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<1>
Accession Number
2011336310
Authors
Myers K. Hajek P. Hinds C. McRobbie H.
Institution
(Myers, Hajek, Hinds, McRobbie) Queen Mary University of London, Barts and
The London School of Medicine and Dentistry, London, England, United
Kingdom
Title
Stopping smoking shortly before surgery and postoperative complications: A
systematic review and meta-analysis.
Source
Archives of Internal Medicine. 171 (11) (pp 983-989), 2011. Date of
Publication: June 13, 2011.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Objective: To examine existing smoking studies that compare surgical
patients who have recently quit smoking with those who continue to smoke
to provide an evidence-based recommendation for front-line staff. Concerns
have been expressed that stopping smoking within 8 weeks before surgery
may be detrimental to postoperative outcomes. This has generated
considerable uncertainty even in health care systems that consider smoking
cessation advice in the hospital setting an important priority. Smokers
who stop smoking shortly before surgery (recent quitters) have been
reported to have worse surgical outcomes than early quitters, but this may
indicate only that recent quitting is less beneficial than early quitting,
not that it is risky. Design: Systematic review with meta-analysis. Data
Sources: British Nursing Index (BNI), The Cochrane Library database,
Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase,
Medline, PsycINFO to May 2010, and reference lists of included studies.
Study Selection: Studies were included that allow a comparison of
postoperative complications in patients undergoing any type of surgery who
stopped smoking within 8 weeks prior to surgery and those who continued to
smoke. Data Extraction: Two reviewers independently screened potential
studies and assessed their methodologic quality. Data were entered into 3
separate meta-analyses that considered all available studies, studies with
a low risk of bias that validated self-reported abstinence (to assess
possible benefits), and studies of pulmonary complications only (to assess
possible risks). Results were combined by using a random-effects model,
and heterogeneity was evaluated by using the I² statistic.
Results: Nine studies met the inclusion criteria. One found a beneficial
effect of recent quitting compared with continuing smoking, and none
identified any detrimental effects. In meta-analyses, quitting smoking
within 8 weeks before surgery was not associated with an increase or
decrease in overall postoperative complications for all available studies
(relative risk [RR], 0.78; 95% confidence interval [CI], 0.57-1.07), for a
group of 3 studies with high-quality scores (RR, 0.57; 95% CI, 0.16-2.01),
or for a group of 4 studies that specifically evaluated pulmonary
complications (RR, 1.18; 95% CI, 0.95-1.46). Conclusions: Existing data
indicate that the concern that stopping smoking only a few weeks prior to
surgery might worsen clinical outcomes is unfounded. Further larger
studies would be useful to arrive at a more robust conclusion. Patients
should be advised to stop smoking as early as possible, but there is no
evidence to suggest that health professionals should not be advising
smokers to quit at any time prior to surgery. 2011 American Medical
Association. All rights reserved.

<2>
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
Balkan Medical Journal. 28 (1) (pp 75-79), 2011. Date of Publication:
2011.
Publisher
Trakya Universitesi (Dergisi Edirne 22030, 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.

<3>
Accession Number
2011327229
Authors
Adamson R.M. Stahovich M. Chillcott S. Baradarian S. Chammas J. Jaski B.
Hoagland P. Dembitsky W.
Institution
(Adamson, Stahovich, Chillcott, Baradarian, Chammas, Jaski, Hoagland,
Dembitsky) Sharp Memorial Hospital, 7910 Frost Street, San Diego, CA
92123, United States
Title
Clinical strategies and outcomes in advanced heart failure patients older
than 70 years of age receiving the heartmate II left ventricular assist
device: A community hospital experience.
Source
Journal of the American College of Cardiology. 57 (25) (pp 2487-2495),
2011. Date of Publication: 21 Jun 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The primary objective of this study was to determine outcomes
in left ventricular assist device (LVAD) patients older than age 70 years.
Background: Food and Drug Administration approval of the HeartMate II
(Thoratec Corporation, Pleasanton, California) LVAD for destination
therapy has provided an attractive option for older patients with advanced
heart failure. Methods: Fifty-five patients received the HeartMate II LVAD
between October 5, 2005, and January 1, 2010, as part of either the bridge
to transplantation or destination therapy trials at a community hospital.
Patients were divided into 2 age groups: <70 years of age (n = 30) and <70
years of age (n = 25). Outcome measures including survival, length of
hospital stay, adverse events, and quality of life were compared between
the 2 groups. Results: Pre-operatively, all patients were in New York
Heart Association functional class IV refractory to maximal medical
therapy. Kaplan-Meier survival for patients <70 years of age (97% at 1
month, 75% at 1 year, and 70% at 2 years) was not statistically different
from patients <70 years of age (96% 1 month, 72% at 1 year, and 65% at 2
years, p = 0.806). Average length of hospital stay for the <70-year age
group was 24 +/- 15 days, similar to that of the <70-year age group (23
+/- 14 days, p = 0.805). There were no differences in the incidence of
adverse events between the 2 groups. Quality of life and functional status
improved significantly in both groups. Conclusions: The LVAD patients <70
years of age have good functional recovery, survival, and quality of life
at 2 years. Advanced age should not be used as an independent
contraindication when selecting a patient for LVAD therapy at experienced
centers. 2011 American College of Cardiology Foundation.

