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<1>
Accession Number
21439030
Authors
Visser M. Davids M. Verberne H.J. Kok W.E. Niessen H.W. van Venrooij L.M.
Cocchieri R. Wisselink W. de Mol B.A. van Leeuwen P.A.
Institution
(Visser) Department of Cardiothoracic Surgery, Academic Medical Center
University of Amsterdam, Amsterdam, The Netherlands.
Title
Rationale and design of a proof-of-concept trial investigating the effect
of uninterrupted perioperative (par)enteral nutrition on amino acid
profile, cardiomyocytes structure, and cardiac perfusion and metabolism of
patients undergoing coronary artery bypass grafting.
Source
Journal of cardiothoracic surgery. 6 (pp 36), 2011. Date of
Publication: 2011.
Abstract
BACKGROUND: Malnutrition is very common in patients undergoing cardiac
surgery. Malnutrition can change myocardial substrate utilization which
can induce adverse effects on myocardial metabolism and function. We aim
to investigate the hypothesis that there is a disturbed amino acids
profile in the cardiac surgical patient which can be normalized by
(par)enteral nutrition before, during and after surgery, subsequently
improving cardiomyocyte structure, cardiac perfusion and glucose
metabolism. METHODS/DESIGN: This randomized controlled intervention study
investigates the effect of uninterrupted perioperative (par)enteral
nutrition on cardiac function in 48 patients undergoing coronary artery
bypass grafting. Patients are given enteral nutrition (n = 16) or
parenteral nutrition (n = 16), at least two days before, during, and two
days after coronary artery bypass grafting, or are treated according to
the standard guidelines (control) (n = 16). We will illustrate the effect
of (par)enteral nutrition on differences in concentrations of amino acids
and asymmetric dimethylarginine and in activity of dimethylarginine
dimethylaminohydrolase and arginase in cardiac tissue and blood plasma. In
addition, cardiomyocyte structure by histological, immuno-histochemical
and ultrastructural analysis will be compared between the (par)enteral and
control group. Furthermore, differences in cardiac perfusion and global
left ventricular function and glucose metabolism, and their changes after
coronary artery bypass grafting are evaluated by electrocardiography-gated
myocardial perfusion scintigraphy and ¹F-fluorodeoxy-glucose
positron emission tomography respectively. Finally, fat free mass is
measured before and after intervention with bioelectrical impedance
spectrometry in order to evaluate nutritional status. TRIAL REGISTRATION:
Netherlands Trial Register (NTR): NTR2183.

<2>
Accession Number
2011401044
Authors
Rodseth R.N. Lurati Buse G.A. Bolliger D. Burkhart C.S. Cuthbertson B.H.
Gibson S.C. Mahla E. Leibowitz D.W. Biccard B.M.
Institution
(Rodseth, Biccard) Department of Anaesthetics, Nelson R. Mandela School of
Medicine, University of KwaZulu-Natal, Durban, South Africa
(Rodseth, Biccard) Department of Anaesthetics, Inkosi Albert Luthuli
Central Hospital, Durban, South Africa
(Lurati Buse, Bolliger, Burkhart) Department of Anaesthesia and Intensive
Care Medicine, University Hospital Basel, Basel, Switzerland
(Cuthbertson) Department of Critical Care Medicine, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, ON, Canada
(Gibson) Specialist Registrar in Surgery, West of Scotland Rotation,
Stobhill Hospital, Glasgow, United Kingdom
(Mahla) Department of Anesthesiology and Intensive Care Medicine, Medical
University of Graz, Graz, Austria
(Leibowitz) Division of Cardiology, Hadassah-Hebrew University Medical
Center, Jerusalem, Israel
Title
The predictive ability of pre-operative B-type natriuretic peptide in
vascular patients for major adverse cardiac events: An individual patient
data meta-analysis.
Source
Journal of the American College of Cardiology. 58 (5) (pp 522-529), 2011.
