91 (6) (pp 1836-1842), 2011. Date of
Publication: June 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: The Surgical Management of Arterial Revascularization
Therapies trial was conceived to rigorously compare completeness of
revascularization, clinical outcomes and resource utilization in
unselected patients referred for elective, primary coronary artery bypass
grafting randomly assigned to undergo off-pump (OPCAB) or conventional
on-pump coronary artery bypass grafting using cardiopulmonary bypass
(CPB). The goal of this follow-up study was to compare long-term survival,
graft patency, myocardial ischemia, and clinical outcomes among survivors
who volunteered to return for clinical evaluation and imaging studies.
Methods: Two hundred unselected patients with multivessel coronary artery
disease were randomly assigned to OPCAB or CPB coronary artery bypass
grafting between March 2000 and August 2001. All-cause mortality was
determined by individual patient contact and referencing the Social
Security Death Master File. Of 140 survivors, 87 volunteered to return
after a minimum of 6.8 years (maximum, 8.4 years; mean, 7.5 years) for
assessment of graft patency (computed tomographic angiography) and
myocardial ischemia (cardiac positron emission tomography and 12-lead
electrocardiogram). Age at follow-up ranged from 38 to 90 years (mean, 68
years). Results: There were 26 deaths from all causes among OPCAB patients
and 31 among CPB patients as of March 30, 2009. Graft patency was similar
between groups among 622 grafts assessed by angiography before hospital
discharge (99% OPCAB versus 97.7% CPB; p = 0.22, Fisher's exact test),
among 511 grafts assessed by angiography at 1 year (93.6% OPCAB versus
95.8% CPB; p = 0.33), and among 190 grafts assessed by computed
tomographic angiography at late follow-up (76% OPCAB versus 83.5% CPB; p =
0.44). Twelve of 34 OPCAB (35.3%) and 16 of 39 CPB patients (41.0%) had
any ischemia on positron emission tomography scanning (p = 0.62). Four
OPCAB patients (11.8%) and 9 CPB patients (23.1%) had an ischemic region
in excess of 10% of myocardium (p = 0.21). At late follow-up, recurrent
angina had occurred in 11 of 43 (25.6%) OPCAB patients and 5 of 44 (11.4%)
CPB patients (p = 0.09). Percutaneous reintervention had been performed at
the discretion of blinded local cardiologists in 1 of 43 (2.3%) OPCAB
patients and 1 of 44 (2.3%) CPB patients (p = 1.0). No patient in either
group has undergone repeat CABG. Conclusions: In this randomized trial,
off-pump and on-pump coronary artery bypass grafting were associated with
similar early and late graft patency, incidence of recurrent or residual
myocardial ischemia, need for reintervention, and long-term survival.
2011 The Society of Thoracic Surgeons.

<10>
Accession Number
2011292099
Authors
Saeidi M. Aghadavoudi O. Sadeghi M.M. Mansouri M.
Institution
(Saeidi, Sadeghi) Department of Cardiac Surgery, School of Medicine,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Aghadavoudi, Mansouri) Department of Anesthesiology, School of Medicine,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Title
The efficacy of preventive parasternal single injection of bupivacaine on
intubation time, blood gas parameters, narcotic requirement, and pain
relief after open heart surgery: A randomize clinical trial study.
Source
Journal of Research in Medical Sciences. 16 (4) (pp 477-483), 2011. Date
of Publication: 2011.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
Background: Postsurgical pain usually results in some complications in the
patients. This study has tried to investigate the effects of parasternal
single injection of bupivacaine on postoperative pulmonary and pain
consequences in patients after open heart surgery. Methods: In a
prospective double blind clinical study, 100 consenting patients
undergoing elective open heart surgery were randomized into two groups. In
case group, bupivacaine was injected at both sides of sternum, immediately
before sternal closure. In the control group, no intervention was
performed. Then, the patients were investigated regarding intubation
period, length of ICU stay, arterial blood gas (ABG) parameters, morphine
requirement, and their severity of postoperative pain using a visual
analogue scale (VAS) device. Results: No differences were found between
the two groups regarding to age, sex, pump time, operation time, and body
mass index and preoperative cardiac ejection fraction. Mean intubation
length in case group was much shorter than that in control group. Mean
PaO₂ in case group was lower in different checking times in
postoperative period. The patients in the case group needed less morphine
compared to those in the control group during the 24-hour observation
period in the ICU. Finally, mean VAS scores of pain in case group were
significantly lower than those in control group at 6, 12, and 24 hours
postoperatively. Conclusions: Patients' pain relief by parasternal single
injection of bupivacaine in early postoperative period can facilitate
earlier ventilator weaning and tracheal extubation after open heart
surgery as well as achieving lower pain scores and narcotic requirements.

