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<1>
Accession Number
2011376063
Authors
Castanheira L. Fresco P. MacEdo A.F.
Institution
(Castanheira, MacEdo) Health Sciences Research Centre, University of Beira
Interior, Av. Infante D. Henrique, 6200-506 Covilha, Portugal
(Fresco) Pharmacology Department, Pharmacy Faculty, Oporto University,
Porto, Portugal
Title
Guidelines for the management of chronic medication in the perioperative
period: Systematic review and formal consensus.
Source
Journal of Clinical Pharmacy and Therapeutics. 36 (4) (pp 446-467), 2011.
Date of Publication: August 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
What is known and Objective: The worldwide volume of surgery is huge and
the number of interventions performed is increasing as a result of
advances in technological resources and refinement of medical teams'
expertise, in a progressively elderly and sick population. Consequently,
half of the general surgical patients take medications unrelated to
surgery. Evidence-based guidelines for perioperative medication management
are therefore critically needed to improve safety in surgery. The purpose
of this work was to develop practice recommendations for the management of
chronic medication in the perioperative period. Methods: A systematic
review and a formal consensus were performed. A search in Medline, Embase,
ISI Web of Knowledge and Medscape were conducted in September 2008. Two
independent investigators assessed the quality of selected studies.
Evidence-based guidelines with strength classification were found for some
therapeutic groups. Those guidelines were adopted and no further analysis
was performed. For the other therapeutic groups, a formal consensus was
used, based on a modified nominal group technique: 32 statements were
formulated considering the literature retrieved. A selected panel of
experts was asked by electronic mail to rate their level of agreement with
each statement. Then, a meeting was convened and a second round survey was
used to determine the final level of agreement. The statements which met
the established criteria of consensus were developed into practice
recommendations, supported by the results of the formal consensus and the
evidence-based findings from systematic review. Results and Discussion: A
total of 23 studies were included in the systematic review; three
randomized controlled trials (RCTs), 13 cohorts, two case-controls and
three clinic-cases. Twenty-two practice recommendations for the management
of chronic medication in the perioperative period resulted from formal
consensus. What is new and Conclusion: Epidemiological studies concerning
the perioperative management of chronic medications are clinically
heterogeneous and there are few RCTs available. However, the formal
consensus method proved to be a helpful tool to integrate different
strands of evidence for the development of practice guidelines. 2010
Blackwell Publishing Ltd.

<2>
Accession Number
2011370331
Authors
Azarfarin R. Sheikhzadeh D. Mirinazhad M. Bilehjani E. Alizadehasl A.
Institution
(Azarfarin, Sheikhzadeh, Mirinazhad, Bilehjani, Alizadehasl)
Cardiovascular Research Center, Madani Heart Hospital, Tabriz University
of Medical Sciences, Daneshgah street, Tabriz, Iran, Islamic Republic of
Title
Do nondiabetic patients undergoing coronary artery bypass grafting surgery
require intraoperative management of hyperglycemia?.
Source
Acta Anaesthesiologica Taiwanica. 49 (2) (pp 41-45), 2011. Date of
Publication: June 2011.
Publisher
Elsevier Taiwan LLC (96 Chung Shan North Road, Section 2, Taipei, Taiwan
(Republic of China))
Abstract
Objective: To study the effect of blood glucose (BG) control with insulin
in preventing hyperglycemia during and after coronary artery bypass
grafting (CABG) surgery in nondiabetic patients. Methods: In a randomized
clinical trial, 120 nondiabetic patients who underwent elective CABG
surgery were enrolled for study of whether the control of hyperglycemia
was a need in such a surgery in a teaching heart hospital. The patients
were randomly divided into study (n = 60) and control (n = 60) groups. In
the study group, insulin was infused to maintain BG level between 110
mg/dL and 126 mg/dL (a modified insulin therapy protocol, and in the
control group, the patients were excepted). Insulin therapy was limited to
intraoperative period. BG levels during surgery and up to 48 hours after
surgery and early postoperative complications were compared between the
study and control groups. Results: One hundred seventeen patients
completed the study (59 patients in study group and 58 in control group).
Peak intraoperative BG level in the study group was 126.4 +/- 17.9 mg/dL
and in the control group was 137.3 +/- 17.6 mg/dL (p = 0.024). The
frequencies of severe hyperglycemia (BG >= 180 mg/dL) were 6 of 59 (10.1%)
in the study group and 19 of 58 (32.7%) in the control group during
operation (p = 0.002). Peak postoperative BG level in the study group was
194.8 +/- 41.2 mg/dL and was 199.8 +/- 43.2 mg/dL in the control group (p
= 0.571). There was no hypoglycemic event in either group. The frequencies
of early postoperative complications were 10 of 59 (16.9%) in the study
group and 19 of 58 (32.7%) in the control group (p = 0.047). Conclusions:
Hyperglycemia (BG >= 126 mg/dL) is common in nondiabetic patients
undergoing CABG surgery. A modified insulin therapy to maintain BG level
between 110 mg/dL and 126 mg/dL may be acceptable for avoiding
hypoglycemia and keeping intraoperative BG levels in acceptable range in
nondiabetics. 2011, Taiwan Society of Anesthesiologists. Published by
Elsevier Taiwan LLC. All rights reserved.