<4>
Accession Number
2011322548
Authors
Sharif S. Zahid I. Routledge T. Scarci M.
Institution
(Sharif, Zahid) Imperial College London, South Kensington Campus, London
SW7 2AZ, United Kingdom
(Routledge, Scarci) Department of Thoracic Surgery, Guy's Hospital, Great
Maze Pond, London SE1 9RT, United Kingdom
Title
Extrapleural pneumonectomy or supportive care: Treatment of malignant
pleural mesothelioma?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (6) (pp 1040-1045),
2011. Date of Publication: June 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 extrapleural
pneumonectomy (EPP) is superior to supportive care in the treatment of
patients with malignant pleural mesothelioma (MPM). Overall, 110 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 are tabulated. We conclude that EPP confers no
advantage to chemotherapy and palliative treatment in terms of survival
and symptom improvement. Ten studies evaluated the role of EPP in the
management of MPM. The median survival was 13 months and perioperative and
30-day mortality rates were 5.7% and 9.1%, respectively. There was a high
morbidity rate of 37% including atrial fibrillation, empyema and
supraventricular arrhythmias. Disease recurred in 73% of patients at a
median time of 10 months. Median hospital stay was 13 days and intensive
care unit stay was 1.5 days. At three months postsurgery, improvement in
symptoms was achieved in 68% of patients. Significant advantages were
observed in patients with epithelial MPM (19 vs. 8 months, P<0.01)
compared to non-epithelial MPM and with N2 disease (19 vs. 10 months)
compared to N1 or N0 disease, respectively. Two studies reported outcomes
after chemotherapy in patients with MPM. The median survival was 13 months
and symptoms improved in 50% of patients. Response rate of 21% was
achieved and the median time to disease progression was 7.2 months.
Postoperative haematological toxicity was common and included neutropenia
(25%), anaemia (5%) and thrombocytopenia (7.4%). Two studies analysed
palliative treatment in mesothelioma and reported a median survival of
seven months and improvement in symptoms in 25% of patients at one-year
post-treatment. The 30-day mortality rate was 7.8% and complications
included prolonged air leak (9.8%) and empyema (4%). Median hospital stay
was seven days. Overall, EPP shows no benefit in terms of survival or
symptom improvement which is compounded by its high operative mortality
and recurrence rate. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<5>
Accession Number
2011322547
Authors
Bianchi G. Bevilacqua S. Solinas M. Glauber M.
Institution
(Bianchi, Bevilacqua, Solinas, Glauber) Hospital and Research Institute
CREAS IFC CNR, G. Pasquinucci Heart Hospital, via Aurelia Sud, 54100
Massa, Italy
Title
In adult patients undergoing redo surgery for left atrioventricular valve
regurgitation after atrioventricular septal defect correction, is
replacement superior to repair?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (6) (pp 1033-1039),
2011. Date of Publication: June 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'In adult patients
undergoing redo surgery for left atrioventricular valve regurgitation
after atrioventricular septal defect correction, is replacement superior
to repair?' Altogether more than 109 papers were found using the reported
search, of which eight 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. We conclude that left atrioventricular valve (LAVV)
repair should be the first line approach and the use of transesophageal
echocardiography (TEE) in operating room is mandatory. When complex
anatomy and multiple anomalies of the LAVV are present the risk of a
suboptimal repair is high and is associated with elevated subsequent risk
of early reintervention. Prosthetic valve replacement is suggested in
these cases and there is no long-term survival difference compared to
repair procedures. Unfortunately, the risk of complete heart block and
permanent pacemaker (PMK) implantation is higher when replacement is
performed. Prosthetic valve choice is in favor of mechanical valves,
mainly due to the young age of the patients. In the selected articles the
frequency of valve replacement ranged from 14 to 34% and a mechanical
valve was used in nearly all cases in the presented series. We feel that
for older patients or for those in whom long-term anticoagulation is a
concern, biological prosthesis can be an option, also due to the growing
and expanding experience of percutaneousytransapical valve-in-valve
replacement in mitral position. Since in these patients the number of
previous sternotomies is usually one or more and re-entry injuries can be
a major source of perioperative mortality and morbidity, we believe that
mini-thoracotomy approach can avoid potential damage; furthermore,
arterial cannulation can be either central or peripheral according to the
degree of visceral adhesions or surgeon's choice. Venous drainage should
be provided by a percutaneous vacuum-assisted femoral double stage venous
drainage, which is useful especially when concomitant tricuspid valve
surgery is planned. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<6>
Accession Number
2011322546
Authors
Tavare A.N. Parvizi N.
Institution
(Tavare) Section of Investigative Medicine, Imperial College London,
Hammersmith Hospital, London, United Kingdom
(Parvizi) Department of Vascular Surgery, Northwick Park Hospital, London,
United Kingdom
Title
Does use of intraoperative cell-salvage delay recovery in patients
undergoing elective abdominal aortic surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (6) (pp 1028-1032),
2011. Date of Publication: June 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in vascular surgery was written according to a
structured protocol. The question addressed was whether the use
ofintraoperative cell-salvage (ICS) leads to negative outcomes in patients
undergoing elective abdominal aortic surgery? Altogether 305papers were
found using the reported search, of which 10 were judged to represent the
best evidence to answer the clinical question. Theauthors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers weretabulated. None of the 10 papers
included in the analysis demonstrated that ICS use led to significantly
higher incidence of cardiac orseptic postoperative complications.
Similarly, length of intensive treatment unit (ITU) or hospital stay and
mortality in elective abdominalaortic surgery were not adversely affected.
Indeed two trials actually show a significantly shorter hospital stay
after ICS use, one a shorterITU stay and another suggests lower rates of
chest sepsis. Based on these papers, we concluded that the use of ICS does
not cause increasedmorbidity or mortality when compared to standard
practise of transfusion of allogenic blood, and may actually improve some
clinicaloutcomes. As abdominal aortic surgery inevitably causes
significant intraoperative blood loss, in the range of 661-3755 ml as
described inthe papers detailed in this review, ICS is a useful and safe
strategy to minimise use of allogenic blood. 2011 Published by European
Association for Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
2011322544
Authors
Jarral O.A. McCormack D.J. Ibrahim S. Shipolini A.R.
Institution
(Jarral, McCormack, Ibrahim, Shipolini) Department of Cardiothoracic
Surgery, London Chest Hospital, Bonner Road, London E2 9JX, United Kingdom
Title
Should surgeons scrub with chlorhexidine or iodine prior to surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (6) (pp 1017-1021),
2011. Date of Publication: June 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether chlorhexidine gluconate is equivalent or
superior to the use of povidone-iodine during surgical hand scrub. A total
of 593 papers were found using the reported searches of which eight
represented the best evidence to answer the clinical question. The
authors, date, journal, study type, population, main outcome measures and
results are tabulated. We conclude that whilst both chlorhexidine and
povidone-iodine reduce bacterial count after scrubbing, the effect of
chlorhexidine is both more profound and longer lasting. The studies found
analysed the difference in reduction in colony forming units or bacterial
count following surgical scrub in order to conclude that chlorhexidine was
superior. Four studies went further to analyse cumulative and residual
activity by testing for bacterial reduction after using a scrub solution
for a number of days, an area in which chlorhexidine showed consistent
advantages over povidone-iodine. These findings are given more credibility
by the clinical finding of a recent meta-analysis of over 5000 patients in
which chlorhexidine as an antiseptic skin preparation was associated with
significantly reduced surgical site infection (SSI) in clean-contaminated
surgery. Despite this, there is no evidence suggesting the use of
chlorhexidine during hand scrub reduces SSI, which perhaps explains why
guidelines from the World Health Organization, the Centers for Disease
Control and Prevention and the Association for Perioperative Practice do
not recommend one specific antimicrobial over another for hand scrub.
2011 Published by European Association for Cardio-Thoracic Surgery. All
rights reserved.

