EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2011387355
Authors
Zhang Y.-H. Gu T.-X. Zhang G.-W. Wang C. Liu Y. Yu Y.
Institution
(Zhang, Gu, Zhang, Wang, Liu, Yu) Department of Cardiac Surgery, First
Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning
Province, China
Title
Injection of fibrin glue directly into the sternum for sternal bleeding in
old patients with osteoporosis during coronary artery bypass.
Source
Journal of Clinical Rehabilitative Tissue Engineering Research. 15 (25)
(pp 4735-4738), 2011. Date of Publication: June 2011.
Publisher
Journal of Clinical Rehabilitative (P.O. Box 1200, Shenyang 110004, China)
Abstract
Background: Currently, fibrin glue play a hemostasis role through wound
smearing; however, studies about injection of fibrin glue into the bone
cavity are rare. Objective: To observe the effect of injecting fibrin glue
directly into the sternum for hemostasis in elder patients with
osteoporosis during coronary artery bypass. Methods: Forty-eight elder
patients with severe osteoporosis, aged over 75 years, undergoing the
coronary artery bypass were randomly divided into 2 groups using random
digits table: experimental group and control group. Fibrin glue injected
directly into the sternum in the experimental group; bone wax was used to
stop bleeding in the control group. The drainage volume within the first
12 hours, total postoperative volume, the time of removing the drainage
tube, wound healing condition were recorded and observed. Results and
Conclusion: As compared with the control group, the drainage volume within
the first 12 hours and total volume, the time of removing the drainage
tube and the time of discharge were obviously decreased in the
experimental group (P < 0.05), but there was no significant difference in
the time of continuous fever and the number of patients with postoperative
sternal rupture between the two groups. In the control group, there was 1
case of wound infection and dehiscence. No adverse effects were found in
the experimental group. It is indicated that direct injection of fibrin
glue into the sternum can decrease the occurrence of hemorrhage and
complications, and have no effect on sternum healing in elder patients
with severe osteoporosis during coronary artery bypass.

<2>
Accession Number
2011385280
Authors
Ho K.M. Tan J.A.
Institution
(Ho, Tan) Department of Intensive Care Medicine, Royal Perth Hospital,
Perth, WA 6000, Australia
(Ho) School of Population Health, University of Western Australia, Perth,
WA 6009, Australia
Title
Benefits and risks of maintaining normothermia during cardiopulmonary
bypass in adult cardiac surgery: A systematic review.
Source
Cardiovascular Therapeutics. 29 (4) (pp 260-279), 2011. Date of
Publication: August 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Cardiopulmonary bypass is associated with significant morbidities, and the
ideal temperature management during cardiopulmonary bypass remains
uncertain. This review assessed the benefits and risks of maintaining
normothermia during cardiopulmonary bypass in adult cardiac surgery. A
total of 6731 patients from 44 randomized controlled trials in 14
countries, comparing normothermic (>34degreeC) and hypothermic
(<=34degreeC) cardiopulmonary bypass in cardiac surgery (>18 years of
age), were identified from MEDLINE (1966 to August 10, 2009), EMBASE (1988
to August 10, 2009), and Cochrane controlled trials register and subject
to meta-analysis. Two investigators examined all studies and extracted the
data independently. Mortality after normothermic and hypothermic bypass
was not significantly different (1.4% vs. 1.9% respectively, relative risk
[RR] 1.38, 95% confidence interval [CI] 0.94-2.04, I²= 0%, P=
0.10). Hypothermic bypass was, however, associated with an increased risk
of allogeneic red blood cells (RR 1.19, 95% CI 1.07-1.34, I²=
0%, P= 0.002), fresh frozen plasma (RR 1.54, 95% CI 1.06-2.24,
I²= 7.7%, P= 0.02), and platelet transfusion (RR 2.53, 95% CI
1.26-5.06, I²= 44%, P= 0.009). The risk of stroke, cognitive
decline, atrial fibrillation, use of inotropic support or intra-aortic
balloon pump, myocardial infarction, all-cause infections, and acute
kidney injury after cardiac surgery was not significantly different
between the two groups. The differences in the bypass time and targeted
perfusion temperature were not significantly related to the risk of
mortality and stroke. The current evidence suggests that maintaining
normothermia during cardiopulmonary bypass in adult cardiac surgery is as
safe as that of hypothermic surgery, and associated with a reduced risk of
allogeneic blood transfusion. 2009 Blackwell Publishing Ltd.

<3>
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Accession Number
2011386803
Authors
Patel J.K. Kobashigawa J.A.
Institution
(Patel, Kobashigawa) Cedars-Sinai Heart Institute, 8700 Beverly Boulevard,
Los Angeles, CA 90048, United States
Title
Everolimus for cardiac allograft vasculopathy-every patient, at any time?.
Source
Transplantation. 92 (2) (pp 127-128), 2011. Date of Publication: 27 Jul
2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)

<4>
Accession Number
2011391706
Authors
Ben-Gal Y. Stone G.W. Smith C.R. Williams M.R. Weisz G. Stewart A.S.
Takayama H. Genereux P. Argenziano M.
Institution
(Ben-Gal, Smith, Williams, Stewart, Takayama, Argenziano) Department of
Surgery, College of Physicians and Surgeons, Columbia University Medical
Center, New York, NY, United States
(Stone, Williams, Weisz, Genereux) Center for Interventional Vascular
Therapy, Columbia University, Medical Center, New York, NY, United States
Title
On-pump versus off-pump surgical revascularization in patients with acute
coronary syndromes: Analysis from the Acute Catheterization and Urgent
Intervention Triage Strategy trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (2) (pp e33-e39),
2011. Date of Publication: August 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Early invasive strategy, defined as early coronary angiography
and subsequent revascularization, when appropriate, is recommended by
current guidelines for the management of patients with moderate- to
high-risk acute coronary syndromes. We sought to compare the outcomes of
patients with acute coronary syndromes undergoing surgical
revascularization with an on-pump versus off-pump approach. Methods: Among
a total of 13,819 patients with moderate- to high-risk acute coronary
syndromes enrolled in the Acute Catheterization and Urgent Intervention
Triage Strategy trial, 1375 patients were triaged to isolated coronary
artery bypass grafting. One thousand one hundred fifty-four patients
underwent operations with cardiopulmonary bypass (the coronary artery
bypass grafting group), and 221 patients underwent off-pump coronary
artery bypass grafting (the off-pump coronary artery bypass grafting
group). Propensity score matching (1:3) was applied to adjust for
differences in baseline clinical and angiographic characteristics,
yielding a total of 880 matched patients with acute coronary syndromes
(220 managed with off-pump coronary artery bypass grafting and 660 managed
with coronary artery bypass grafting). Results: At 30 days, patients
undergoing off-pump coronary artery bypass grafting had fewer events of
bleeding (43.7% vs 56.3%, P = .0005) and myocardial infarction (7.3% vs
12.1%, P = .055) but higher rates of reintervention (3.7% vs 1.2%, P =
.02). At 1 year, there was no difference between groups in death, total
myocardial infarctions, reinterventions, strokes, or major adverse cardiac
events, but there was a lower rate of non-Q-wave myocardial infarctions in
the off-pump coronary artery bypass grafting group (4.6% vs 9.2%, P =
.03). Conclusions: In this large-scale study evaluating the outcomes of
patients with acute coronary syndromes, off-pump coronary artery bypass
grafting was associated with lower rates of bleeding and non-Q-wave
myocardial infarction but more reinterventions early after the procedure.
At 1 year, there was no major outcome difference between the 2 surgical
strategies. Copyright 2011 by The American Association for Thoracic
Surgery.