<3>
Accession Number
2011379019
Authors
Sitniakowsky L.S. Later A.F.L. van de Watering L.M.G. Bogaerts M. Brand A.
Klautz R.J.M. Smit N.P.M. van Hilten J.A.
Institution
(Sitniakowsky, van de Watering, Bogaerts, Brand, van Hilten) Department of
Transfusion Medicine, Sanquin Blood Supply, Research Division, Leiden,
Netherlands
(Later, Klautz) Department of Cardiothoracic Surgery, LUMC, Leiden,
Netherlands
(Brand) Department of Immunohematology and Blood Transfusion, LUMC,
Leiden, Netherlands
(Smit) Department of Clinical Chemistry, LUMC, Leiden, Netherlands
Title
The effect of RBC transfusions on cytokine gene expression after cardiac
surgery in patients developing post-operative multiple organ failure.
Source
Transfusion Medicine. 21 (4) (pp 236-246), 2011. Date of Publication:
August 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Aim: To determine the effect of red blood cell (RBC) transfusions during
cardiac surgery on cytokine gene expression (GE) in relation to multiple
organ failure (MOF) development after systemic inflammatory response
syndrome (SIRS). Background: RBC transfusion in cardiac surgery patients
is dose-dependently associated with post-operative MOF, possibly acting as
a second hit after cardiopulmonary bypass. Methods: For this observational
study, 29 patients divided into four groups of cardiac surgery patients
were selected from a randomised controlled trial (RCT). Group 1: no-RBC,
no-MOF (N = 8); group 2: MOF, no-RBC (N = 7); group 3: RBC, no-MOF (N =
6); group 4: RBC and MOF (N = 8). Selection was based on age, gender,
number of (leukocyte-depleted) RBC transfusions, type and duration of
surgery. A 114 cytokine GE array was applied to blood samples withdrawn
before and 24 h after surgery. Expression of selected genes was confirmed
with reverse transcriptase real time-polymerase chain reaction (RT-PCR).
Results: Nineteen of the 39 detectable genes showed a significant change
in GE after surgery. Confirmed by RT-PCR, transfused MOF patients exhibit
significantly less downregulation of CD40 ligand than control patients.
Patients who would develop MOF show significantly larger increases in GE
of transforming growth factor-alpha (TGF-alpha), tumour necrosis factor
(TNF)-superfamily members 10 and 13B (TNFsf10/13B). Conclusions: When
tested at 24 h after surgery, cytokine GE in peripheral blood leucocytes
showed no significant differences between those transfused and those not
transfused. Some alterations were seen in those developing MOF compared to
those who did not, but the findings offer no role of leukocyte depleted
(LD) RBC transfusion in the development of MOF. 2011 The Authors.
Transfusion Medicine 2011 British Blood Transfusion Society.