<11>
Accession Number
2011302661
Authors
Kim K.-H. Na J.O. Nam G.-B. Jin E.-S. Choi H. Kim S.-H. Choi K.-J. Kim
Y.-H.
Institution
(Kim, Na, Nam, Jin, Choi, Kim, Choi, Kim) Department of Internal Medicine,
Asan Medical Center, University of Ulsan College of Medicine,
Poongnap-dong 388-1, Songpa-gu, Seoul 138-736, South Korea
Title
Effect of catheter ablation on the left ventricular mass index and other
echocardiograph parameters in atrial fibrillation patients: Comparison
with antiarrhythmic drug treatment.
Source
Journal of Echocardiography. 9 (2) (pp 51-58), 2011. Date of
Publication: June 2011.
Publisher
Springer Japan (1-11-11 Kudan-Kita, Chiyoda-ku,Tokyo 102-0073, Japan)
Abstract
Background: Catheter ablation (CA) is reported to improve left ventricular
(LV) function in patients with atrial fibrillation (AF). This study
compared the effects of CA and antiarrhythmic drug treatment (AT) on LV
remodeling and other echocardiography parameters in AF. Methods: We
performed a non-randomized prospective study involving 72 drug-resistant
AF patients who were treated with either CA (n = 42) or who declined CA
and continued on AT (n = 30). Baseline and follow-up (mean 20. 7 +/- 7. 5
months) echocardiography was performed in all patients. The maintenance of
sinus rhythm was determined based on clinical interview,
electrocardiography, and 24-h Holter and event recording. Results: There
were no significant differences between the two groups in regard to
demographic features, blood pressure, and medication. CA was superior to
AT with respect to sinus rhythm maintenance, LV ejection fraction, left
atrium (LA) diameter, and LA volume index. In addition, CA resulted in
decreases in the LV mass [from 190. 5 +/- 36. 1 to 179. 3 +/- 32. 4 g (p =
0. 02)] and the LV mass index [from 104. 2 +/- 20. 5 to 98. 2 +/- 18. 3
g/m² (p = 0. 03)]. No parameter improved in AT patients. These
improved echocardiographic parameters were observed in both groups with
maintained sinus rhythm. Conclusion: Reverse LV remodeling after CA may
include a reduction in the LV mass index, which appears to be associated
with sinus rhythm maintenance. 2010 Japanese Society of Echocardiography.

<12>
Accession Number
2011294372
Authors
Hatemi A.C. Ulusoy R.E. Gursoy M. Tongut A. Canikoglu M. Kaya A. Ay N.P.
Enar R. Sozer F.F. Karaoglu K. Kansiz E.
Institution
(Hatemi, Gursoy, Tongut, Canikoglu, Kansiz) Department of Cardiovascular
Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey
(Ulusoy) Department of Cardiology, Gulhane Military Medical Academy
Haydarpasa Training Hospital, Istanbul, Turkey
(Kaya) Department of Biochemistry Laboratory, Institute of Cardiology,
Istanbul University, Istanbul, Turkey
(Ay) Department of Public Health, Faculty of Medicine, Marmara University,
Istanbul, Turkey
(Enar) Department of Cardiology, Cerrahpasa Faculty of Medicine, Istanbul
University, Istanbul, Turkey
(Sozer, Karaoglu) Department of Anesthesiology and Reanimation, Institute
of Cardiology, Istanbul University, Istanbul, Turkey
Title
Myocardial protection with simultaneous antegrade/vein graft cardioplegia
compared to antegrade cardioplegia alone in elective coronary artery
bypass grafting patients.