<8>
Accession Number
2011322539
Authors
Ovcina I. Knez I. Curcic P. Ozkan S. Nagel B. Sorantin E. Puchinger M.
Tscheliessnigg K.
Institution
(Ovcina, Knez, Curcic, Ozkan, Tscheliessnigg) Division of Cardiac Surgery,
Department of Surgery, Medical University of Graz, Auenbruggerplatz 29,
A-8036 Graz, Austria
(Nagel) Division of Cardiology, Department of Pediatrics, Medical
University of Graz, Graz, Austria
(Sorantin) Division of Radiology, Department of Radiology, Medical
University of Graz, Graz, Austria
(Puchinger) Research Unit of Medical Engineering and Computing, Department
of Surgery, Medical University of Graz, Graz, Austria
Title
Pulmonary valve replacement with mechanical prostheses in re-do Fallot
patients.
Source
Interactive Cardiovascular and Thoracic Surgery. 12 (6) (pp 987-992),
2011. Date of Publication: June 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
In this prospective clinical study, we have compared 17 patients with
tetralogy of Fallot (TOF) who received mechanical valve substitutes and
had concomitant additional right ventricular (RV) volume reduction plasty
(aRVVRP, group 1) with seven patients who underwent solitary re-do
pulmonary valve replacements (PVR, group 2). All patients were evaluated
by magnetic resonance imaging (MRI) two months pre- and four to six months
postoperatively for assessment of ventricular geometry. At a mean
follow-up of 31.9 months, the RV ejection fraction improved from 39.1 to
48.3% in group 1 vs. from 40.1 to 49% in group 2 (P<=0.001), and RV
indexed end-diastolic volume decreased from 174.8 to 119.9
mlym² (group 1) vs. from 142.4 to 99.6 mlym² (group
2, P<0.001). Indexed RV myocardial mass decreased from 52.3 to 38.7
gym² in group 1 vs. 46.9 to 39.1 gym² in group 2
(P<0.001). Follow-up revealed no mortality and distinct improvements in RV
geometry, recommending mechanical prostheses as suitable alternatives for
PVR. Selection criteria for this solution should consider multiple
previous reoperations and assured patient compliance in terms of current
anticoagulant usage and self-testing. aRVVRP could serve as an adjunct in
re-dos of TOF surgery indicated by RV outflow tract dysfunction due to
akinetic fibrous areas. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<9>
Accession Number
2011298412
Authors
Farman M.T. Sial J.A. Khan N.U. Rizvi S.N.H. Saghir T. Khan S.Z.
Institution
(Farman, Sial, Khan, Rizvi, Saghir, Khan) Department of Cardiology,
Karachi Institute of Heart Diseases, Karachi, Pakistan
Title
Outcome of primary percutaneous coronary intervention at public sector
tertiary care hospital in Pakistan.
Source
Journal of the Pakistan Medical Association. 61 (6) (pp 575-581), 2011.
Date of Publication: June 2011.
Publisher
Pakistan Medical Association (Garden Road, Karachi - 3, Pakistan)
Abstract
Objectives: To determine the outcome of Primary Precutaneous Coronary
Intervention (PCI) in our setup and compare the results with the west.
Methods: This study was conducted at a tertiary care teaching Hospital
(National Institute of Cardiovascular Diseases Karachi, Pakistan) during
January 1st, 2008 to December 31st, 2008. A total of 113 patients were
enrolled who came with STEMI and agreed to go for Primary PCI. We excluded
the patients who had history of Thrombolytic therapy within 24 hours,
presented with Non ST-elevation Myocardial Infarction (NSTEMI) and
coronary angiogram revealed significant left Main or equivalent disease.
All Patients received Aspirin, Clopidogrel and Platelet Glycoprotein IIB
IIIA Inhibitor. After Primary PCI patients were planned to follow at one
month, 3 months and 6 months. Primary end point was to document death, MI,
CABG and rehospitalization. Results: Out of 113 cases, 102 (90.3%) were
male and 11 (9.7%) were female, Mean age was 51.2+/-11.7 years, 54 (47.8%)
patients had Hypertension, 28 (24.8%) were Diabetics and 44 (38.9%) were
Smokers. Immediate success was achieved in 111 (98.2%) cases. In hospital
mortality was 5.3% (3.5% in cardiogenic shock, 1.7% in non-shock
patients). Mean Door to Balloon time remained 98.4 minutes. Twelve
patients were lost to follow up. Therefore at 6 months, out of 101
patients, 8 (7.9%) died, 5 (4.9%) underwent Coronary Artery Bypass Graft
(CABG) surgery and 5 (4.9 %) had been re-hospitalized either for recurrent
myocardial infarction or heart failure. Conclusion: Optimal results of
primary percutaneous coronary intervention can be achieved for acute STEMI
in a developing country at a tertiary care public sector hospital. The
results are comparable and nearly similar to the west.