<4>
Accession Number
2011385809
Authors
Piccolo R. Cassese S. Galasso G. De Rosa R. D'Anna C. Piscione F.
Institution
(Piccolo, Cassese, Galasso, De Rosa, D'Anna, Piscione) Department of
Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II
University, Via S. Pansini. 5, 80131 Naples, Italy
Title
Long-term safety and efficacy of drug-eluting stents in patients with
acute myocardial infarction: A meta-analysis of randomized trials.
Source
Atherosclerosis. 217 (1) (pp 149-157), 2011. Date of Publication: July
2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Despite short-term outcomes of patients with ST-segment
elevation myocardial infarction (STEMI) indicate a benefit of DES in terms
of reintervention, limited information is available on the long-term
safety and efficacy of DES in these patients. Our aim was to perform a
meta-analysis of randomized trials evaluating the long-term outcomes of
drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with
STEMI. Methods and results: A systematic literature search of MEDLINE,
EMBASE, the Cochrane Central Register of Controlled Trials, scientific
session abstracts and relevant websites, through September 2010, was
performed using specific search terms. Included trials were randomized
studies comparing DES to BMS in patients presenting with STEMI, with a
follow-up >=3 years. Ten of the 1496 studies initially identified met
inclusion criteria, with a total of 6774 patients enrolled. At a mean
follow-up of 3.6 years, DES significantly reduced target-vessel
revascularization compared with BMS (odds ratio [OR], 0.51; 95% confidence
interval [CI], 0.43-0.59; p<. 0.0001), without increasing mortality (OR,
0.88; 95% CI, 0.72-1.06; p= 0.18), reinfarction (OR, 1.02; 95% CI,
0.81-1.27; p= 0.88) and overall stent thrombosis (OR, 1.06; 95% CI,
0.83-1.35; p= 0.66). Very late stent thrombosis, occurring 1 year after
revascularization, was significantly increased with DES (OR, 1.71; 95% CI,
1.05-2.79; p= 0.03). Conclusions: At long-term follow-up, percutaneous
coronary intervention with DES reduces need for target-vessel
revascularization, without increasing the risk for death and reinfarction.
However, the strong reduction in reintervention with DES trades off a
slight but significant increase in very late stent thrombosis. 2011
Elsevier Ireland Ltd.

<5>
Accession Number
2011356959
Authors
Okada T. Yamamoto H. Okimoto T. Otsuka M. Ishibashi K. Dohi Y. Fujii T.
Tadehara F. Kurisu S. Hayashi Y. Kihara Y.
Institution
(Okada, Yamamoto, Okimoto, Otsuka, Ishibashi, Fujii, Kurisu, Kihara)
Department of Cardiovascular Medicine, Hiroshima university, Graduate
School of Biomedical Sciences, Hiroshima, Japan
(Okimoto, Otsuka, Hayashi) Division of Cardiology, Cardiovascular Center,
Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
(Dohi, Fujii) Division of Cardiology, Kure Kyosai Hospital, Kure, Japan
(Fujii) Division of Cardiology, JA Hiroshima General Hospital,
Hatsukaichi, Japan
(Tadehara) Division of Cardiology, Mazda Hospital, Hiroshima, Japan
Title
Beneficial effects of valsartan on target lesion revascularization after
percutaneous coronary interventions with bare-metal stents.
Source
Circulation Journal. 75 (7) (pp 1641-1648), 2011. Date of Publication:
July 2011.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Angiotensin II receptor blockers (ARB) have been shown to
reduce cardiovascular events in patients at risk. The effect of valsartan
on outcomes after percutaneous coronary interventions (PCI) with
bare-metal stents (BMS) was investigated. Methods and Results: The
prospective, randomized study included 191 patients at 5 participating
institutions, who were randomly assigned to either a 40-80 mg valsartan
add-on or non-ARB treatment. The primary endpoint was a composite of
all-cause death, non-fatal myocardial infarction, and target lesion
revascularization (TLR) at 18 months. Enrollment was stopped when the use
of drug-eluting stents has been expanded in Japan. No significant
differences existed between the groups in terms of primary endpoint (18.9%
vs. 24.8%; hazard ratio [HR], 0.84; 95% confidence interval [CI],
0.61-1.14; P=0.26). In the valsartan group, as compared with the non-ARB
group, the secondary endpoint of TLR was significantly reduced at a median
follow-up 4.4 years; the rate of TLR was from 27.8% to 14.5% (HR, 0.69;
95%CI, 0.49-0.96; P=0.024). Conclusions: Valsartan treatment was not
superior to non-ARB treatment in reducing the primary endpoint after PCI
at 18 months. The pre-specified secondary endpoint of TLR was lower in the
valsartan group, but this needs to be proved statistically with an
adequate study sampling.

<6>
Accession Number
2011353422
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 frst 12^th hour (p>0.05) between the
groups, whereas in the study group a peak for total CK, CKMB, cTnI and
actate, consistent with myocardial injury (p<0.05), was found in the frst
24^th hour, which returned in the 48^th hour (p>0.05).
Conclusion: The primary fnding 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.