Source
Trakya Universitesi Tip Fakultesi Dergisi. 28 (1) (pp 75-79), 2011. Date
of Publication: 2011.
Publisher
Ekin Tibbi Yayincilik (Osmanaga Mah. Nuzhet Efendi Sok. Yonca Apt.
No:29/3, Kadikoy, Istanbul 34714, Turkey)
Abstract
Objective: Cardioplegia distribution beyond a stenotic coronary artery may
not be adequate. This problem can be overcome by direct delivery of
cardioplegia via the vein grafts anastomosed during the operation. The aim
of this study is to investigate the results of simultaneous antegrade/vein
graft cardioplegia versus antegrade cardioplegia alone in elective CABG
patients. Material and Methods: Forty consecutive patients were randomized
into the study group to whom antegrade/vein cardioplegia and to the
control group to whom only antegrade cardioplegia was given. Both groups
were similar with respect to demographic characteristics, postoperative
ECG changes and arrhythmia in the ICU, as well as in terms of operative
and postoperative variables (p>0.05). Results: All patients had excellent
operative and postoperative periods without any complications or death.
Release of total CK, CKMB, cTnI and lactate did not differ in the
preoperative and the first 12^th hour (p>0.05) between the
groups, whereas in the study group a peak for total CK, CKMB, cTnI and
lactate, consistent with myocardial injury (p<0.05), was found in the
first 24^th hour, which returned in the 48th hour (p>0.05).
Conclusion: The primary finding of this study is the inferiority of
myocardial protection with simultaneous antegrade/vein graft cardioplegia
compared with antegrade cardioplegia alone. Trakya University Faculty of
Medicine.

<13>
Accession Number
2011291462
Authors
Stefanini G.G. Serruys P.W. Silber S. Khattab A.A. Van Geuns R.J. Richardt
G. Buszman P.E. Kelbaek H. Van Boven A.J. Hofma S.H. Linke A. Klauss V.
Wijns W. MacAya C. Garot P. Di Mario C. Manoharan G. Kornowski R.
Ischinger T. Bartorelli A.L. Gobbens P. Windecker S.
Institution
(Stefanini, Khattab, Windecker) Department of Cardiology, Swiss
Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse,
3010 Bern, Switzerland
(Serruys, Van Geuns) Erasmus Medical Center, Rotterdam, Netherlands
(Silber) Kardiologische Praxis und Praxisklinik, Munich, Germany
(Richardt) Herzzentrum, Segeberger Kliniken, Bad Segeberg, Germany
(Buszman) Medical University of Silesia, Katowice, Poland
(Kelbaek) Rigshospitalet, Copenhagen, Denmark
(Van Boven, Hofma) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Linke) Herzzentrum Leipzig, Leipzig, Germany
(Klauss) Department of Cardiology, University Hospital Munich
(Innenstadt), Munich, Germany
(Wijns) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
(MacAya) Servicio de Cardiologa, Hospital Universitario, Madrid, Spain
(Garot) Institut Cardiovasculaire Paris-Sud, Quincy, France
(Di Mario) Department of Cardiology, Royal Brompton Hospital, London,
United Kingdom
(Manoharan) Royal Victoria Hospital, Belfast, United Kingdom
(Kornowski) Department of Cardiology, Rabin Medical Center, Tel Aviv
University, Tel Aviv, Israel
(Ischinger) Department of Cardiology, Hospital Bogenhausen, Munich,
Germany
(Bartorelli) Centro Cardiologico Monzino, IRCCS, University of Milan,
Milan, Italy
(Gobbens) Cardialysis, Rotterdam, Netherlands
Title
The impact of patient and lesion complexity on clinical and angiographic
outcomes after revascularization with zotarolimus- and everolimus-eluting
stents: A substudy of the RESOLUTE all comers trial (a randomized
comparison of a zotarolimus-eluting stent with an everolimus-eluting stent
for percutaneous coronary intervention).