<5>
Accession Number
2011391700
Authors
Iyer A. Gilfillan I. Thakur S. Sharma S.
Institution
(Iyer, Gilfillan, Thakur, Sharma) Department of Cardiothoracic Surgery,
Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia
Title
Reduction of surgical site infection using a microbial sealant: A
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (2) (pp 438-442),
2011. Date of Publication: August 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Surgical site infection is a major cause of mortality and
morbidity. We have explored the use of a microbial sealant applied before
the surgical incision to reduce surgical site infection. Methods: We
conducted a prospective, randomized, controlled clinical trial to
determine the efficacy of a cyanoacrylate sealant in patients undergoing
coronary artery bypass grafting. Both left and right long saphenous veins
were harvested in individual patients below the knee if 3 or more lengths
of vein were required. The sealant (Kimberly-Clark InteguSeal, Roswell,
Ga) was applied to 1 leg chosen randomly, and the other leg was prepared
in a conventional fashion. Microbiological swabs from the leg wounds were
taken at 5 days, and wounds were assessed according to the Southampton
score at 30 days by 2 blinded observers. Results: The baseline
characteristics of the treated and untreated legs were similar because the
procedure was conducted on each individual patient. The study was
terminated at 47 patients after review. Patients in whom the sealant was
used had 1 (2.1%) wound infection, and there were 12 (25.5%) wound
infections in the conventionally prepared leg (P = .001). There were 13
positive cultures from the treated leg and 22 positive cultures from the
untreated site. Conclusions: The microbial skin sealant applied
immediately before the incision significantly reduced the rate of surgical
site infection. There was no sensitivity or adverse reaction after
application. The treatment was easily integrated with existing routine
preoperative procedures. Microbial sealant may thus be a useful addition
to a multimodal approach to minimize surgical site infection. Copyright
2011 by The American Association for Thoracic Surgery.

<6>
Accession Number
2011391692
Authors
Misfeld M. Brereton R.J.L. Sweetman E.A. Doig G.S.
Institution
(Misfeld) Department of Cardiac Surgery, Heart Centre Leipzig, University
of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
(Brereton) Department of Cardiothoracic Surgery, University of Sydney,
Royal North Shore Hospital, Sydney, Australia
(Sweetman, Doig) Department of Intensive Care Medicine, University of
Sydney, Royal North Shore Hospital, Sydney, Australia
Title
Neurologic complications after off-pump coronary artery bypass grafting
with and without aortic manipulation: Meta-analysis of 11,398 cases from 8
studies.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (2) (pp e11-e17),
2011. Date of Publication: August 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Neurologic complications after coronary artery bypass grafting
remain a concern. Off-pump coronary artery bypass grafting is a surgical
strategy proposed to decrease this risk. Use of an off-pump anaortic
technique, which leaves the ascending aorta untouched, may result in
further reductions. This systematic review of all published evidence
compares neurologic complications after anaortic off-pump coronary artery
bypass grafting versus that with aortic manipulation. Methods: PubMed and
Embase were searched up to August 2008. Experts were contacted, and
reference lists of retrieved articles were hand searched. The search
process was not limited to English-language sources. Observational studies
comparing standard off-pump coronary artery bypass grafting technique with
anaortic technique were eligible for inclusion if they reported neurologic
complications (stroke and transient ischemic attack). Meta-analysis was
conducted to assess differences between groups with regard to neurologic
complications. Results: Electronic search identified 1428 abstracts, which
resulted in retrieval and detailed review of 331 full-text articles. Eight
observational studies reported neurologic complications in 5619 anaortic
off-pump coronary artery bypass grafting cases and 5779 cases with aortic
manipulation. Postsurgical neurologic complications were significantly
lower in anaortic off-pump coronary artery bypass grafting cases (odds
ratio, 0.46; 95% confidence interval, 0.29-0.72; I² = 0.8%; P =
.0008). Conclusions: Avoidance of aortic manipulation during off-pump
coronary artery bypass grafting decreases neurologic complications
relative to standard technique in which the ascending aorta is
manipulated. In patients at high risk for stroke or transient ischemic
attack, we recommend avoidance of aortic manipulation during off-pump
coronary artery bypass grafting. Copyright 2011 by The American
Association for Thoracic Surgery.

<7>
Accession Number
2011376910
Authors
El-Kader S.M.A.
Institution
(El-Kader) Cairo University, Faculty of Physical Therapy, Physical Therapy
of Cardiopulmonary Disorders and Geriatrics, Egypt
Title
Blood gases response to different breathing modalities in phase i of
cardiac rehabilitation program after coronary artery bypass graft.
Source
European Journal of General Medicine. 8 (2) (pp 85-91), 2011. Date of
Publication: 2011.
Publisher
TIP ARASTIRMALARI DERNEGI (PO Box 33, VAN 65200, Turkey)
Abstract
Aim: One major cause of postoperative respiratory complications is
pulmonary atelectasis. Atelectasis and the associated loss of functional
alveolar units has been recognized as a major pathophysiological mechanism
responsible for postoperative hypoxemia after coronary artery bypass graft
(CABG). The aim of this study was to determine which therapeutic breathing
method from incentive spirometry (IS), non-invasive intermittent positive
pressure breathing (IPPB) and continuous positive airway pressure
breathing (CPAP) in addition to postoperative pulmonary physiotherapy
obtain the best improvement in blood gases in phase I of cardiac
rehabilitation program after CABG. Method: Thirty six patients of both
sexes who underwent CABG divided into three groups. Group (A) received
breathing training with IS (5 minutes 5 times per day) in addition the
chest physiotherapy program for patients after CABG and Group (B) received
breathing training with CPAP (10 cmH2O for 15 minutes once daily) in
addition to the chest physiotherapy program for patients after CABG.,
where Group(C) received breathing training with IPPB (maximum 15 cmH2O for
15 minutes once daily) in addition to the chest physiotherapy program for
patients after CABG. Measurements of blood gases were done before the
study in the first post operative day and repeated at the end of the study
in the tenth postoperative day. Result: Blood gases were improved in all
groups in addition to a significant difference between IS & CPAP and IS &
IPPB groups. Where there was no significant difference between CPAP & IPPB
groups. Conclusion: Incentive spirometry in addition to the usual
respiratory physical therapy is recommended for patients in phase I of
cardiac rehabilitation program after CABG.

<8>
Accession Number
2011393443
Authors
Ranucci M. Aronson S. Dietrich W. Dyke C.M. Hofmann A. Karkouti K. Levi M.
Murphy G.J. Sellke F.W. Shore-Lesserson L. Von Heymann C.
Institution
(Ranucci) Department of Cardiothoracic-vascular Anesthesia and Intensive
Care, IRCCS Policlinico S. Donato, Via Morandi 30, San Donato Milanese,
Milan, 20097, Italy
(Aronson) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
(Dietrich) Working Group on Perioperative Hemostasis, Department of
Anaesthesia, Ludwig Maximilian University Muenchen, Munich, Germany
(Dyke) SouthEast Texas Cardiovascular Surgery Associates, PA, Houston, TX,
United States
(Hofmann) Centre for Population Health Research, Curtin Health Innovation
Research Institute (CHIRI), Curtin University, Perth, WA, Australia
(Hofmann) Medical Society for Blood Management, Laxenburg, Austria
(Karkouti) Department of Anesthesia, Toronto General Hospital, University
Health Network, Toronto, ON, Canada
(Levi) Department of Vascular Medicine and Internal Medicine, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Murphy) Bristol Heart Institute, University of Bristol, Bristol Royal
Infirmary, Bristol, United Kingdom
(Sellke) Division of Cardiothoracic Surgery, Alpert Medical School of
Brown University, Rhode Island Hospital, Providence, RI, United States
(Shore-Lesserson) Department of Anesthesiology, Cardiothoracic
Anesthesiology, Montefiore Medical Center, Bronx, NY, United States
(Von Heymann) Department of Anaesthesiology and Intensive Care Medicine,
Charite-Universitatsmedizin Berlin, Berlin, Germany
Title
Patient blood management during cardiac surgery: Do we have enough
evidence for clinical practice?.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (2) (pp
249.e1-249.e32), 2011. Date of Publication: August 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)