<7>
Accession Number
2011365060
Authors
Khamoushi A.J. Kashfi F. Hosseini S. Ghavidel A.R.A. Samiei N. Haddadzadeh
M.
Institution
(Khamoushi, Kashfi, Hosseini, Ghavidel, Samiei) Heart Valve Research
Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran
University of Medical Science, Tehran, Iran, Islamic Republic of
(Kashfi) Epidemiology and Reproductive Health Department, Royan Institute
for Reproductive Biomedicine, ACECR, Tehran, Iran, Islamic Republic of
(Haddadzadeh) Cardiac Surgery Department, Afshar Hospital, Yazd, Iran,
Islamic Republic of
Title
Anti-coagulation during pregnancy in women with mechanical heart valves: A
prospective study.
Source
International Journal of Fertility and Sterility. 5 (1) (pp 47-51), 2011.
Date of Publication: Apr-Jun 2011.
Publisher
Royan Institute (P.O. Box 19395-4644, Tehran, Iran, Islamic Republic of)
Abstract
Background: Pregnancy is associated with a hypercoagulable state,
therefore the optimal anticoagulants for potential use in pregnant women
with prosthetic heart valves are controversial. The aim of this study is
to investigate the effect of anticoagulants on pregnancy outcomes and
their potential risks in pregnant women with mechanical heart valves.
Materials and Methods: In this prospective cohort study, we followed 44
women with 49 pregnancies who had mechanical heart valves from September
2002 to September 2007. A total of 38 patients took warfarin throughout
their pregnancies (group A). In 11 patients, warfarin was changed to
heparin during the first trimester and then again to warfarin during
12^th to 36^th weeks of gestational age (group B). All
women took warfarin from 36^th weeks of gestational age until
delivery. Results: In group A, there were 22 live births (57.9%), 15
abortions (39.5%) and 1 maternal death (2.6%). In group B, there were
seven live births (63.6%), three spontaneous abortions (27.3%) and one
intra-uterine fetal death (9.1%). There was no significant difference in
live birth rate between the two groups (p=0.24). Thirty-three pregnancies
(86.8%) in group A and five pregnancies (45.4%) in group B had no maternal
complications (p=0.004). The difference in pregnancy complications between
both groups was significant (p<0.001) Conclusion: The present study shows
that low dose warfarin (5 mg/day or less) may be safe during the first
trimester of pregnancy. Maternal adverse events are low when pregnant
women with mechanical heart valves remain on a warfarin regimen. The risk
of embryopathy does not necessarily increase.

<8>
Accession Number
2011371915
Authors
Huang Y. Don-Wauchope A.C.
Institution
(Huang, Don-Wauchope) Department of Pathology and Molecular Medicine,
McMaster University, 1200 Main Street West, Hamilton, ON, L8S 4J9, Canada
Title
The clinical utility of kidney injury molecule 1 in the prediction,
diagnosis and prognosis of acute kidney injury: A systematic review.
Source
Inflammation and Allergy - Drug Targets. 10 (4) (pp 260-271), 2011. Date
of Publication: August 2011.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Objective: This systematic review evaluates the clinical utility of a
novel biomarker kidney injury molecule 1 (Kim-1) in the prediction,
diagnosis and prognosis of acute kidney injury (AKI). Methods: We searched
literature in electronic databases from January 2002 to December 2009 by
the key words "kidney injury molecule 1" or "Kim-1" and "acute kidney
injury" or "acute renal failure". Studies were eligible for inclusion if
they were primary studies published in English, in which Kim-1 was
measured for the purpose of prediction, diagnosis or prognosis of AKI in
patients. Results: Eight articles met the selection criteria for inclusion
in the study. Compared to non AKI patients, Kim-1 increased significantly
(at least p<0.05) in AKI patients by 2 hours after cardiac surgery. In the
prediction of AKI in patients within 24 hours of cardiac surgery, the
sensitivity of Kim-1 ranged from 92% to 100% and AUC between 0.78 and
0.91. Kim-1 increased significantly (at least p<0.05) in AKI established
patients, especially in patients with acute tubular necrosis (ATN). The
AUC of Kim-1 in the diagnosis of AKI was from 0.9 to 0.95. However, Kim-1
showed weak association with the need of renal replacement therapy and
death of AKI patient. Conclusions: Kim-1 is a potential novel urinary
biomarker in the early detection of AKI within 24 hours after kidney
insult. It might be especially beneficial in the diagnosis of ischemic
ATN. 2011 Bentham Science Publishers Ltd.