Date of Publication: 26 Jul 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The aims of this study were to perform an individual patient
data meta-analysis of studies using B-type natriuretic peptides (BNPs) to
predict the primary composite endpoint of cardiac death and nonfatal
myocardial infarction (MI) within 30 days of vascular surgery and to
determine: 1) the cut points for a natriuretic peptide (NP) diagnostic,
optimal, and screening test; and 2) if pre-operative NPs improve the
predictive accuracy of the revised cardiac risk index (RCRI). Background:
NPs are independent predictors of cardiovascular events in noncardiac and
vascular surgery. Their addition to clinical risk indexes may improve
pre-operative risk stratification. Methods: Studies reporting the
association of pre-operative NP concentrations and the primary study
endpoint, post-operative major adverse cardiovascular events (defined as
cardiovascular death and nonfatal MI) in vascular surgery, were identified
by electronic database search. Secondary study endpoints included
all-cause mortality, cardiac death, and nonfatal MI. Results: Six data
sets were obtained, 5 for BNP (n = 632) and 1 for N-terminal pro-BNP (n =
218). An NP level higher than the optimal cut point was an independent
predictor for the primary composite endpoint (odds ratio: 7.9; 95%
confidence interval: 4.7 to 13.3). BNP cut points were 30 pg/ml for
screening (95% sensitivity, 44% specificity), 116 pg/ml for optimal
(highest accuracy point; 66% sensitivity, 82% specificity), and 372 pg/ml
for diagnostic (32% sensitivity, 95% specificity). Subsequent to revised
cardiac risk index stratification, reclassification using the optimal cut
point significantly improved risk prediction in all groups (net
reclassification improvement 58%, p < 0.000001), particularly in the
intermediate-risk group (net reclassification improvement 84%, p < 0.001).
Conclusions: Pre-operative NP levels can be used to independently predict
cardiovascular events in the first 30 days after vascular surgery and to
significantly improve the predictive performance of the revised cardiac
risk index. 2011 American College of Cardiology Foundation.

<3>
Accession Number
2011401035
Authors
Giraldi F. Cattadori G. Roberto M. Carbucicchio C. Pepi M. Ballerini G.
Alamanni F. Della Bella P. Pontone G. Andreini D. Tondo C. Agostoni P.G.
Institution
(Giraldi, Cattadori, Roberto, Carbucicchio, Pepi, Ballerini, Alamanni,
Della Bella, Pontone, Andreini, Tondo, Agostoni) Centro Cardiologico
Monzino, IRCCS, Via Parea 4, 20138 Milan, Italy
(Della Bella) Arrhythmia Department and Electrophysiology Laboratories,
Ospedale San Raffaele, Milan, Italy
(Agostoni) Department of Cardiovascular Sciences, University of Milan,
Milan, Italy
Title
Long-term effectiveness of cardiac resynchronization therapy in heart
failure patients with unfavorable cardiac veins anatomy: Comparison of
surgical versus hemodynamic procedure.
Source
Journal of the American College of Cardiology. 58 (5) (pp 483-490), 2011.