<9>
Accession Number
2011380381
Authors
Cikirikcioglu M. Cherian S. Schussler O. Kalangos A.
Institution
(Cikirikcioglu, Cherian, Schussler, Kalangos) Division of Cardiovascular
Surgery, University Hospitals and Medical, Faculty of Geneva, Geneva,
Switzerland
Title
Regarding "the EVEREST II Trial: Design and rationale for a randomized
study of the Evalve MitraClip system compared with mitral valve surgery
for mitral regurgitation".
Source
American Heart Journal. 162 (1) (pp e11-e12), 2011. Date of Publication:
July 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)

<10>
Accession Number
2011380376
Authors
Mozaffarian D. Marchioli R. Gardner T. Ferrazzi P. O'Gara P. Latini R.
Libby P. Lombardi F. MacChia A. Page R. Santini M. Tavazzi L. Tognoni G.
Institution
(Mozaffarian) Departments of Epidemiology and Nutrition, Harvard School of
Public Health, Brigham and Women's Hospital, Boston, MA 02115, United
States
(Marchioli) Department of Clinical Pharmacology and Epidemiology,
Consorzio Mario Negri Sud, Via Nazionale 8/A, 66030 Santa Maria Imbaro,
Italy
(Gardner) Christiana Care Health System, Newark, DE, United States
(Ferrazzi) Cardiovascular Department, Cardiac Surgery, Ospedali Riuniti di
Bergamo, Bergamo, Italy
(O'Gara, Libby) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Latini) Department of Cardiovascular Research, Istituto di Ricerche
Farmacologiche Mario Negri, Milano, Italy
(Lombardi) University of Milan, Cardiology Division, San Paolo Hospital,
Milan, Italy
(MacChia) GESICA Foundation, Buenos Aires, Argentina
(Page) Department of Medicine, University of Wisconsin, School of Medicine
and Public Health, Madison, WI, United States
(Santini) Department of Cardiovascular Diseases, Ospedale San Filippo
Neri, Rome, Italy
(Tavazzi) GVM Hospitals of Care and Research, Villa Maria Cecilia
Hospital, Cotignola, Italy
(Tognoni) Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
Title
The -3 fatty acids for Prevention of Post-Operative Atrial Fibrillation
trial-rationale and design.
Source
American Heart Journal. 162 (1) (pp 56-63.e3), 2011. Date of
Publication: July 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Postoperative atrial fibrillation/flutter (PoAF) commonly complicates
cardiac surgery, occurring in 25% to 60% of patients. Postoperative atrial
fibrillation/flutter is associated with significant morbidity, higher
long-term mortality, and increased health care costs. Novel preventive
therapies are clearly needed. In experiments and short-term trials,
seafood-derived long-chain -3 polyunsaturated fatty acids (PUFAs)
influence several risk factors that might reduce risk of PoAF. A few small
and generally underpowered trials have evaluated effects of -3-PUFAs
supplementation on PoAF with mixed results. The OPERA trial is an
appropriately powered, investigator-initiated, randomized, double-blind,
placebo-controlled, multinational trial to determine whether perioperative
oral -3-PUFAs reduces occurrence of PoAF in patients undergoing cardiac
surgery. Additional aims include evaluation of resource use, biologic
pathways and mechanisms, postoperative cognitive decline, and safety.
Broad inclusion criteria encompass a "real-world" population of
outpatients and inpatients scheduled for cardiac surgery. Treatment
comprises a total preoperative loading dose of 8 to 10 g of -3-PUFAs or
placebo divided over 2 to 5 days, followed by 2 g/d until hospital
discharge or postoperative day 10, whichever comes first. Based on
anticipated 30% event rate in controls, total enrollment of 1,516 patients
(758 per treatment arm) will provide 90% power to detect 25% reduction in
PoAF. The OPERA trial will provide invaluable evidence to inform biologic
pathways; proof of concept that -3-PUFAs influence cardiac arrhythmias;
and potential regulatory standards and clinical use of this simple,
inexpensive, and low-risk intervention to prevent PoAF. 2011 Mosby, Inc.

<11>
Accession Number
2011380373
Authors
Albert M.A. Glynn R.J. Fonseca F.A.H. Lorenzatti A.J. Ferdinand K.C.
MacFadyen J.G. Ridker P.M.
Institution
(Albert, Ridker) Division of Cardiovascular Diseases, Harvard Medical
School, Brigham and Women's Hospital, Boston, MA, United States
(Albert, Glynn, MacFadyen, Ridker) Division of Preventive Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
(Fonseca) Universidade Federal de Sao Paulo, Disciplina de Cardiologia,
Setor de Lipides, Aterosclerose e Biologia Vascular, Sao Paulo, Brazil
(Lorenzatti) Hospital Cordoba, Cordoba, Argentina
(Ferdinand) Emory University, Division of Cardiology, Atlanta, GA, United
States
Title
Race, ethnicity, and the efficacy of rosuvastatin in primary prevention:
The Justification for the Use of Statins in Prevention: An Intervention
Trial Evaluating Rosuvastatin (JUPITER) trial.
Source
American Heart Journal. 162 (1) (pp 106-114.e2), 2011. Date of
Publication: July 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: The aim of this study was to evaluate the effect of statin
treatment in primary prevention of cardiovascular events in different
race/ethnic groups. Background: Clinical trial evidence about the efficacy
of statins in the primary prevention of cardiovascular events among
nonwhites is uncertain. Methods: JUPITER trial, a randomized,
double-blind, placebo-controlled evaluation of rosuvastatin 20 mg in the
primary prevention of myocardial infarction (MI), stroke, arterial
revascularization, hospitalization for unstable angina, and cardiovascular
death included 12,683 whites and 5,117 nonwhites with low-density
lipoprotein levels <130 mg/dL and high-sensitivity C-reactive protein
levels >=2.0 mg/L. Results: Random allocation to rosuvastatin resulted in
a 45% reduction in the primary end point among whites (hazard ratio [HR]
0.55, 95% CI 0.43-0.69) and a 37% reduction among nonwhites (HR 0.63, 95%
CI 0.41-0.99). Blacks (HR 0.65, 95% CI 0.35-1.22) and Hispanics (HR 0.58,
95% CI 0.25-1.39) had similar risk reductions. Among nonwhites in the
placebo group, the stroke rate exceeded the MI rate (0.44 vs 0.20 per 100
person-years); an opposite pattern was observed among whites (0.31 vs 0.42
per 100 person-years). Nonwhites had higher death rates than whites (2.25
vs 0.93 per 100 person-years); however, all-cause mortality was similar at
20% with rosuvastatin treatment in both participant groups. Conclusions:
When used in primary prevention among individuals with low-density
lipoprotein <130 mg/dL and high-sensitivity C-reactive protein >=2 mg/L,
rosuvastatin significantly reduced first MI, stroke, arterial
revascularization, hospitalization for unstable angina, and cardiovascular
death among whites and nonwhites. 2011 Mosby, Inc.