Source
Journal of the American College of Cardiology. 57 (22) (pp 2221-2232),
2011. Date of Publication: 31 May 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The aim of this study was to investigate the impact of patient
and lesion complexity on outcomes with newer-generation
zotarolimus-eluting stents (ZES) and everolimus-eluting stents (EES).
Background: Clinical and angiographic outcomes of newer-generation stents
have not been described among complex patients. Methods: Patients enrolled
in the RESOLUTE All Comers trial (A Randomized Comparison of a
Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for
Percutaneous Coronary Intervention) were stratified into "complex" and
"simple." Results: Of 2,292 patients, 1,520 (66.3%) were complex and
treated with ZES (n = 764) or EES (n = 756). Event rates were higher among
complex patients, and results did not differ between ZES and EES,
regardless of complexity. At 1 year, target lesion failure was 8.9% in
ZES- and 9.7% in EES-treated complex patients (p = 0.66) and 6.8% in ZES-
and 5.7% in EES-treated simple patients (p = 0.55). Rates of cardiac death
(1.3% vs. 2.2%, p = 0.24), target-vessel myocardial infarction (4.3% vs.
4.4%, p = 0.90), and clinically indicated target lesion revascularization
(4.4% vs. 4.0%, p = 0.80) were similar for both stent types among complex
patients. Definite or probable stent thrombosis occurred in 20 (1.3%)
complex patients with no difference between ZES (1.7%) and EES (0.9%, p =
0.26). Angiographic follow-up showed similar results for ZES and EES in
terms of in-stent percentage diameter stenosis (22.2 +/- 15.4% vs. 21.4
+/- 15.8%, p = 0.67) and in-segment binary restenosis (6.6% vs. 8.0%, p =
0.82) in the complex group. Conclusions: In this all-comers randomized
trial, major adverse cardiovascular events were more frequent among
complex than simple patients. The newer-generation ZES and EES proved to
be safe and effective, regardless of complexity, with similar clinical and
angiographic outcomes for both stent types through 1 year. (RESOLUTE-III
All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent
With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention;
NCT00617084) 2011 American College of Cardiology Foundation.

<14>
Accession Number
2011286034
Authors
Crawford-Faucher A.
Title
Home- and center-based cardiac rehabilitation equally effective.
Source
American Family Physician. 82 (8) (pp 994-995), 2010. Date of
Publication: October 15, 2010.
Publisher
American Academy of Family Physicians (11400 Tomahawk Creek Parkway, Suite
440, Leawood KS 66211, United States)
Abstract
Background: Heart disease continues to be a notable cause of morbidity and
mortality worldwide. In many developed countries, cardiac-related
mortality has decreased in recent decades. However, morbidity has
increased because more patients survive their initial cardiac event.
Cardiac rehabilitation after myocardial infarction or revascularization
improves physical health and reduces cardiac-related morbidity and
mortality. These programs usually include exercise, education, counseling,
and support, and offer strategies to change patient behaviors to modify
cardiac risk factors. Two recent randomized controlled trials reported a
20 percent reduction in all-cause mortality and a 27 percent reduction in
cardiacrelated mortality for participants at two to five years. Despite
the effectiveness of cardiac rehabilitation programs, participation is
low, with patients citing program access difficulties, dislike of groups,
and time conflicts with work and home responsibilities. A small systematic
re comparing home- and center-based rehabilitation programs found no
difference in effectiveness, but two large randomized controlled trials
have been published since that re was completed. Dalal and colleagues
provided an updated systematic re of the effects of home- versus
center-based cardiac rehabilitation on morbidity, mortality,
health-related quality of life, and modifiable cardiac risk factors in
patients who have had a cardiac event. The Study: Trials were identified
from the previously published systematic re and by additional literature
searches of clinical databases, including the Cochrane Central Register of
Controlled Trials, Medline, EMBASE, CINAHL, and PsycINFO. Studies were
eligible if they included patients who had participated in, or had been
invited to participate in, formal cardiac rehabilitation following
myocardial infarction, angina, heart failure, or revascularization (i.e.,
coronary artery bypass grafting, percutaneous transluminal coronary
angioplasty, or coronary artery stenting). Studies involving patients with
heart transplants, cardiac resynchronization devices, or implantable
defibrillators were excluded. Home-based rehabilitation was defined as a
structured program that included clear objectives and incorporated regular
monitoring and follow-up. Center-based rehabilitation included supervised
group programs, usually located at hospitals or sports centers. Results:
This re included 12 studies and 1,938 participants: three studies from the
United Kingdom; four from the United States; and one each from Canada,
Turkey, Italy, Iran, and China. Of these trials, nine reported outcomes up
to 12 months; the remainder had follow-up for 14 to 24 months. The
programs varied in content and intensity; eight programs included exercise
with education or counseling and four reported only on exercise. The
center-based programs used treadmills or bicycles for exercise, and the
home-based programs were based on walking protocols. Most studies
recruited patients at low risk of subsequent events. After accounting for
study heterogeneity, the authors found no significant differences between
home- and center-based cardiac rehabilitation on all-cause or
cardiac-related mortality, morbidity, short-term exercise capacity, blood
pressure, smoking cessation, or health-related quality of life measures.