<10>
Accession Number
2011348574
Authors
Leino K. Hynynen M. Jalonen J. Salmenpera M. Scheinin H. Aantaa R.
Institution
(Leino, Jalonen, Aantaa) Department of Anaesthesiology, Intensive Care,
Emergency Care and Pain Medicine, Turku University Hospital, Turku,
Finland
(Hynynen) Department of Anesthesia and Intensive Care Medicine, Helsinki
University Hospital, Jorvi Hospital, Espoo, Finland
(Salmenpera) Department of Anesthesiology and Intensive Care, Helsinki
University Hospital, Helsinki, Finland
(Scheinin) Department of Pharmacology, University of Turku, Turku, Finland
Title
Renal effects of dexmedetomidine during coronary artery bypass surgery: A
randomized placebo-controlled study.
Source
BMC Anesthesiology. 11 , 2011. Article Number: 9. Date of Publication:
23 May 2011.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: Dexmedetomidine, an alpha₂-adrenoceptor agonist,
has been evaluated as an adjunct to anesthesia and for the delivery of
sedation and perioperative hemodynamic stability. It provokes
dose-dependent and centrally-mediated sympatholysis. Coronary artery
bypass grafting (CABG) with extracorporeal circulation is a stressful
procedure increasing sympathetic nervous system activity which could
attenuate renal function due the interrelation of sympathetic nervous
system, hemodynamics and renal function. We tested the hypothesis that
dexmetomidine would improve kidney function in patients undergoing
elective CABG during the first two postoperative days.Methods: This was a
double-blind, randomized, parallel-group study. Patients with normal renal
function and scheduled for elective CABG were randomized to placebo or to
infusion of dexmedetomidine to achieve a pseudo steady-state plasma
concentration of 0.60 ng/ml. The infusion was started after anesthesia
induction and continued until 4 h after surgery. The primary endpoint was
creatinine clearance. Other variables included urinary creatinine and
output, fractional sodium and potassium excretion, urinary potassium,
sodium and glucose, serum and urinary osmolality and plasma catecholamine
concentrations. The data were analyzed with repeated-measures ANOVA or
Cochran-Mantel-Haenszel test.Results: Sixty-six of 87 randomized patients
were evaluable for analysis. No significant between-group differences were
recorded for any indices of renal function except for a mean 74% increase
in urinary output with dexmedetomidine in the first 4 h after insertion of
a urinary catheter (p < 0.001). Confidence interval examination revealed
that the sample size was large enough for the no-difference statement for
creatinine clearance.Conclusions: Use of intravenous dexmedetomidine did
not alter renal function in this cohort of relatively low-risk elective
CABG patients but was associated with an increase in urinary output.This
study was carried out in 1994-1997 and was thus not registered. 2011
Leino et al; licensee BioMed Central Ltd.

<11>
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Accession Number
2011344649
Authors
Schilling T. Kozian A. Senturk M. Huth C. Reinhold A. Hedenstierna G.
Hachenberg T.
Institution
(Schilling, Kozian, Senturk, Hachenberg) Department of Anesthesiology and
Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Leipziger
Strasse 44, D-39120 Magdeburg, Germany
(Huth) Department of Cardiovascular and Thoracic Surgery,
Otto-von-Guericke-University Magdeburg, Germany
(Reinhold) Institute of Molecular and Clinical Immunology,
Otto-von-Guericke-University Magdeburg, Germany
(Hedenstierna) Department of Clinical Physiology, Uppsala University,
Uppsala, Sweden
Title
Effects of volatile and intravenous anesthesia on the alveolar and
systemic inflammatory response in thoracic surgical patients.
Source
Anesthesiology. 115 (1) (pp 65-74), 2011. Date of Publication: July
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: One-lung ventilation (OLV) results in alveolar proinflammatory
effects, whereas their extent may depend on administration of anesthetic
drugs. The current study evaluates the effects of different volatile
anesthetics compared with an intravenous anesthetic and the relationship
between pulmonary and systemic inflammation in patients undergoing open
thoracic surgery. Methods: Sixty-three patients scheduled for elective
open thoracic surgery were randomized to receive anesthesia with 4 mg * kg
* h propofol (n = 21), 1 minimum alveolar concentration desflurane (n =
21), or 1 minimum alveolar concentration sevoflurane (n = 21). Analgesia
was provided by remifentanil (0.25 mug * kg * min). After intubation, all
patients received pressure-controlled mechanical ventilation with a tidal
volume of approximately 7 ml * kg ideal body weight, a peak airway
pressure lower than 30 cm H2O, a respiratory rate adjusted to a Paco2 of
40 mmHg, and a fraction of inspired oxygen lower than 0.8 during OLV.
Fiberoptic bronchoalveolar lavage of the ventilated lung was performed
immediately after intubation and after surgery. The expression of
inflammatory cytokines was determined in the lavage fluids and serum
samples by multiplexed bead-based immunoassays. Results: Proinflammatory
cytokines increased in the ventilated lung after OLV. Mediator release was
more enhanced during propofol anesthesia compared with desflurane or
sevoflurane administration. For tumor necrosis factor-alpha, the values
were as follows: propofol, 5.7 (8.6); desflurane, 1.6 (0.6); and
sevoflurane, 1.6 (0.7). For interleukin-8, the values were as follows:
propofol, 924 (1680); desflurane, 390 (813); and sevoflurane, 412 (410).
(Values are given as median [interquartile range] pg * ml).
Interleukin-1beta was similarly reduced during volatile anesthesia. The
postoperative serum interleukin-6 concentration was increased in all
patients, whereas the systemic proinflammatory response was negligible.
Conclusions: OLV increases the alveolar concentrations of proinflammatory
mediators in the ventilated lung. Both desflurane and sevoflurane suppress
the local alveolar, but not the systemic, inflammatory responses to OLV
and thoracic surgery. Copyright 2011, the American Society of
Anesthesiologists, Inc. Lippincott Williams & Wilkins.

<12>
Accession Number
2011331113
Authors
Rafnsson S.B. Saravanan P. Bhopal R.S. Yajnik C.S.
Institution
(Rafnsson, Bhopal) Public Health Sciences Section, School of Clinical
Sciences and Community Health, University of Edinburgh, Teviot Place,
Edinburgh EH8 9AG, United Kingdom
(Saravanan) Clinical Sciences Research Institute, Warwick Medical School,
UHCW NHS Trust, Coventry CV2 2DX, United Kingdom
(Yajnik) Diabetes Unit, KEM Hospital and Research Centre, Rasta Peth,
Pune, Maharashtra 411 011, India
Title
Is a low blood level of vitamin B12 a cardiovascular and diabetes risk
factor? A systematic review of cohort studies.
Source
European Journal of Nutrition. 50 (2) (pp 97-106), 2011. Date of
Publication: March 2011.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Purpose: To assess the prior hypothesis that low blood vitamin B12, partly
through hyperhomocysteinemia and partly through direct effects, increases
the risk of cardiovascular diseases and diabetes. As background, we also
extracted all-cause mortality from the studies that met our criteria.
Methods: A systematic review of prospective cohort studies identified
through searching six electronic databases, screening of reference lists,
and citation search. Included studies reported data on the association
between vitamin B12 blood levels, or other appropriate surrogate
biological markers e.g. holotranscobalamin or serum/urine methylmalonic
acid, and fatal or non-fatal incident diabetes and cardiovascular events.
Results: Seven studies were included. Studies differed regarding the
population studied, length of follow-up, study outcomes, and data analysis
- a narrative synthesis approach was performed to examine the results.
Most studies met few of the quality assessment criteria which were adapted
from the Scottish Intercollegiate Guidelines Network (SIGN). Only one
high-quality study reported that low B12 increased the risk of incident
cerebral ischaemia (RR = 1.76; 95% CI = 1.16-2.68). After controlling for
homocysteine, the association persisted although weakened (RR = 1.57; 95%
CI = 1.02-2.43), suggesting that the effects of low B12 were only partly
mediated by homocysteine. In two studies, higher B12 levels were
associated with a greater risk of total mortality (RR = 1.00; 95% CI =
1.00-1.00 and HR = 1.15; 95% CI = 1.08-1.22, respectively) and combined
fatal and non-fatal coronary events (RR = 1.00; 95% CI = 1.00-1.00). No
association between study outcomes and vitamin B12 levels was found in
four other studies. Conclusions: Surprisingly, there is only very limited
evidence that vitamin B12 deficiency predisposes to the risk of mortality
and morbidity from either cardiovascular diseases or diabetes in adults.
Current data do not support vitamin B12 supplementation to reduce the risk
of cardiovascular diseases or diabetes. Springer-Verlag 2010.