<12>
Accession Number
2011384870
Authors
Bigdeli A.K. Kaczmarek I. Eifert S. Beiras-Fernandez A. Kober S. Nikolaou
K. Oberhoffer M. Vicol C.
Institution
(Bigdeli, Kaczmarek, Eifert, Beiras-Fernandez, Kober, Oberhoffer, Vicol)
Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig Maximilians
University, Munich, Germany
(Nikolaou) Department of Radiology, Klinikum Grosshadern, Ludwig
Maximilians University, Munich, Germany
Title
Interrupted nitinol U-Clips versus standard running suture for the central
arterial T-graft anastomosis: A prospective randomized study.
Source
European Journal of Cardio-thoracic Surgery. 40 (2) (pp e93-e97), 2011.
Date of Publication: August 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objectives: Studies carried out to date suggest that the interrupted
suture technique using U-Clips for anastomoses in coronary surgery may be
superior to the standard running polypropylene suture. The purpose of this
study was to compare safety and effectiveness of a central T-graft
anastomosis constructed with the left internal thoracic artery (LITA) in
situ (to the left anterior descending (LAD)) in which the free right
internal thoracic artery (to the circumflex branch of the right coronary
artery (RCX)) was implanted (RITA-to-LITA) using either self-closing
nitinol U-Clips or simple continuous suture. We hypothesized that internal
thoracic arteries could adapt their diameter to the blood flow. Methods:
Thirty patients underwent total arterial revascularization using a T-graft
constructed with free LITA in situ to LAD in which the free RITA to the
circumflex artery was implanted (central T-graft anastomosis). In all
cases, free RITA was used as a sequential graft with two peripheral
anastomoses. Patients were randomly assigned to two groups: in group A (n=
15), central T-graft anastomosis was performed using a standard 8/0
polypropylene running suture. In group B (n= 15), central T-graft
anastomosis was performed using U-Clips. Intra-operative transit time flow
measurements were recorded. Patency control was performed in 30 patients 2
weeks and 6 months postoperatively, using 64-slice computed tomography
(CT) angiography. The diameter of the LITA was measured proximal and
distal and the diameter of the RITA distal to the central T-graft
anastomosis. Results: Perioperative results were similar in the two groups
(P= ns). Intra-operative transit time flow measurement showed patent
grafts in all patients. There were no hospital deaths. Two weeks
postoperatively, all grafts were patent. At 6-month follow-up, one RITA
and one LITA (both in group B) were closed distal to the central T-graft
anastomosis. There was no death and no re-intervention during follow-up.
Statistical analysis showed no significant changes in graft diameters
after 2 weeks and 6 months in both groups. Conclusions: The U-Clip
anastomosis technique is in our experience safe but not superior to the
standard running suture using polypropylene material. Remodeling of the
ITA grafts close to the central T-graft anastomosis was neither observed
for the standard running suture nor for the U-Clip anastomoses. 2011
European Association for Cardio-Thoracic Surgery.

<13>
Accession Number
2011384869
Authors
Tsagkaropoulos S. Belmans A. Verleden G.M. Coosemans W. Decaluwe H. De
Leyn P. Nafteux P. Van Raemdonck D.
Institution
(Tsagkaropoulos) Department of Thoracic Surgery, University La Sapienza
Rome, Rome, Italy
(Belmans) Biostatistics and Statistical Bioinformatics Centre, Katholieke
Universiteit Leuven, Leuven, Belgium
(Verleden) Department of Pneumology, University Hospitals Leuven, Leuven,
Belgium
(Coosemans, Decaluwe, De Leyn, Nafteux, Van Raemdonck) Department of
Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
Title
Single-lung transplantation: Does side matter?.
Source
European Journal of Cardio-thoracic Surgery. 40 (2) (pp e83-e92), 2011.
Date of Publication: August 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Single-lung transplantation (SLTx) is a valid treatment option
for patients with non-suppurative end-stage pulmonary disease. This
strategy helps to overcome current organ shortage. Side is usually chosen
based on pre-transplant quantitative perfusion scan, unless specific
recipient considerations or contralateral lung offer dictates opposite
side. It remains largely unknown whether outcome differs between left (L)
versus right (R) SLTx. Methods: Between July 1991 and July 2009, 142 first
SLTx (M/F=87/55; age=59 (29-69) years) were performed from 142 deceased
donors (M/F=81/61; age=40 (14-66) years) with a median follow-up of 32
(0-202) months. Indications for SLTx were emphysema (55.6%), pulmonary
fibrosis (36.6%), primary pulmonary hypertension (0.7%), and others
(7.0%). Recipients of L-SLTx (n=72) and R-SLTx (n=70) were compared for
donor and recipient characteristics and for early and late outcome.
Results: Donors of L-SLTx were younger (37 (14-65) vs 43 (16-66) years;
p=0.033). R-SLTx recipients had more often emphysema (67.1% vs 44.4%;
p=0.046) and replacement of native lung with >=50% perfusion (47.1% vs
23.6%; p=0.003). The need for bypass, time to extubation, intensive care
unit (ICU) and hospital stay, and 30-day mortality did not differ between
groups. Overall survival at 1, 3, and 5 years was 78.4%, 60.5%, and 49.4%,
respectively, with a median survival of 60 months, with no significant
differences between sides. Forced expiratory volume in 1s
(FEV₁) improved (p<0.01) in both groups to comparable values up
to 36 months. Complications overall (44.4% vs 50.0%) or in allograft
(25.0% vs 24.3.0%) as well as time to bronchiolitis obliterans syndrome
(BOS) (35 months) and 5-year freedom from BOS (68.9% vs 75.0%) were
comparable after L-SLTx versus R-SLTx, respectively. There were no
differences in all causes of death (p=0.766). On multivariate analysis,
BOS was a strong negative predictor for survival (hazard ratio (HR) 6.78;
p<0.001), whereas side and mismatch for perfusion were not. Conclusion:
The preferred side for SLTx differed between fibrotic versus emphysema
recipients. Transplant side does not influence recipient survival, freedom
from BOS, complications, or pulmonary function after SLTx. Besides
surgical considerations in the recipient, offer of a donor lung opposite
to the preferred side should not be a reason to postpone the
transplantation until a better-matched donor is found. 2011 European
Association for Cardio-Thoracic Surgery.

<14>
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Accession Number
2011383385
Authors
Aronson S. Dyke C.M. Levy J.H. Cheung A.T. Lumb P.D. Avery E.G. Hu M.-Y.
Newman M.F.
Institution
(Aronson, Newman) Department of Anesthesiology, Duke University Medical
Center, Durham, NC, United States
(Dyke) SouthEast Texas Cardiovascular Surgery Associates, Houston, TX,
United States
(Levy) Department of Anesthesiology, Emory University, School of Medicine,
Atlanta, GA, United States
(Cheung) Department of Anesthesiology and Critical Care, University of
Pennsylvania, Philadelphia, PA, United States
(Lumb) Department of Anesthesiology, Keck School of Medicine, Los Angeles,
CA, United States
(Avery) Department of Anesthesiology and Perioperative Medicine,
University Hospitals Case Medical Center, Cleveland, OH, United States
(Hu) Medicines Company, Parsippany, NJ, United States
Title
Does perioperative systolic blood pressure variability predict mortality
after cardiac surgery? An exploratory analysis of the ECLIPSE trials.
Source
Anesthesia and Analgesia. 113 (1) (pp 19-30), 2011. Date of Publication:
July 2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background: Few studies describe an association of perioperative blood
pressure stability with postoperative outcome. We tested the hypothesis
that systolic blood pressure (SBP) variability in patients undergoing
cardiac surgery is associated with 30-day mortality. Methods:
Perioperative blood pressure variability was evaluated in the 1512
patients who were randomized and had perioperative hypertension in the
ECLIPSE trials. Blood pressure variability was assessed as the product of
magnitude x duration of SBP excursions outside defined SBP ranges (area
under the curve). SBP ranges were analyzed from 65 to 135 mm Hg
intraoperatively and 75 to 145 mm Hg pre- or postoperatively, up to 105 to
135 mm Hg intraoperatively and 115 to 145 mm Hg pre- or postoperatively,
with the narrower ranges defined by progressively increasing the lower SBP
limit by 10 mm Hg increments. Multiple logistic regression was used to
assess the association of blood pressure variability with 30-day mortality
obtained from the primary ECLIPSE trial results. Results: Increased SBP
variability outside a range of 75 to 135 mm Hg intraoperatively and 85 to
145 mm Hg pre- and postoperatively is significantly associated with 30-day
mortality. The odds ratio was 1.16 (95% confidence interval, 1.04-1.30)
for 30-day mortality risk per incremental SBP excursion of 60 mm Hg x
min/h. The predicted probability of 30-day mortality increased for
low-risk patients from 0.2% to 0.5%, and for high-risk patients from 42.4%
to 60.7% if the area under the curve increased from 0 to 300 mm Hg x
min/h. Conclusions: Perioperative blood pressure variability is associated
with 30-day mortality in cardiac surgical patients, proportionate to the
extent of SBP excursions outside the range of 75 to 135 mm Hg
intraoperatively and 85 to 145 mm Hg pre- and postoperatively. Predicted
mortality was greater for high-risk patients than for low-risk patients.
2011 International Anesthesia Research Society.