Date of Publication: 26 Jul 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to compare clinical, echocardiographic, and
cardiopulmonary exercise testing response to cardiac resynchronization
therapy (CRT) in patients with unfavorable anatomy of coronary sinus (CS)
veins, randomized to transvenous versus surgical left ventricular (LV)
lead implantation. Background: CRT efficacy depends on proper positioning
of the LV lead over the posterolateral wall. A detailed pre-operative
knowledge of CS anatomy might be of pivotal importance to accomplish a
proper LV lead placement over this area. Methods: Study population
included 40 patients (age 66 +/- 4 years) with heart failure and
indication to CRT, with unsuitable CS branches anatomy documented by
pre-operative multislice computed cardiac tomography; 20 patients (Group
1) underwent surgical minithoracotomic LV lead implantation whereas 20
(Group 2) were implanted transvenously. New York Heart Association
functional class, echocardiographic, and cardiopulmonary exercise testing
data were assessed before and 1 year after CRT-system implant. Results: In
all Group 1 patients, the LV leads were placed over the middle-basal
segments of the posterolateral wall of the LV. This was not possible in
Group 2 patients. One year after CRT, in Group 1, a significant
improvement of New York Heart Association functional class, LV ejection
fraction (from 28.8 +/- 9.2% to 33.9 +/- 7.2%, p < 0.01), LV end-systolic
volume (from 165 +/- 53 ml to 134 +/- 48 ml, p < 0.001), and peak
Vo₂/kg (from 10.4 +/- 4.5 ml/kg/min to 13.1 +/- 3.1 ml/kg/min,
p < 0.02) was observed. However, no improvement was observed in Group 2:
LV ejection fraction varied from 27.4 +/- 4.8% to 27.4 +/- 5.7% (p = 0.9),
LV end-systolic volume from 175 +/- 46 ml to 166 +/- 44 ml (p = 0.15), and
peak Vo₂/kg from 11.2 +/- 3.2 ml/kg/min to 11.3 +/- 3.4
ml/kg/min (p = 0.9). Changes after CRT between groups were highly
significant. Conclusions: In the setting of unfavorable CS branches of
anatomy, CRT by a surgical minithoracotomic approach is preferable to
transvenous lead implantation. 2011 American College of Cardiology
Foundation.

<4>
Accession Number
2011400207
Authors
Asaad O.M. Hanafy M.S.
Institution
(Asaad) Department of Anesthesia, Faculty of Medicine, Cairo University,
Egypt
(Hanafy) Department of Cardiothoracic Surgery, Chest Diseases Hospital,
Ministry of Health, Kuwait
Title
Levosimendan's effect on coronary artery grafts blood flow in patients
with left ventricular dysfunction, assessment by transit time flow meter.
Source
Egyptian Journal of Anaesthesia. 27 (1) (pp 45-53), 2011. Date of
Publication: January 2011.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Objectives: Levosimendan improves the function of stunned myocardium and
cardiac performance in heart failure without significantly increasing
myocardial oxygen consumption. We evaluated the effects of levosimendan on
hemodynamics and coronary grafts blood flow (CBF) in patients with left
ventricular dysfunction undergoing pump coronary artery bypass grafts
(CABG) surgery using transit time flow meter (TTFM). Methods: Twenty
patients with stable angina and left ventricular ejection fraction 30-50%
scheduled for elective CABG surgery were randomized to receive
levosimendan (0.1 mg/kg/min) or placebo, started immediately after
induction of anesthesia and continued for 24 h in ICU. Coronary bypass
grafts flow was measured 30 min after termination of cardiopulmonary
bypass (CPB). Flow curve pattern, mean graft flow, and pulsatile index
(PI) were measured and analyzed. Hemodynamics was collected serially at
five time points. Results: Mean flow in all grafts was significantly
higher in the Levosimendan group in comparison to control group (p <
0.05). When we compared mean flow between different types of grafts in
Levosimendan group, we found that venous sequential grafts had higher flow
than non-sequential graft (p < 0.001) and arterial grafts (p = 0.005).
Also saphenous vein grafts (SVG) had higher flow in comparison to left
internal mammary artery (LIMA) grafts (p = 0.004). As regard PI, it was
also more significant in the Levosimendan group for all grafts (p < 0.001)
in comparison to control group. Intragroup comparison of PI values between
different types of grafts in Levosimendan group showed more significant PI
values in sequential grafts (p = 0.002) in relation to SVG, and also it
was more significant in comparison to LIMA grafts (p = 0.0027).
Conclusions: Levosimendan significantly increased the flow in arterial and
vein grafts after CPB, and improved hemodynamics compared with placebo.
2011 Egyptian Society of Anesthesiologists. Production and hosting by
Elsevier B.V. All rights reserved.