<13>
Accession Number
2011345653
Authors
Pettila V. Westbrook A.J. Nichol A.D. Bailey M.J. Wood E.M. Syres G.
Phillips L.E. Street A. French C. Murray L. Orford N. Santamaria J.D.
Bellomo R. Cooper D.J.
Institution
(Pettila, Westbrook, Nichol, Bailey, Syres, Murray, Bellomo, Cooper)
Australian and New Zealand Intensive Care Research Centre, Department of
Epidemiology and Preventive Medicine, Monash University, Commercial Road,
Melbourne 3004, VIC, Australia
(Nichol, Cooper) Department of Intensive Care and Hyperbaric Medicine, The
Alfred Hospital, Commercial Road, Melbourne 3004, VIC, Australia
(Wood) Australian Red Cross Blood Service, St Kilda Road, Melbourne 3004,
VIC, Australia
(Wood, Phillips) Transfusion Outcomes Research Collaborative, Department
of Epidemiology and Preventive Medicine, School of Public Health and
Preventive Medicine Monash University, Commercial Road, Melbourne 3004,
VIC, Australia
(Street) Haematology Unit, The Alfred Hospital, Commercial Road, Melbourne
3004, VIC, Australia
(French) Department of Intensive Care, Western Health, Gordon Street,
Fitzroy 3011, VIC, Australia
(Orford) Department of Intensive Care, The Geelong Hospital, Ryrie Street,
Geelong 3220, VIC, Australia
(Santamaria) Intensive Care Unit, St Vincent's Hospital, Victoria Parade,
Fitzroy 3065, VIC, Australia
Title
Age of red blood cells and mortality in the critically ill.
Source
Critical Care. 15 (2) , 2011. Article Number: R116. Date of
Publication: 15 Apr 2011.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Introduction: In critically ill patients, it is uncertain whether exposure
to older red blood cells (RBCs) may contribute to mortality. We therefore
aimed to evaluate the association between the age of RBCs and outcome in a
large unselected cohort of critically ill patients in Australia and New
Zealand. We hypothesized that exposure to even a single unit of older RBCs
may be associated with an increased risk of death.Methods: We conducted a
prospective, multicenter observational study in 47 ICUs during a 5-week
period between August 2008 and September 2008. We included 757 critically
ill adult patients receiving at least one unit of RBCs. To test our
hypothesis we compared hospital mortality according to quartiles of
exposure to maximum age of RBCs without and with adjustment for possible
confounding factors.Results: Compared with other quartiles (mean maximum
red cell age 22.7 days; mortality 121/568 (21.3%)), patients treated with
exposure to the lowest quartile of oldest RBCs (mean maximum red cell age
7.7 days; hospital mortality 25/189 (13.2%)) had an unadjusted absolute
risk reduction in hospital mortality of 8.1% (95% confidence interval =
2.2 to 14.0%). After adjustment for Acute Physiology and Chronic Health
Evaluation III score, other blood component transfusions, number of RBC
transfusions, pretransfusion hemoglobin concentration, and cardiac
surgery, the odds ratio for hospital mortality for patients exposed to the
older three quartiles compared with the lowest quartile was 2.01 (95%
confidence interval = 1.07 to 3.77).Conclusions: In critically ill
patients, in Australia and New Zealand, exposure to older RBCs is
independently associated with an increased risk of death. 2011 Pettila et
al.; licensee BioMed Central Ltd.

<14>
Accession Number
2011345006
Authors
Pilgrim T. Rber L. Limacher A. Loffel L. Wenaweser P. Cook S. Stauffer
J.-C. Togni M. Vogel R. Garachemani A. Moschovitis A. Khattab A.A. Seiler
C. Meier B. Juni P. Windecker S.
Institution
(Pilgrim, Rber, Loffel, Wenaweser, Togni, Vogel, Moschovitis, Khattab,
Seiler, Meier, Windecker) Department of Cardiology, Bern University
Hospital, 3010 Bern, Switzerland
(Limacher, Juni, Windecker) Clinical Trials Unit, Bern University
Hospital, Bern, Switzerland
(Juni) Institute of Social and Preventive Medicine, University of Bern,
Bern, Switzerland
(Garachemani) Department of Cardiology, Clinic Sonnenhof, Bern,
Switzerland
(Cook, Stauffer) Department of Cardiology, University of Fribourg,
Fribourg, Switzerland
Title
Comparison of titanium-nitride-oxidecoated stents with zotarolimus-eluting
stents for coronary revascularization: A randomized controlled trial.
Source
JACC: Cardiovascular Interventions. 4 (6) (pp 672-682), 2011. Date of
Publication: June 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to compare the efficacy of passive stent
coating with titanium-nitride-oxide (TiNO) with drug-eluting stents
releasing zotarolimus (ZES) (Endeavor, Medtronic, Minneapolis, Minnesota).
Background: Stent coating with TiNO has been shown to reduce restenosis
compared with bare-metal stents in experimental and clinical studies.
Methods: In an assessor-blind noninferiority study, 302 patients
undergoing percutaneous coronary intervention were randomized to treatment
with TiNO or ZES. The primary endpoint was in-stent late loss at 6 to 8
months, and analysis was by intention to treat. Results: Both groups were
well balanced with respect to baseline clinical and angiographic
characteristics. The TiNO group failed to reach the pre-specified
noninferiority margin for the primary endpoint (in-stent late loss: 0.64
+/- 0.61 mm vs. 0.47 +/- 0.48 mm, difference: 0.16, upper 1-sided 95%
confidence interval [CI]: 0.26; p_{noninferiority} = 0.54), and
subsequent superiority testing was in favor of ZES
(p_superiority = 0.02). In-segment binary restenosis was lower
with ZES (11.1%) than with TiNO (20.5%; p_superiority = 0.04). A
stratified analysis of the primary endpoint found particularly pronounced
differences between stents among diabetic versus nondiabetic patients
(0.90 +/- 0.69 mm vs. 0.39 +/- 0.38 mm; p_interaction = 0.04).
Clinical outcomes showed a similar rate of death (0.7% vs. 0.7%; p =
1.00), myocardial infarction (5.3% vs. 6.7%; p = 0.60), and major adverse
cardiac events (21.1% vs. 18.0%, hazard ratio: 1.19, 95% CI: 0.71 to 2.00;
p = 0.50) at 1 year. There were no differences in rates of definite or
probable stent thrombosis (0.7% vs. 0%; p = 0.51) at 1 year. Conclusions:
Compared with TiNO, ZES was superior with regard to late loss and binary
restenosis. The concept of passive stent coating with TiNO remains
inferior to drug-eluting stent technology in reducing restenosis. ([TIDE]
Randomized Trial Comparing Titan Stent With Zotarolimus-Eluting Stent:
NCT00492908) 2011 American College of Cardiology Foundation.