<15>
Accession Number
2011384819
Authors
Tan C. Utley M. Paschalides C. Pilling J. Robb J.D. Harrison-Phipps K.M.
Lang-Lazdunski L. Treasure T.
Institution
(Pilling, Robb, Harrison-Phipps, Lang-Lazdunski) Department of Thoracic
Surgery, Guy's Hospital, London, United Kingdom
(Utley, Paschalides, Treasure) Clinical Operational Research Unit,
University College London, London, United Kingdom
(Tan) St George's Hospital, London, United Kingdom
Title
A prospective randomized controlled study to assess the effectiveness of
CoSeal to seal air leaks in lung surgery.
Source
European Journal of Cardio-thoracic Surgery. 40 (2) (pp 304-308), 2011.
Date of Publication: August 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objectives: Prolonged alveolar air leak is the most common complication
after pulmonary surgery. We conducted an investigator-led randomized trial
to evaluate the effectiveness of CoSeal surgical sealant
(Cohesion Technologies Inc.; manufactured and distributed by Baxter
Healthcare) for the closure of alveolar air leak after anatomical
pulmonary resection. Methods: Patients undergoing primary open lobectomy,
bilobectomy, or sublobar resection with a demonstrable air leak on
intra-operative testing were randomized to either standard care or
standard care plus application of CoSeal surgical sealant to
areas of air leak. A second application of CoSeal was used in
the treatment group if air leak persisted. Patients were allocated at the
point of entry to the trial by unbiased allocation with minimization to
ensure balance between the two arms with respect to age, sex, surgeon,
number of segments resected, preoperative forced expiratory volume in 1s
(FEV₁), and grade of air leak. Kaplan-Meier analysis of
air-leak duration and a log rank test were performed on an
intention-to-treat basis, with observations censored at death, transfer to
the intensive care unit, or discharge. Results: Of the 200 patients, who
entered the trial over a 24-month period, 121 with demonstrable
intra-operative air leak were randomly allocated to the two groups. Data
were missing for one patient in the CoSeal group. In 57%, the
air leak was stopped at the first application; a quarter continued to leak
after the second. At 24h, there was no difference in air leak and fewer
patients in the control group were leaking at 48h postoperatively. By log
rank test, the difference was not significant (p=0.09). Conclusions:
Patients treated with CoSeal in this study had, as a group, a
longer duration of air leak and hence we cannot recommend its routine use.
2010 European Association for Cardio-Thoracic Surgery.

<16>
Accession Number
2011384820
Authors
D'Journo X.B. Rolain J.M. Doddoli C. Raoult D. Thomas P.A.
Institution
(D'Journo, Rolain, Doddoli, Raoult, Thomas) University of the
Mediterranean and Assistance, Publique-Hopitaux de Marseille, Hopital
Nord, Marseille, France
(D'Journo, Doddoli, Thomas) Service de Chirurgie Thoracique et des
Maladies de l'OEsophage, Hopital Nord, Marseille, France
(D'Journo, Rolain, Doddoli, Raoult, Thomas) Unite de Recherche sur les
Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS-IRD, UMR
6236 Faculte de Medecine, Universite de la Mediterranee, Marseille, France
Title
Airways colonizations in patients undergoing lung cancer surgery.
Source
European Journal of Cardio-thoracic Surgery. 40 (2) (pp 309-319), 2011.
Date of Publication: August 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Lung cancer remains the main leading cancer-related cause of death in the
world. For early-stage tumor, surgery stands out as the best curative
option offering the greatest chance for cure. Despite improvement of per-
and postoperative management, surgery continues to carry a high morbidity
with a significant mortality. Among postoperative complications,
respiratory failures (nosocomial pneumonia and acute respiratory distress
syndrome) are currently the most frequent and serious, as well as being
the primary cause of hospital death, after a lung resection for cancer.
Because infectious etiologies have been highly incriminated in the
development of these pulmonary complications, microbial airways
colonizations (AWCs) are supposed to be an essential first step in the
pathogenesis of these failures occurring in hospitalized and chronically
ill individuals. These patients fulfill all the predisposing factors to
bronchial colonizations and are particularly exposed to the development of
respiratory failures in the postoperative setting, when secretion
clearance and cough reflex are impaired. Under immunosuppressive
conditions, AWC should act in a manner that increases its ability to
stimulate microorganisms and increase the risks of superimposed
infections. Few studies have addressed the problem of AWCs in patients
submitted for lung cancer surgery. Because of several limitations,
especially the lack of exhaustive microbiological studies, the conclusions
that can be reached remain inconclusive. This review aims to report the
existing literature on this critical and controversial issue, focusing on
their specific incidence, their predisposing factors, their correlation
with development of respiratory failures, and, in turn, the reliability of
the current antibiotic prophylaxis for their prevention. 2010 European
Association for Cardio-Thoracic Surgery.

<17>
Accession Number
2011384816
Authors
Mohsen T.A. Zeid A.A.A. Meshref M. Tawfeek N. Redmond K. Ananiadou O.G.
Haj-Yahia S.
Institution
(Mohsen) Department of Cardiothoracic Surgery, Kasr El Aini Hospital,
Cairo University Hospitals, El Mani, Egypt
(Zeid) Department of Chest Medicine, Kasr El Aini Hospital, Cairo
University Hospitals, El Manial, Egypt
(Meshref) Department of Oncology Medicine, Kasr El Aini Hospital, Cairo
University Hospitals, El Manial, Egypt
(Tawfeek) Department of General Medicine, Kasr El Aini Hospital, Cairo
University Hospitals, El Manial, Egypt
(Redmond) Thoracic Surgery Department, Royal Brompton and Harefield
Hospital, London, United Kingdom
(Ananiadou) Department of Cardiothoracic Surgery, 'G. Papanikolaou'
General Hospital, Thessaloniki, Greece
(Haj-Yahia) Cardiothoracic Surgery, Transplantation and Mechanical
Circulatory Support, The Heart and Lung Centre, The Golden Jubilee
National Hospital, Glasgow, United Kingdom
(Haj-Yahia) Pharmacology Group, Airway Disease Section, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
Title
Local iodine pleurodesis versus thoracoscopic talc insufflation in
recurrent malignant pleural effusion: A prospective randomized control
trial.
Source
European Journal of Cardio-thoracic Surgery. 40 (2) (pp 282-286), 2011.
Date of Publication: August 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: To compare the efficacy, safety, and outcome of thoracoscopic
talc poudrage (TTP) versus povidone-iodine pleurodesis (PIP) through a
thoracostomy tube as a palliative treatment of pleural effusion due to
metastatic breast carcinoma (MBC). Methods: A total of 42 MBC patients
were prospectively enrolled in a randomized controlled trial. Twenty-two
patients received TTP (group A), whereas 20 patients (group B) underwent
pleurodesis by instilling povidone-iodine through a thoracostomy tube, as
a bedside procedure. Results: The mean age was 48.2 +/- 9.9 (range: 29-64)
years and 50.2 +/- 7 (range: 32-62) years for groups A and B, respectively
(p= ns). At presentation, all patients had moderate to severe dyspnea, New
York Heart Association (NYHA) > II and Medical Research Council (MRC)
dyspnea scale 3-5. Morbidity in both groups was low. Post-procedure
analgesic requirements due to severe pleuritic chest pain were higher in
group A (18% vs 0%, p= 0.2). Four patients in group A (18%) and one in
group B (5%) were febrile (>38 degreeC) within 48. h of the procedure.
Both groups achieved good symptom control, with improvement in MRC dyspnea
scale (1-3). There were no in-hospital deaths. Post-procedure hospital
stay was lower in group B (p= 0.009). The mean progression-free interval
was 6.6 (range 3-15) months. At follow-up (mean: 22.6 (range: 8-48)
months), recurrence of significant pleural effusion requiring intervention
was noted in two and three patients in group A and group B, respectively
(p= ns). Conclusion: Povidone-iodine can be considered as a good
alternative to TTP to ensure effective pleurodesis for patients with
malignant pleural effusion due to MBC. The drug is available, cost
effective and safe, can be given through a thoracostomy tube and can be
repeated if necessary. 2010 European Association for Cardio-Thoracic
Surgery.