<9>
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Accession Number
2011369444
Authors
Ghanayem N.S. Wernovsky G. Hoffman G.M.
Institution
(Ghanayem, Hoffman) Division Critical Care, Department of Pediatrics,
United States
(Hoffman) Department of Anesthesiology, Medical College of Wisconsin,
Children's Hospital of Wisconsin, Milwaukee, WI, United States
(Wernovsky) Division of Pediatric Cardiology, Children's Hospital of
Philadelphia, University of Pennsylvania School of Medicine, Philadelphia,
PA, United States
Title
Near-infrared spectroscopy as a hemodynamic monitor in critical illness.
Source
Pediatric Critical Care Medicine. 12 (4 SUPPL.) (pp S27-S32), 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: Near-infrared spectroscopy has moved from a research tool to a
widely used clinical monitor in the critically ill pediatric patient over
the last decade. The physiological and clinical evidence supporting this
technology in practice is reviewed here. Methodology: A search of MEDLINE
and PubMed was conducted to find validation studies, controlled trials,
and other reports of near-infrared spectroscopy use in children and adults
in the clinical setting. Guidelines published by the American Heart
Association, the American Academy of Pediatrics, and the International
Liaison Committee on Resuscitation were reviewed including further review
of references cited. RESULTS:: The biophysical properties of near-infrared
spectroscopy devices allow measurement of capillary-venous oxyhemoglobin
saturation in tissues a few centimeters beneath the surface sensor with
validated accuracy in neonates, infants, and small patients. The biologic
basis for the relationship of capillary-venous oxyhemoglobin saturation to
cerebral injury has been described in animal and human studies. Normal
ranges for cerebral and somatic capillary-venous oxyhemoglobin saturation
have been described for normal newborns and infants and children with
congenital heart disease and other disease states. The capillary-venous
oxyhemoglobin saturation from both cerebral and somatic regions has been
used to estimate mixed venous saturation and to predict biochemical shock,
multiorgan dysfunction, and mortality in different populations. The
relationship of cerebral capillary-venous oxyhemoglobin saturation to
neuroimaging and functional assessment of outcome is limited but ongoing.
Although there are numerous conflicting reports in small populations,
expert opinion would suggest that special use may exist for near-infrared
spectroscopy in patients with complex circulatory anatomy, with extremes
of physiology, and in whom extended noninvasive monitoring is useful.
CONCLUSIONS:: Class II, level B evidence supports the conclusion that
near-infrared spectroscopy offers a favorable risk-benefit profile and can
be effective and beneficial as a hemodynamic monitor for the care of
critically patients. Copyright 2011 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies.

<10>
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Accession Number
2011369441
Authors
Sivarajan V.B. Bohn D.
Institution
(Sivarajan) Departments of Critical Care Medicine and Paediatrics, Labatt
Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada
(Sivarajan) Department of Critical Care Medicine and Paediatrics, Faculty
of Medicine, University of Toronto, Toronto, ON, Canada
(Bohn) Department of Critical Care Medicine (DB), Hospital for Sick
Children, University of Toronto, Canada
(Bohn) Department of Critical Care Medicine, Hospital for Sick Children,
Toronto, ON, Canada
Title
Monitoring of standard hemodynamic parameters: Heart rate, systemic blood
pressure, atrial pressure, pulse oximetry, and end-tidal CO2.
Source
Pediatric Critical Care Medicine. 12 (4 SUPPL.) (pp S2-S11), 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: Continuous monitoring of various clinical parameters of
hemodynamic and respiratory status in pediatric critical care medicine has
become routine. The evidence supporting these practices is examined in
this review. Methodology: A search of MEDLINE, EMBASE, PubMed, and the
Cochrane Database was conducted to find controlled trials of heart rate,
electrocardiography, noninvasive and invasive blood pressure, atrial
pressure, end-tidal carbon dioxide, and pulse oximetry monitoring. Adult
and pediatric data were considered. Guidelines published by the Society
for Critical Care Medicine, the American Heart Association, the American
Academy of Pediatrics, and the International Liaison Committee on
Resuscitation were reviewed, including further review of references cited.
Results and Conclusions: Use of heart rate, electrocardiography,
noninvasive and arterial blood pressure, atrial pressure, pulse oximetry,
and end-tidal carbon dioxide monitoring in the pediatric critical care
unit is commonplace; this practice, however, is not supported by
well-controlled clinical trials. Despite the majority of literature being
case series, expert opinion would suggest that use of routine pulse
oximetry and end-tidal carbon dioxide is the current standard of care. In
addition, literature would suggest that invasive arterial monitoring is
the current standard for monitoring in the setting of shock. The use of
heart rate, electrocardiography. and atrial pressure monitoring is
advantageous in specific clinical scenarios (postoperative cardiac
surgery); however, the evidence for this is based on numerous case series
only. Copyright 2011 by the Society of Critical Care Medicine and the
World Federation of Pediatric Intensive and Critical Care Societies.