<15>
Accession Number
2011341796
Authors
Cole J.A. Smith S.M. Hart N. Cupples M.E.
Institution
(Cole, Hart, Cupples) UKCRC Centre of Excellence for Public Health
(Northern Ireland), Queen's University Belfast, Dunluce Health Centre, 1
Dunluce Avenue, Belfast BT9 7HR, United Kingdom
(Smith) Department of Public Health and Primary Care, Trinity College
Centre for Health Sciences, AMNCH, Tallaght, Dublin 24, Ireland
Title
Systematic review of the effect of diet and exercise lifestyle
interventions in the secondary prevention of coronary heart disease.
Source
Cardiology Research and Practice. 1 (1) , 2011. Article Number: 232351.
Date of Publication: 2011.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
The effectiveness of lifestyle interventions within secondary prevention
of coronary heart disease (CHD) remains unclear. This systematic review
aimed to determine their effectiveness and included randomized controlled
trials of lifestyle interventions, in primary care or community settings,
with a minimum follow-up of three months, published since 1990. 21 trials
with 10,799 patients were included; the interventions were multifactorial
(10), educational (4), psychological (3), dietary (1), organisational (2),
and exercise (1). The overall results for modifiable risk factors
suggested improvements in dietary and exercise outcomes but no overall
effect on smoking outcomes. In trials that examined mortality and
morbidity, significant benefits were reported for total mortality (in 4 of
6 trials; overall risk ratio (RR) 0.75 (95 confidence intervals (CI) 0.65,
0.87)), cardiovascular mortality (3 of 8 trials; overall RR 0.63 (95 CI
0.47, 0.84)), and nonfatal cardiac events (5 of 9 trials; overall RR 0.68
(95 CI 0.55, 0.84)). The heterogeneity between trials and generally poor
quality of trials make any concrete conclusions difficult. However, the
beneficial effects observed in this review are encouraging and should
stimulate further research. Copyright 2011 Judith A. Cole et al.

<16>
Accession Number
2011341520
Authors
Marks W.H. Ilsley J.N. Dharnidharka V.R.
Institution
(Marks) Department of Organ Transplantation, Swedish Medical Center,
Seattle, WA, United States
(Ilsley) Medical Affairs, Genzyme Corporation, Cambridge, MA, United
States
(Dharnidharka) Division of Pediatric Nephrology, University of Florida
Health Science Center, Shands Children's Hospital, 1600 SW Archer Road,
Gainesville, FL 32610-0296, United States
Title
Posttransplantation lymphoproliferative disorder in kidney and heart
transplant recipients receiving thymoglobulin: A systematic review.
Source
Transplantation Proceedings. 43 (5) (pp 1395-1404), 2011. Date of
Publication: June 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Posttransplantation lymphoproliferative disorder (PTLD) is an important
complication of transplantation. Risk factors include increased overall
immunosuppression exposure and inadequate antiviral prophylaxis; however,
the effects of T-cell-depleting agents on PTLD are unclear. A systematic
literature review was conducted to assess PTLD in clinical studies
published 1999-2009 in transplant patients with <3 years follow-up who
received Thymoglobulin for induction. Twenty studies were identified (12
kidney, 7 heart, and 1 liver), of which 3 were excluded for insufficient
PTLD reporting. The final study group comprised 2,246 kidney and heart
transplant recipients (liver study excluded) who received Thymoglobulin.
At a median follow-up of 5 years, the incidence of PTLD was 0.98% (kidney,
0.93%; heart, 1.05%) among Thymoglobulin-treated patients. The cumulative
Thymoglobulin dose reported in these studies was not associated with the
development of PTLD (P = NS). However, incidence of PTLD was significantly
lower with antiviral prophylaxis (0.63%) than without (1.87%; P = .013).
Heart transplant recipients not receiving antiviral prophylaxis had the
highest PTLD incidence, possibly attributable to a greater overall
immunosuppressive burden. This analysis revealed that PTLD incidences in
kidney and heart transplant recipients receiving Thymoglobulin were low
overall and perhaps related more to concomitant anti-viral prophylaxis
use. 2011 Elsevier Inc.