The cost for each type of program depended on the health care economy of
each country; there were no notable cost differences between home- and
center-based care. Conclusion: The authors conclude that structured
cardiac rehabilitation programs are effective for secondary prevention in
patients with a low risk of further cardiac events. Home-based programs
are as effective as center-based programs. 2010 by the American Academy
of Family Physicians.

<15>
Accession Number
70435869
Authors
Illuminati G. Ricco J.-B.
Institution
(Illuminati) University La Sapienza, Roma, Italy
(Ricco) University of Poitiers, Poitiers, France
Title
Randomized controlled trial examining the timing of carotid endarterectomy
in patients with asymptomatic carotid stenosis undergoing coronary
arterybypass grafting.
Source
Journal of Vascular Surgery. Conference: 2011 Vascular Annual Meeting of
the Society for Vascular Surgery Chicago, IL United States. Conference
Start: 20110616 Conference End: 20110618. Conference Publication:
(var.pagings). 53 (6 SUPPL. 1) (pp 101S), 2011. Date of Publication:
June 2011.
Publisher
Mosby Inc.
Abstract
Objectives: Evaluate the timing of carotid endarterectomy (CEA) in the
prevention of stroke in patients having an asymptomatic carotid stenosis >
70% and receiving a coronary artery bypass graft (CABG). Methods: From
January 2004 to December 2009, 185 patients candidate to CABG, having a
unilateral asymptomatic carotid artery stenosis > 70%, were randomized in
2 groups. In group A, 94 patients received a CABG with either previous or
simultaneous CEA. In group B, 91 patients underwent CABG followed by CEA.
All the patients had a preoperative helical CT-scan excluding significant
atheroma of the thoracic aorta. Baseline characteristics of the patients,
type of coronary arteries lesions, preoperative myocardial function, were
comparable in the two groups. In group A, all patients underwent CEA under
general anesthesia with the systematic use of a carotid shunt. In this
group, 79 patients had a combined procedure, and 15 underwent CEA a few
days before CABG. In Group B all patients underwent CEA within 3 months
after CABG. Results: Two patients died in the postoperative period of
cardiac failure, one in each group. Operative mortality was 1.0% in group
A, and 1.1% in group B (p =0.98). No stroke occurred in group A vs. 7
ipsilateral ischemic strokes in group B including 3 immediate
postoperative strokes and 4 late strokes at 39, 50, 58 and 66 days after
CABG. These late strokes occurred in patients for whom CEA was delayed due
to an incomplete sternal wound healing or for completion of a cardiac
rehabilitation program. The 90-day stroke and death rate was 1.0% (1/94)
in group A, and 8.8% (8/91) in group B (p =.01, odds ratio:0.11[95%
CI:0.01-0.91]. Logistic regression analysis showed that only delayed CEA
(p=.03) and duration of cardiopulmonary bypass (p=.004) are associated
with a higher risk of stroke and death. Conclusions: This study suggests
that previous or simultaneous carotid revascularization in patients with
unilateral, asymptomatic carotid stenosis may reduce the rate of death and
stroke after CABG.