<18>
Accession Number
21391924
Authors
Kim J.C. Hong S.W. Shim J.K. Yoo K.J. Chun D.H. Kwak Y.L.
Institution
(Kim) Department of Anesthesiology and Pain Medicine, Anesthesia and Pain
Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Title
Effect of N-acetylcysteine on pulmonary function in patients undergoing
off-pump coronary artery bypass surgery.
Source
Acta anaesthesiologica Scandinavica. 55 (4) (pp 452-459), 2011. Date of
Publication: Apr 2011.
Abstract
Pulmonary dysfunction related to inflammatory response and radical oxygen
species remains a problem in off-pump coronary bypass graft surgery
(OPCAB), especially in patients with reduced left ventricular (LV)
function. The aim of this study was to evaluate the effect of
N-acetylcysteine (NAC) on pulmonary function following OPCAB. Patients
with LV ejection fraction <=40% were randomly assigned to receive either a
bolus of 100 mg/kg of intravenous NAC over a 15-min period immediately
after anesthetic induction, followed by an intravenous infusion at 40
mg/kg/day for 24 h (NAC group, n=24), or a placebo (control group, n=24).
Hemodynamic and pulmonary parameters, and the incidence of acute lung
injury (PaO(2)/FiO(2)<300 mmHg) were assessed and compared. The pulmonary
vascular resistance index (PVRI) did not change during mechanical heart
displacement compared with the baseline value in the NAC group while it
was significantly increased in the control group. Significantly less
number of patients developed acute lung injury at 2 h after the surgery in
the NAC group. The other pulmonary parameters and the duration of
ventilator care were all similar. NAC demonstrated promising results in
terms of mitigating the increase in PVRI during mechanical heart
displacement and attenuating the development of acute lung injury in the
immediate post-operative period. However, NAC could not induce a definite
improvement in the other important pulmonary variables including
PaO(2)/FiO(2) and Q(s)/Q(t), and did not lead to a decreased duration of
ventilatory care or length of stay in the intensive care unit. 2011 The
Authors. Acta Anaesthesiologica Scandinavica 2011 The Acta
Anaesthesiologica Scandinavica Foundation.

<19>
[Use Link to view the full text]
Accession Number
2011389133
Authors
Papageorgiou N. Tousoulis D. Stefanadis C.
Institution
(Papageorgiou, Tousoulis, Stefanadis) 1st Cardiology Unit, Athens
University Medical School, Hippokration Hospital, Athens, Greece
Title
Letter by Papageorgiou et al regarding article, "oMEGA, a randomized,
placebo-controlled trial to test the effect of highly purified omega-3
fatty acids on top of modern guideline-adjusted therapy after myocardial
infarction".
Source
Circulation. 124 (1) (pp e22), 2011. Date of Publication: 05 Jul 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<20>
[Use Link to view the full text]
Accession Number
2011389132
Authors
Halcox J.P.
Institution
(Halcox) Cardiff University, Cardiff, United Kingdom
Title
Letter by Halcox regarding article, "oMEGA, a randomized,
placebo-controlled trial to test the effect of highly purified omega-3
fatty acids on top of modern guideline-adjusted therapy after myocardial
infarction".
Source
Circulation. 124 (1) (pp e21), 2011. Date of Publication: 05 Jul 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<21>
Accession Number
2011373240
Authors
Fedacko J. Pella D. Fedackova P. Vargova V. de Meester F. Durcikova P.
Singh R.B.
Institution
(Fedacko, Pella, Fedackova, Vargova) 3 rd Department of Internal Medicine,
Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia
(de Meester) Columbus Paradigm Institute, Waterloo, Belgium
(Durcikova) Faculty of Medicine, Safaric University, Kosice, Slovakia
(Singh) Halberg Hospital and Research Institute, Moradabad, India
Title
Coenzyme Q10 in heart and brain diseases.
Source
Open Nutraceuticals Journal. 4 (pp 69-87), 2011. Date of Publication:
2011.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Several cardiovascular, neurological and other diseases are
associated with coenzyme Q10(CoQ) deficiency. The objective is to evaluate
possible benefits of ubiquinone supplementation in cardiovascular diseases
and degenerative diseases of the brain. Methods: An internet search in
PubMed, Vitasearch, In Circulation. Net, till 2008, discussions with
colleagues, own experiences. Results: Ubiquinone (Coenzyme Q10) deficiency
has been observed in several cardiovascular and neurological diseases.
CoQ10 has strong influence on lipid metabolism, oxidation of blood lipids,
vascular inflammation and on the cell membranes of cardiac and arterial
cells and neurons. These pathogenetic mechanisms seem to be important in
patients with neurological and cardiac disease as well as in brain-heart
connection. Its supplementation has several beneficial effects including
the stabilisation of atherosclerotic plaque and decreasing the size of
myoacardial infarction and the protection of neurons. Antioxidant
properties of CoQ10 are responsible for the prevention of many drug side
effects. Several studies have suggested the beneficial effect of CoQ10 in
neuro-cardiovascular diseases, that will require further confirmation.
Adverse effects such as nausea and vomiting may be reduced by using highly
bio-available brands, that reduce the oral dosage of COQ. Conclusions:
CoQ10 is still in the investigational stages and the list of possible
indications related to brain and heart diseases and their linkage, appears
to be quite extensive. There is still the need for a number of large,
double blind multicenter, randomized, controlled clinical trials, in order
to confirm the possible beneficial effects of CoQ10 supplementation in
different neurocardiological conditions. Fedacko et al.