<11>
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Accession Number
2011375179
Authors
Baran D.A. Zucker M.J. Arroyo L.H. Camacho M. Goldschmidt M.E. Nicholls
S.J. Prevost-Fernandez J. Carr C. Adams L. Pardi S. Hou V. Binetti M.
McCahill J. Chichetti J. Viloria V. SanAgustin M.G. Ebuenga-Smith J. Mele
L. Martin A. Blicharz D. Wolski K. Olesnicky L. Qian F. Gass A.L. Cohen M.
Institution
(Baran, Zucker, Arroyo, Camacho, Goldschmidt, Prevost-Fernandez, Carr,
Adams, Pardi, Hou, Binetti, McCahill, Chichetti, Viloria, SanAgustin,
Ebuenga-Smith, Mele, Martin, Blicharz, Olesnicky, Qian, Cohen) Newark Beth
Israel Medical Center, L-4 Transplant Center, 201 Lyons Avenue, Newark, NJ
07112, United States
(Nicholls, Wolski) Cleveland Clinic, Cleveland, OH, United States
(Gass) Westchester Medical Center, Valhalla, NY, United States
Title
A prospective, randomized trial of single-drug versus dual-drug
immunosuppression in heart transplantation: The tacrolimus in combination,
tacrolimus alone compared (TICTAC) trial.
Source
Circulation: Heart Failure. 4 (2) (pp 129-137), 2011. Date of
Publication: March 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Cardiac transplantation, a procedure nearly abandoned in the
1970s, has evolved into the standard of care for appropriate patients with
end-stage heart failure. Much of this success has been due to improvements
in immunosuppression, including the introduction of a triple-drug regimen.
Retrospective reports suggested that single-drug immunosuppression with
tacrolimus was feasible. As such, a prospective, randomized trial was
conducted to test this approach. Methods and Results-One hundred fifty
adult de novo heart transplant recipients were enrolled in a prospective,
randomized, controlled, open-label trial comparing tacrolimus monotherapy
(MONO) with tacrolimus and mycophenolate mofetil therapy (COMBO).
Corticosteroids were used in the early postoperative period but
discontinued in all patients over 8 to 9 weeks. The primary end point was
the composite biopsy score at 6 months after transplant. Patients were
followed for 1 to 5 years. The composite biopsy score was similar between
groups at 6 and 12 months: 6-month MONO, 0.70+/-0.44 (95% confidence
interval, 0.60 to 0.80) versus COMBO, 0.65+/-0.40 (95% confidence
interval, 0.55 to 0.74; P=0.44). Allograft vasculopathy was assessed by
angiography and intravascular ultrasound, with no significant differences
noted. Three-year survival was also similar (92.4% MONO versus 97% COMBO;
P=0.58, log-rank). Conclusions-Addition of mycophenolate to single-agent
immunosuppression did not provide an advantage over single-agent
immunosuppression in terms of rejection, allograft vasculopathy, or 3-year
survival. Corticosteroids, which have traditionally been a mainstay of
therapy, were successfully discontinued in all patients. These conclusions
are tempered by the limited statistical power associated with a sample
size of only 150 patients. 2011 American Heart Association, Inc.

<12>
Accession Number
2011374105
Authors
Nayak R.
Institution
(Nayak) Queen's University School of Medicine, Queen's University,
Kingston, ON, K7L 1B4, Canada
Title
Evolution of the coronary artery stent.
Source
Journal of Long-Term Effects of Medical Implants. 21 (1) (pp 1-23), 2011.
Date of Publication: 2011.
Publisher
Begell House Inc. (50 Cross Highway, Redding CT 06886, United States)
Abstract
"Necessity, who is the mother of invention." - Plato. There has been a
steady rise in the incidence and prevalence of coronary artery disease. In
most developed countries, it is the number one cause of morbidity and
mortality. As this disease has become an ever increasing burden on
society, it has spurred on the development of many radical and innovative
procedures and implants. This paper will discuss, briefl y, the history of
coronary interventions ranging from coronary artery bypass grafts (CABG)
to drug-eluting stents. It will then compare and contrast some of the
several drug-eluting stents available on the market today; specifi cally
focusing on the Cypher, Taxus, Endeavour, and Xience V stents. The
comparisons will include a basic overview of the specifications of each
stent as well as the short- and long-term outcomes of these implants.
Finally, the paper will provide an introduction to some of the latest
stent technology awaiting FDA approval. 2011 by Begell House, Inc.