<17>
Accession Number
2011341439
Authors
Stypmann J. Engelen M.A. Eckernkemper S. Amler S. Gunia S. Sindermann J.R.
Rothenburger M. Rukosujew A. Drees G. Welp H.A.
Institution
(Stypmann, Engelen, Eckernkemper, Gunia) Department of Cardiology and
Angiology, University Hospital Munster, Germany
(Amler) Department of Medical Informatics and Biomathematics, University
of Munster, Germany
(Sindermann, Rothenburger, Rukosujew, Drees, Welp) University Hospital
Munster, Department of Thoracic and Cardiovascular Surgery,
Albert-Schweitzer-Str. 33, D-48149 Munster, Germany
Title
Calcineurin inhibitor-free immunosuppression using everolimus (certican)
after heart transplantation: 2 years' follow-up from the university
hospital Munster.
Source
Transplantation Proceedings. 43 (5) (pp 1847-1852), 2011. Date of
Publication: June 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Everolimus is a proliferation-signal inhibitor which was
introduced for heart transplant recipients in 2004. To date, there are
only sparse data about long-term calcineurin inhibitor (CNI)free
immunosuppression using everolimus. Methods: After heart transplantation,
patients receiving everolimus were consecutively enrolled. Reasons for
switching to everolimus were side effects of CNI immunosuppression, such
as deterioration of kidney function and recurrent rejection episodes. All
60 patients underwent standardized switching protocols, 42 patients
completed 24-month follow-up. Blood was sampled for lipid status, renal
function, routine controls, and levels of immunosuppressive agents. On
days 0, 14, and 28, and then every 3 months, echocardiography and physical
examination were performed. Results: After switching to everolimus, most
patients recovered from the side effects. Renal function improved
significantly after 24 months (creatinine, 2.1 +/- 0.6 vs 1.8 +/- 1 mg/dL;
P < .001; creatinine clearance, 41.8 +/- 22 vs 48.6 +/- 21.8 mL/min; P <
.001). Median blood pressure increased from 120.0/75.0 mm Hg at baseline
to 123.8/80.0 mm Hg at month 24 (P values .008 and .003 for systolic and
diastolic pressures, respectively). Tremor, peripheral edema, hirsutism,
and gingival hyperplasia markedly improved. Levels of interleukin-6 were
stable between baseline and 24-month levels. Temporary adverse events
occurred in 8 patients [13.3%: interstitial pneumonia (n = 2), skin
disorders (n = 2); reactivated hepatitis B (n = 1), and fever of unknown
origin (n = 3)]. Conclusion: CNI-free immunosuppression using everolimus
is safe, with excellent efficacy in maintenance of heart transplant
recipients. Arterial hypertension and renal function significantly
improved. CNI-induced side effects, such as tremor, peripheral edema,
hirsutism, and gingival hyperplasia, markedly improved in most patients.
2011 Elsevier Inc.

<18>
Accession Number
2011339801
Authors
Izawa K.P. Watanabe S. Oka K. Hiraki K. Morio Y. Kasahara Y. Osada N.
Omiya K. Makuuchi H.
Institution
(Izawa, Watanabe, Hiraki, Morio, Kasahara) Department of Rehabilitation
Medicine, St. Marianna University School of Medicine Hospital, 2-16-1
Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
(Oka) Faculty of Sport Sciences, Waseda University, Saitama, Japan
(Osada, Omiya) Division of Cardiology, Department of Internal Medicine,
St. Marianna University School of Medicine, Kanagawa, Japan
(Makuuchi) Department of Cardiovascular Surgery, St. Marianna University
School of Medicine, Kanagawa, Japan
Title
Cardiac rehabilitation outcome following percutaneous coronary
intervention compared to cardiac surgery.
Source
Recent Patents on Cardiovascular Drug Discovery. 6 (2) (pp 133-139),
2011. Date of Publication: May 2011.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
To examine differences in objective and subjective outcomes in outpatients
undergoing percutaneous coronary intervention (PCI) performed for acute
myocardial infarction versus cardiac surgery (CS) following a phase II
cardiac rehabilitation (CR). Longitudinal observational study of 437
consecutive cardiac outpatients after 8 weeks of phase II CR. Patients
were divided into the PCI group (n = 281) and CS group (n = 156). Handgrip
and knee extensor muscle strength, peak oxygen uptake (VO2), upper- and
lower-body self-efficacy for physical activity (SEPA), and physical
component summary (PCS) and mental component summary (MCS) scores as
assessed by Short Form-36 were measured at 1 and 3 months after PCI or CS.
All outcomes increased significantly between months 1 and 3 in both
groups. However, increases were greater in the CS versus PCI group in
handgrip strength (+12.3 % vs. +8.1%, P < 0.01), knee extensor muscle
strength (+19.3% vs. +17.5%, P = 0.008), peak VO2 (+20.9% vs. +16.9%, P <
0.01), upper-body SEPA (+27.7% vs. +9.2%, P = 0.001), and PCS score (+6.5%
vs. +4.1%, P = 0.001). Although this relatively short-term phase II CR
increased all outcomes for both groups, outcomes showed the recovery
process was different between the PCI and CS groups, slightly favoring CS
patients. Furthermore, patents in the field of CR are presented. 2011
Bentham Science Publishers.

<19>
[Use Link to view the full text]
Accession Number
2011344722
Authors
Raber L. Wohlwend L. Wigger M. Togni M. Wandel S. Wenaweser P. Cook S.
Moschovitis A. Vogel R. Kalesan B. Seiler C. Eberli F. Luscher T.F. Meier
B. Juni P. Windecker S.
Institution
(Raber, Wohlwend, Wigger, Togni, Wenaweser, Cook, Moschovitis, Vogel,
Seiler, Meier, Windecker) Department of Cardiology, Bern University
Hospital, Bern, Switzerland
(Juni, Windecker) Clinical Trials Unit, Bern University Hospital, Bern,
Switzerland
(Wandel, Kalesan, Juni) Institute of Social and Preventive Medicine,
University of Bern, Bern, Switzerland
(Eberli) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Luscher) Department of Cardiology, University Hospital Zurich, Zurich,
Switzerland
(Windecker) Bern University Hospital, 3010 Bern, Switzerland
Title
Five-year clinical and angiographic outcomes of a randomized comparison of
sirolimus-eluting and paclitaxel-eluting stents: Results of the
sirolimus-eluting versus paclitaxel-eluting stents for coronary
revascularization LATE trial.
Source
Circulation. 123 (24) (pp 2819-2828), 2011. Date of Publication: 21 Jun
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-: Long-term comparative data of first-generation drug-eluting
stents are scarce. We investigated clinical and angiographic outcomes of
sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) at 5 years as
part of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for
Coronary Revascularization (SIRTAX) LATE study. Methods and Results-: A
total of 1012 patients were randomly assigned to SES or PES. Repeat
angiography was completed in 444 of 1012 patients (43.8%) at 5 years.
Major adverse cardiac events occurred in 19.7% of SES- and 21.4% of
PES-treated patients (hazard ratio, 0.89; 95% confidence interval, 0.68 to
1.17; P=0.39) at 5 years. There were no differences between SES and PES in
terms of cardiac death (5.8% versus 5.7%; P=0.35), myocardial infarction
(6.6% versus 6.9%; P=0.51), and target lesion revascularization (13.1%
versus 15.1%; P=0.29). Between 1 and 5 years, the annual rate of target
lesion revascularization was 2.0% (95% confidence interval, 1.4% to 2.6%)
for SES and 1.4% (95% confidence interval, 0.9% to 2.0%) for PES. Among
patients undergoing paired angiography at 8 months and 5 years, delayed
lumen loss amounted to 0.37+/-0.73 mm for SES and 0.29+/-0.59 mm for PES
(P=0.32). The overall rate of definite stent thrombosis was 4.6% for SES
and 4.1% for PES (P=0.74), and very late definite stent thrombosis
occurred at an annual rate of 0.65% (95% confidence interval, 0.40% to
0.90%). Conclusions-: Long-term follow-up of first-generation drug-eluting
stents shows no significant differences in clinical and angiographic
outcomes between SES and PES. The continuous increase in late lumen loss
in conjunction with the ongoing risk of very late stent thrombosis
suggests that vascular healing remains incomplete up to 5 years after
implantation of first-generation drug-eluting stents. 2011 American Heart
Association, Inc.