<22>
Accession Number
2011382361
Authors
El-Haddad M.A. Zalawadiya S.K. Awdallah H. Sabet S. El-Haddad H.A. Mostafa
A. Rashed A. El-Naggar W. Farag N. Saleb M.A. Jacob S.
Institution
(El-Haddad, Awdallah, Sabet, Farag, Saleb) Dar Al-Fouad Hospital, Giza,
Egypt
(Jacob) Division of Cardiology Electrophysiology, Wayne State University,
Detroit Medical Center, Detroit, MI, United States
(El-Haddad, Zalawadiya, Mostafa, Jacob) Department of Internal Medicine,
Wayne State University, Detroit Medical Center, 4201 St Antoine, 2E,
Detroit, MI 48201, United States
(El-Haddad, Rashed, El-Naggar) Cairo University, School of Medicine, Giza,
Egypt
Title
Role of irbesartan in prevention of post-coronary artery bypass graft
atrial fibrillation.
Source
American Journal of Cardiovascular Drugs. 11 (4) (pp 277-284), 2011.
Date of Publication: 2011.
Publisher
Adis International Ltd (41 Centorian Drive, Private Bag 65901, Mairangi
Bay, Auckland 10 1311, New Zealand)
Abstract
Background and Objective: Atrial fibrillation (AF) is a common
complication of cardiothoracic surgery (CTS). Existing evidence about the
potential protective role of angiotensin II type 1 receptor antagonists
(angiotensin receptor blockers [ARBs]) for post-CTS AF has been limited
and conflicting. In this singleblind, open-label, randomized prospective
pilot study, we evaluated the potential protective role of irbesartan (an
ARB) in post-coronary artery bypass graft (CABG) AF. Methods: A total of
100 consecutive patients undergoing CABG were randomly assigned to
irbesartan (n = 50) versus no irbesartan (n = 50) for 5 days prior to the
scheduled surgery. Data were collected for imaging studies, laboratory
values, and peri-operative details. Patients were monitored
post-operatively for in-hospital AF episodes. Unadjusted and adjusted
logistic regression analysis was performed to assess the effect of
irbesartan on the incidence of post-CABG AF. Results: A total of 14
patients developed AF during their post-operative hospital stay. The
incidence of AF in patients who received irbesartan was 6% (n = 3)
compared with 22% (n = 11) in patients who did not receive irbesartan (p =
0.021). Univariate logistic regression analysis identified irbesartan and
age as statistically significant variables. An adjusted multivariate
logistic model identified irbesartan as an important protective factor
against development of post-CABG AF (adjusted odds ratio [OR] 0.20; 95%
confidence interval [CI] 0.04, 0.94; p = 0.04). Increasing age (adjusted
OR 1.09, 95% CI 1.01, 1.17; p = 0.03) was also identified as an
independent risk factor for development of post-CABG AF. Conclusion:
Pretreatment with irbesartan tends to have a significant protective effect
against the occurrence of AF during the post-operative period in patients
undergoing CABG. 2011 Adis Data Information BV. All rights reserved.

<23>
Accession Number
2011380367
Authors
Chung S.-C. Hlatky M.A. Stone R.A. Rana J.S. Escobedo J. Rogers W.J.
Bromberger J.T. Kelsey S.F. Brooks M.M.
Institution
(Chung, Stone, Bromberger, Kelsey, Brooks) Department of Epidemiology and
Biostatistics, University of Pittsburgh, GSPH, 130 DeSoto Street,
Pittsburgh, PA 15261, United States
(Hlatky) Stanford University, School of Medicine, Stanford, CA, United
States
(Rana) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Escobedo) Medical Research Unit on Clinical Epidemiology, Mexican Social
Security Institute, Mexico City, D.F., Mexico
(Rogers) University of Alabama at Birmingham, Birmingham, AL, United
States
Title
Body mass index and health status in the Bypass Angioplasty
Revascularization Investigation 2 Diabetes Trial (BARI 2D).
Source
American Heart Journal. 162 (1) (pp 184-192.e3), 2011. Date of
Publication: July 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: The longitudinal association between obesity, weight
variability, and health status outcomes is important for patients with
coronary disease and diabetes. Methods: The BARI 2D was a multicenter
randomized clinical trial designed to evaluate treatment strategies for
patients with both documented stable ischemic heart disease and type 2
diabetes. We examined BARI 2D participants for 4 years to study how body
mass index (BMI) was associated with health status outcomes. Health status
was evaluated by the Duke Activity Status Index (DASI), RAND
Energy/fatigue, Health Distress, and Self-rated Health. Body mass index
was measured quarterly throughout follow-up years, and health status was
assessed at each annual follow-up visit. Variation in BMI measures was
separated into between-person and within-person change in longitudinal
analysis. Results: Higher mean BMI during follow-up years (the
between-person BMI) was associated with poorer health status outcomes.
Decreasing BMI (the within-person BMI change) was associated with better
Self-rated health. The relationships between BMI variability and DASI or
Energy appeared to be curvilinear and differed by baseline obesity status.
Decreasing BMI was associated with better outcomes if patients were obese
at baseline but was associated with poorer DASI and Energy outcomes if
patients were nonobese at baseline. Conclusions: For patients with stable
ischemic heart disease and diabetes, weight gain was associated with
poorer health status outcomes, independent of obesity-related
comorbidities. Weight reduction is associated with better functional
capacity and perceived energy for obese patients but not for nonobese
patients at baseline. 2011 Mosby, Inc.

<24>
Accession Number
21721351
Authors
Jeysen Z.Y. Gerard L. Levant G. Cowen M. Cale A. Griffin S.
Institution
(Jeysen) Department of Cardiothoracic Surgery, Castle Hill Hospital,
Cottingham, United Kingdom.
Title
Research report: the effects of hyperbaric oxygen preconditioning on
myocardial biomarkers of cardioprotection in patients having coronary
artery bypass graft surgery.
Source
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric
Medical Society, Inc. 38 (3) (pp 175-185), 2011. Date of Publication:
2011 May-Jun.
Abstract
We have previously conducted and reported on the primary endpoint of a
clinical study which demonstrated that hyperbaric oxygen (HBO2)
preconditioning consisting of two 30-minute intervals of 100% oxygen at
2.4 atmospheres absolute (ATA) prior to coronary artery bypass graft
(CABG) surgery leads to an improvement in left ventricular stroke work
(LVSW) 24 hours following CABG. In that study, 81 patients were randomized
to treatment with HBO2 (HBO2; n = 41) or routine treatment (Control Group;
n = 40) prior to surgery. The objective of this manuscript is to further
report on the result of the exploratory secondary endpoints from that
study, specifically the effects of HBO2 preconditioning on biomarkers of
myocardial protection. Intraoperative right atrial biopsies were assessed,
via an Enzyme Linked ImmunoSorbent Assay (ELISA), for the expression of
eNOS and HSP72. In this study, no significant differences were observed
between the groups with respect to the quantity of myocardial eNOS and
HSP72. However, in the HBO2 Group, following ischemia and reperfusion, the
quantities of myocardial eNOS and HSP72 were increased. This suggests that
HBO2 preconditioning in this group of patients may be capable of inducing
endogenous cardioprotection following ischemic reperfusion injury (IRI).

<25>
Accession Number
70472220
Authors
Heather Arthur H. Smith K.M. Thorpe K. Mckelvie R.S.
Institution
(Heather Arthur) McMaster University, Hamilton Health Sciences, Hamilton,
Canada
(Smith) University of Illinois at Chicago, Chicago, United States
(Thorpe) University of Toronto, Toronto, Canada
(Mckelvie) Population Health Research Institute, Hamilton, Canada
Title
Changes in health-related quality of life and social support six-years
after cardiac rehabilitation.
Source
European Journal of Cardiovascular Prevention and Rehabilitation.
Conference: EuroPRevent 2011 Geneva Switzerland. Conference Start:
20110414 Conference End: 20110416. Conference Publication: (var.pagings).
18 (1 SUPPL. 1) (pp S45), 2011. Date of Publication: April 2011.
Publisher
SAGE Publications Inc.
Abstract
Purpose: Health related quality of life (HRQoL) is a multidimensional
concept. Cardiac rehabilitation (CR) contributes to improvement in HRQoL.
Social support is also an important factor influencing cardiac prognosis;
however, fewer studies have examined the effect of CR on social support.
We examined changes in HRQoL and social support 6 years after discharge
from a randomized controlled trial of monitored home-based (home) versus
standard hospital-based (hospital) exercise training following coronary
artery bypass graft surgery. Methods: Patients who participated in the
original trial and attended follow-up one-year after completion of CR
(n=196) were approached for participation in the 6-year follow-up. HRQoL
was assessed using the Medical Outcomes Study- Short Form 36 (SF36) health
survey. Social support was measured using the Interpersonal Support and
Evaluation List (ISEL). Changes between the one-year and the 6-year
follow-up were of interest. Comparisons with baseline (CR entry) were also
examined. An alpha of +/-0.05 was considered significant. Results: Of
eligible patients, 144 (75.5%; n=74 hospital, n=70 home) were available
for participation a mean of 6.6+/-0.34 years after CR. Participants were
predominantly male (n=120; 83.3%) aged 70+/-9.5 years. The physical
component summary score (PCS) of the SF36 was similar in home and hospital
patients at 6-years (42.5+/-11.4 vs. 44.8+/-10.3; p=0.174). The mental
component summary score (MCS) of the SF36 improved slightly (2.3, 95% CI:
0.245-4.426; p=0.013) between the one and 6-year follow-up (p=0.029) and
was similar in both home and hospital groups (51.4+/-10.3 vs. 54.5+/-10.7;
p=0.160). The sample mean on the PCS was lower than CR entry (p=0.013) but
was similar to U.S. population norms for 65-74 year olds. Social support
declined between the one and six-year follow-ups (p<0.0001) and was
similar in the home (21.0+/-3.4) and hospital (21.1+/-4.1) groups.
Conclusions: CR, whether in the hospital or home, appears to assist
patients in maintaining HRQoL scores that are similar to population norms
up to 6-years after CR ends and despite the changes imposed by aging. CR,
thus, may contribute to positive perceptions of health and wellbeing in
the long term. Decline in social support may be attributed to factors such
reductions in the size of the social support network associated with
aging, or loss of support that was obtained through participation in
hospital-based CR or from telephone monitoring during the trial.