<13>
Accession Number
2011371141
Authors
Alba A.C. McDonald M. Rao V. Ross H.J. Delgado D.H.
Institution
(Alba, McDonald, Ross, Delgado) Division of Cardiology and Heart
Transplantation, Toronto General Hospital, 585 University Ave., 11c-1207,
Toronto, ON M5G 2N2, Canada
(Rao) Division of Cardiovascular Surgery, Toronto General Hospital,
Toronto, ON, Canada
Title
The effect of ventricular assist devices on long-term post-transplant
outcomes: A systematic review of observational studies.
Source
European Journal of Heart Failure. 13 (7) (pp 785-795), 2011. Date of
Publication: July 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsVentricular assist device (VAD) therapy is widely used as a bridge to
cardiac transplant. Studies addressing the effect of VADs on
post-transplant outcomes have shown conflicting results. It is imperative
to review this evidence to inform clinical decision making and future
research. Our aim was to systematically evaluate the effect of VAD therapy
on long-term post-transplant outcomes in heart transplant
recipients.Methods and resultsWe searched online databases (Medline,
PubMed, Embase, and CINAHL) and references of included articles.
Comparative studies evaluating the effect of VADs on post-transplant
outcomes in adults were included and study results were meta-analysed
using random-effects models. We conducted subgroup analyses to assess the
effect estimate of extra- vs. intra-corporeal VADs and to evaluate the
impact of transplant era and listing status. Overall, we identified 31
observational studies. One-year post-transplant mortality in recipients
bridged with an extra-corporeal VAD was significantly higher than in
non-bridged recipients (RR 1.8, 95 CI 1.532.13, I² 1), while
patients supported with an intra-corporeal VAD had similar mortality to
non-bridged recipients (RR 1.08, 95 CI 0.951.22, I² 0). The
risks of rejection within the first post-transplant year and coronary
allograft vasculopathy were not significantly different between patients
with or without VAD support prior to transplant. Publication bias was low;
however, the risk of bias across studies was moderate to
high.ConclusionIntra-corporeal VAD support does not have a deleterious
impact on post-transplant outcomes. However, post-transplant survival may
be poorer in the subgroup of patients supported with extra-corporeal
devices. Studies with greater methodological rigour are warranted. 2011
The Author.

<14>
Accession Number
2011371135
Authors
Kunadian V. Zaman A. Qiu W.
Institution
(Kunadian) Cardiothoracic Division, James Cook University Hospital,
Middlesbrough, United Kingdom
(Zaman) Cardiothoracic Centre, Freeman Hospital, Newcastle University,
Newcastle upon Tyne, United Kingdom
(Qiu) Channing Laboratory, Department of Medicine, Brigham and Women's
Hospital, Boston, MA, United States
Title
Revascularization among patients with severe left ventricular dysfunction:
A meta-analysis of observational studies.
Source
European Journal of Heart Failure. 13 (7) (pp 773-784), 2011. Date of
Publication: July 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsCoronary artery bypass graft (CABG) surgery is the standard of care
for the management of patients with severe three-vessel and left main
coronary artery disease (CAD). However, the optimal strategy for
management of patients with CAD and severe left ventricular (LV)
dysfunction [ejection fraction (EF) <=35] is not clear. A meta-analysis of
observational studies was performed to determine the operative mortality
and long-term (5-year actuarial survival) outcomes among patients with
severe LV dysfunction undergoing CABG.Methods and resultsA systematic
computerized literature search was performed and observational studies
consisting of patients undergoing isolated CABG for CAD and severe LV
dysfunction were included. Studies that did not report operative
mortality, long-term (<1 year) survival data, or pre-operative EF and
multiple studies from the same group were excluded. In total, 4119
patients from 26 observational clinical studies were included. The
estimated mean age was 63.9 years and 82.4 of patients were men. The mean
(estimate) pre-operative EF was 24.7 (95 CI 22.527.0). The operative
mortality among patients (26 studies, n 3621) who underwent on-pump CABG
was 5.4, n 189 (95 CI 4.56.4). The 5-year actuarial survival among
patients (13 studies, n 1980) who underwent on-pump CABG was 73.4, n 1483
(95 CI 68.777.7). Patients who underwent off-pump CABG (7 studies, n 498)
tended to have reduced operative mortality of 4.4, n 20 (95 CI 2.86.4).
The mean (estimate) post-operative EF was 35.19 (95 CI
31.9538.43).ConclusionThe present meta-analysis demonstrates that based on
data from available observational clinical studies, CABG can be performed
with acceptable operative mortality and 5-year actuarial survival in
patients with severe LV dysfunction. 2011 The Author.