<20>
Accession Number
2011338594
Authors
Smith K.M. McKelvie R.S. Thorpe K.E. Arthur H.M.
Institution
(Smith) University of Illinois College of Medicine at Chicago, Department
of Medicine, Section of Health Promotion Research, 808 South Wood Street,
Chicago, IL 60612-7309, United States
(McKelvie) David Braley Cardiac, Vascular, and Stroke Research Institute,
McMaster University, Hamilton, ON, Canada
(Thorpe) Dalla Lana School of Public Health, University of Toronto,
Toronto, ON, Canada
(Arthur) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Arthur) Hamilton Health Sciences, Hamilton, ON, Canada
Title
Six-year follow-up of a randomised controlled trial examining hospital
versus home-based exercise training after coronary artery bypass graft
surgery.
Source
Heart. 97 (14) (pp 1169-1174), 2011. Date of Publication: July 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To compare the long-term effectiveness of hospital versus
telephone-monitored home-based exercise training during cardiac
rehabilitation (CR) on exercise capacity and habitual physical activity.
Design: Six-year follow-up of patients who participated in a randomised
controlled trial of hospital versus monitored home-based exercise training
during CR after coronary artery bypass graft surgery. Setting: Outpatient
CR centre in Central-South Ontario, Canada. Participants: 196 Patients who
participated in the original randomised controlled trial and who attended
an evaluation 1 year after CR. Interventions 6 months of home or
hospital-based exercise training during CR. Main outcome measures: Peak
oxygen uptake (peak VO₂), Physical Activity Scale in the
Elderly (PASE) to assess habitual activity, semi-structured interviews to
assess vital status, demographic and descriptive information. Results: Of
the 196 eligible patients, 144 (75.5%; 74 Hospital, 70 Home) were
available for participation. Patients were predominantly male (n=120;
83.3%) aged 70+/-9.5 years. Clinical and sociodemographic outcomes were
similar in both groups. While exercise performance declined over time,
there were significant between-group differences in peak VO₂
(1506+/-418 ml/min vs 1393+/-341 ml/min; p=0.017) and PASE scores
(166.7+/-90.2 vs 139.7+/-66.5; p=0.001) at 6-year follow-up in favour of
the home group. Conclusions: Home and hospital-based exercise training
maintained exercise capacity above pre-CR levels 6 years after CR.
Exercise training initiated in the home environment in low-risk patients
undergoing coronary artery bypass graft surgery conferred greater
long-term benefit on VO₂ and persistent physical activity
compared with traditional hospital-based CR.

<21>
[Use Link to view the full text]
Accession Number
2011344683
Authors
Mertz D. Johnstone J. Loeb M.
Institution
(Mertz, Johnstone, Loeb) Department of Clinical Epidemiology and
Biostatistics, McMaster University, MDCL 3203, 1200 Main St W, Hamilton,
ON L8N 3Z5, Canada
(Mertz, Johnstone, Loeb) Michael G. DeGroote Institute for Infectious
Disease Research, McMaster University, Hamilton, ON, Canada
(Johnstone, Loeb) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Loeb) Department of Pathology and Molecular Medicine, McMaster
University, MDCL 3203, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada
Title
Does duration of perioperative antibiotic prophylaxis matter in cardiac
surgery? A systematic review and meta-analysis.
Source
Annals of Surgery. 254 (1) (pp 48-54), 2011. Date of Publication: July
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective: We aimed to compare the efficacy of short-term (<24 hours)
versus longer-term antibiotic prophylaxis (>=24 hours) in open heart
surgery. Background: The optimal duration of antibiotic prophylaxis for
adults undergoing cardiac surgery is unknown and guideline recommendations
are inconsistent. Methods: We searched MEDLINE, EMBASE, CINAHL, and
CENTRAL for parallel-group randomized trials comparing any antibiotic
prophylaxis administered for <24 hours to any antibiotic prophylaxis for
>=24 hours in adult patients undergoing open heart surgery. Reference
lists of selected articles, clinical practice guidelines, review articles,
and congress abstracts were searched. Study selection, data extraction and
assessment of risk of bias were performed independently by 2 reviewers.
Results: Of the 1338 citations identified by our search strategy, 12
studies involving 7893 patients were selected. Compared with short-term
antibiotic prophylaxis, longer-term antibiotic prophylaxis reduced the
risk of sternal surgical site infection (SSI) by 38% (risk ratio 1.38, 95%
confidence interval (CI) 1.13-1.69, P = 0.002) and deep sternal SSI by 68%
(risk ratio 1.68, 95% CI 1.12-2.53, P = 0.01). There were no statistically
significant differences in mortality, infections overall and adverse
events. Eleven of the trials were at high risk for bias due to limitations
in study design. Conclusions: Perioperative antibiotic prophylaxis of >=24
hours may be more efficacious in preventing sternal SSIs in patients
undergoing cardiac surgery compared to shorter regimens. The findings
however are limited by the heterogeneity of antibiotic regimens used and
the risk of bias in the published studies. Copyright 2011 by Lippincott
Williams & Wilkins.