<26>
Accession Number
70472063
Authors
Alexander Michael Clark A.M. Scott J. Schopflocher D. Myers J. Paterson I.
Warburton D. Jones L. Haykowsky M.
Institution
(Alexander Michael Clark, Schopflocher, Paterson, Haykowsky) University of
Alberta, Edmonton, Canada
(Scott, Warburton) University of British Columbia, Vancouver, Canada
(Myers) Stanford University, Stanford, United States
(Jones) Duke University, Durham, United States
Title
A Meta-analysis of the effects of Exercise Training on Left Ventricular
Remodeling Following Myocardial Infarction: Start early and go longer for
greatest exercise benefits on mortality.
Source
European Journal of Cardiovascular Prevention and Rehabilitation.
Conference: EuroPRevent 2011 Geneva Switzerland. Conference Start:
20110414 Conference End: 20110416. Conference Publication: (var.pagings).
18 (1 SUPPL. 1) (pp S1), 2011. Date of Publication: April 2011.
Publisher
SAGE Publications Inc.
Abstract
Oblective: To identify the effects of variations in exercise training on
Left ventricular (LV) remodeling in patients shortly after Myocardial
Infarction (MI) Design: Systematic review incorporating meta-analysis
using meta-regression Data sources: Studies were identified via systematic
searches of: OVID MEDLINE (1950 to 2009), Cochrane Central Register of
Controlled Trials (1991 to 2009), AMED (1985 to 2009), EMBASE (1988 to
2009), PUBMED (1966 to 2009), SPORT DISCUS (1975 to 2009), SCOPUS (1950 to
2009) and WEB OF SCIENCE (1950 to 2009) using the medical subject
headings: myocardial infarction, post myocardial infarction, post
infarction, heart attack, ventricular remodeling, ventricular volumes,
ejection fraction, left ventricular function, exercise, exercise therapy,
kinesiotherapy, exercise training. Reference lists of all identified
studies were also manually searched for further relevant studies.
Eligibility criteria for selecting studies: Randomized controlled trials
of exercise training interventions reporting ejection fraction (EF) and/or
ventricular volumes in patients following recent MI (<= 3 months) post-MI
patients involving control groups. Studies were excluded if they were not
randomized, did not have a 'usual-care' control (involving no exercise),
evaluated a non-exercise intervention, or did not involve human subjects.
Non-English studies were also excluded. Results: After screening of 1029
trials, trials were identified that reported EF (12 trials, n = 647), ESV
(9 trials, n = 475) and EDV (10 trials, n = 512). Meta-regression
identified that changes in EF effect size difference decreased as the time
between MI and initiation of the exercise program lengthened, and
increased as the duration of the program increased (Q=25.48, df=2, p<0.01,
R2=0.76) Greater reductions in ESV and EDV (as indicated by effect size
decreases) occurred with earlier initiation of exercise training and with
longer training durations (ESV: Q=23.89, df=2, p<0.05, R2=0.79; EDV:
Q=27.42, df=2, p<0.01, R2=0.83). Differences remained following
sensitivity analysis. Each week that exercise was delayed required an
additional month of training to achieve the same level of benefit on LV
remodeling. Conclusions: Exercise training has beneficial effects on LV
remodeling in clinically stable post- MI patients with greatest benefits
occurring when training starts earlier following MI (from one week) and
lasts longer than 3 months.

<27>
Accession Number
70471618
Authors
Thielmann M. Kottenberg E. Boengler K. Raffelsieper C. Wendt D. Neuhauser
M. Peters J. Jakob H. Heusch G.
Institution
(Thielmann, Raffelsieper, Wendt, Jakob) West-German Heart Center Essen,
Essen, Germany
(Kottenberg, Boengler, Peters, Heusch) Universitity Hospital Essen, Essen,
Germany
(Neuhauser) Koblenz University of Applied Science, Remagen, Germany
Title
Remote ischemic preconditioning reduces myocardial and renal injury in
elective coronary artery bypass surgery with crystalloid cardioplegic
arrest: A randomized controlled trial.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: Annual Scientific Meeting of the International
Society for Minimally Invasive Cardiothoracic Surgery, ISMICS 2010 Berlin
Germany. Conference Start: 20100616 Conference End: 20100619. Conference
Publication: (var.pagings). 5 (3) (pp 239), 2010. Date of Publication:
May-June 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Remote ischemic preconditioning (RIPC) with transient upper
limb ischemia has been proposed to reduce myocardial as well as renal
injury in coronary artery bypass (CABG) surgery with cross-clamp
fibrillation for myocardial protection. Whether such protection is still
operative when crystalloid cardioplegic arrest is used for myocardial
protection is as yet uncertain. Methods: In a prospective, randomized,
single-blinded protocol, fifty-three consecutive, non-diabetic patients
with triple-vessel disease (64+/-12 years of age; mean=SD), who underwent
elective CABG surgery with crystalloid (Bretschneider) cardioplegic arrest
were allocated to either receive a RIPC protocol (consisting of three 5min
cycles of transient left upper arm ischemia induced by inflating a blood
pressure cuff to 200 mm Hg with 5 min of reperfusion in between) or
control. Cardiac troponin I (cTnI), as a marker for myocardial injury, and
serum creatinine as well as the estimated glomerular filtration rate
(eGFR) to detect renal injury, were measured preoperatively and over 72
hours (h) postoperatively. Results: Mean postoperative cTnI release was
significantly lower with RIPC (n=27) at 6h, 12h, 24h, and 48h after
surgery (P<0.001; ANOVA) than in controls (N=26). Peak postoperative cTnI
concentration was also significantly reduced from 13.7+/-7.7ng/ml in
controls to 8.9+/-4.4ng/ml in RIPC (P<0.01).The area under the cTnI curve
was significantly reduced with RIPC as compared to control (3.6+/-2.4
versus 6.6+/-5.4ng/ml/h; P<0.03) indicating an absolute reduction of
postoperative cTnI release with RIPC of 46%. Peak postoperative creatinine
serum levels were reduced with RIPC as compared to controls (1.28+/-0.23
vs. 1.48+/-0.44mg/dL; P<0.04) and conversely, eGFR_min was
significantly higher with RIPC (61+/-12ml/h versus 52+/-12; P<0.02) than
in controls. Conclusions: These data indicate that RIPC induced by a
simple repetitive inflation of a cuff around the left upper arm before
surgery enhances myocardial and renal protection in patients undergoing
CABG surgery with antegrade cold crystalloid (Bretschneider) cardioplegia.