<15>
Accession Number
2011373751
Authors
Cassese S. Piccolo R. Galasso G. De Rosa R. Piscione F.
Institution
(Cassese, Piccolo, Galasso, De Rosa, Piscione) Department of Clinical
Medicine, Cardiovascular Sciences and Immunology, Federico II University
of Naples, Italy, Via S. Pansini, 5, 80131, Naples, Italy
Title
Twelve-month clinical outcomes of everolimus-eluting stent as compared to
paclitaxel- and sirolimus-eluting stent in patients undergoing
percutaneous coronary interventions. A meta-analysis of randomized
clinical trials.
Source
International Journal of Cardiology. 150 (1) (pp 84-89), 2011. Date of
Publication: 01 Jul 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: It is well established that both PES and SES reduce the need
for reintervention as compared with bare-metal stents. Whether
everolimus-eluting stent (EES) a "second-generation" drug-eluting stent,
further improves clinical outcomes compared to PES and SES still remains
uncertain. The aim of this study was to perform a meta-analysis of
randomized trials evaluating safety and efficacy of EES compared with
paclitaxel- (PES) and sirolimus-eluting stent (SES), in patients
undergoing percutaneous coronary intervention (PCI). Methods: We undertook
a literature search using Medline, EMBASE, the Cochrane Central Register
of Controlled Trials, scientific session abstracts and relevant websites,
until August 2010. Included studies comprised randomized trials evaluating
EES vs PES/SES, in patients undergoing PCI, at 1-year follow-up. Results:
Five studies, enrolling 8058 patients, were included. At 12-month
follow-up, patients treated with EES, as compared with PES/SES,
experienced lower target-lesion revascularization (OR [95% CI] = 0.56
[0.45-0.70], p < 0.00001) and myocardial infarction rates (OR [95% CI] =
0.57 [0.43-0.77], p = 0.0002), without difference in mortality (OR [95%
CI] = 0.88 [0.62-1.24], p = 0.46). A trend towards lower stent thrombosis
rates in favour of EES vs PES/SES was found (OR [95% CI] = 0.45
[0.20-1.01], p = 0.05). However, after the exclusion of SES, EES
significantly reduced stent thrombosis as compared with PES (OR [95% CI] =
0.35 [0.14-0.86], p = 0.02). Conclusions: At 12-month follow-up, treatment
with EES is associated with decreased target-lesion revascularization and
myocardial infarction rates, without differences in mortality, as compared
with PES/SES. EES vs PES/SES use is associated with a trend towards lower
stent thrombosis rates. Moreover, EES significantly reduce stent
thrombosis with respect to PES. 2011 Elsevier Ireland Ltd. All rights
reserved.

<16>
Accession Number
70463625
Authors
Benck U. Hoeger S. Uwe G. Duygu D. Yard B.A. Peter S.
Institution
(Benck, Hoeger, Uwe, Duygu, Yard, Peter) 5th Medical Clinic, University
Medical Centre, Mannheim, Germany
Title
Effects of donor pretreatment with dopamine on graft function after heart
transplantation: Data from a randomized controlled trial.
Source
American Journal of Transplantation. Conference: American Transplant
Congress 2010, ATC 2010 San Diego, CA United States. Conference Start:
20100501 Conference End: 20100505. Conference Publication: (var.pagings).
10 (pp 119), 2010. Date of Publication: April 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Background Treatment of the deceased heart-beating donor with low-dose
dopamine results in less dialysis requirement after kidney
transplantation. This study investigates the development of the cardiac
allografts from multi-organ donors that were enrolled in the randomized
dopamine trial. (ClinicalTrials.gov number, NCT00115115.) Methods Between
March 2004 and August 2007, 264 brain-dead donors were randomly assigned
to receive or to not receive low-dose dopamine. Eligibility criteria
included circulatory stability under low-dose norepinephrine. The present
investigation was initiated under safety considerations and is nested in
the multicenter randomized controlled trial on donor pretreatment with
dopamine. We assessed the outcomes of 99 cardiac transplants performed at
22 European centers. Results Dopamine was infused for a median duration of
400 minutes [IQR 232 minutes]. Donors and recipients were very similar in
demographic and clinical baseline characteristics. Fewer recipients of a
pretreated graft required a cardiac assist device or hemofiltration
immediately after transplantation [13/49 (26.5%) vs. 23/50 (46.0%),
P=0.04]. The beneficial effect was particularly enhanced when dopamine was
administered to the donors until cross clamping. Circulatory parameters of
the donors had no effect on the transplantation outcomes. Donor dopamine
resulted in a Significant survival Benefit 3 years after heart
transplantation [85.7% vs. 65.7%, P=0.02]. Accordingly, treatment of 5
cardiac donors would rescue one heart allograft. Conclusions Treatment of
brain-dead donors with low-dose dopamine at a dosage of 4mug/kg/ min is
definitely not harmful for the cardiac allograft but appears to
substantially improve patient and graft survival after heart
transplantation.