<5>
Accession Number
2011352985
Authors
Rasoli S. Kourliouros A. Harling L. Athanasiou T.
Institution
(Rasoli, Harling, Athanasiou) Department of Cardiothoracic Surgery,
Imperial College Healthcare, London, United Kingdom
(Kourliouros) Division of Surgery, Imperial College London, St Mary's
Hospital, 10th Floor QEQM Building, South Wharf Road, London W2 1NY,
United Kingdom
Title
Does prophylactic therapy with antioxidant vitamins have an effect on
atrial fbrillation following cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (1) (pp 82-85), 2011.
Date of Publication: June 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether prophylactic
therapy with antioxidant vitamins reduces the incidence of postoperative
atrial fibrillation (AF). One hundred and fifty-four papers were found
using the reported search, of which five were judged to represent the best
evidence to answer the question. The authors, journal, date, country of
publication, patient group studied, study type, relevant outcomes and
results were tabulated. Four of the five studies found antioxidant
vitamins to significantly reduce the incidence of postoperative AF. Two of
the studies show that prophylactic treatment with adjuvant vitamin C and
beta-blockers is more effective than p-blocker therapy alone. The quality
of these studies was assessed using a Jadad scoring system, which
identified four of the studies to be of low and one to be of high
methodological quality. We conclude that although preliminary evidence
suggests that prophylactic antioxidant vitamins may be effective in
reducing the incidence of postoperative AF, there is a lack of
high-quality data. Additional large-scale, adequately powered clinical
studies are warranted before antioxidant vitamins can be considered for
routine use in this setting. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<6>
Accession Number
2011352984
Authors
Hughes M.J. Chowdhry M.F. Walker W.S.
Institution
(Hughes, Chowdhry, Walker) Department of Thoracic Surgery, Royal Infrmary
of Edinburgh, Edinburgh EH16 4SA, United Kingdom
Title
Can thoracoscopic heller's myotomy give equivalent results to the more
usual laparoscopic heller's myotomy in thetreatment of achalasia?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (1) (pp 77-81), 2011.
Date of Publication: June 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Can thoracoscopic
Heller's myotomy (THM) give equivalent results to the more usual
laparoscopic Heller's myotomy (LHM) in the treatment of achalasia?'
Altogether, more than 478 papers were found using the reported search, of
which eight represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group
studied, study type, relevant outcomes and results of these papers are
tabulated. THM and LHM are two recognised approaches to the performance of
a distal oesophageal myotomy in the treatment of achalasia. Of the two
meta-analyses on this subject, Campos et al. [Campos GM, Vittinghoff E,
Rabl C, Takata M, Gadenstatter M, Lin F, Ciovica R. Endoscopic and
surgical treatments for achalasia: a systematic review and meta-analysis.
Ann Surg 2009;249:45-57] illustrated improved symptom control in LHM
compared with THM. Wang et al. [Wang L, Li Y, Li L, Yu C. A systematic
review and metaanalysis of the Chinese literature for the treatment of
achalasia. World J Gastroenterol 2008;14:5900-5906], however, observed no
difference in remission rates following either approach. Close scrutiny of
comparison studies revealed superiority in long-term outcomes and symptoms
following LHM in three studies. There were, however, studies that
illustrated comparable outcome results for THM in both resolution of
dysphagia and refux. Morbidity rates following THM were noted to be
similar to or slightly higher than those following LHM in fve studies, but
no statistically signifcant difference was illustrated in these studies.
Operating time and length of stay were noted to be signifcantly shorter in
LHM when compared with THM in three studies, although there were
exceptions to this, with two studies illustrating shorter or equal
operating times for THM. However, LHM operating times have been shown to
improve with experience gained. We conclude that there is good evidence
demonstrating the effectiveness and safety of LHM, and it has come to be
regarded as the gold standard treatment of achalasia. When THM is compared
with LHM, the long-term results approach parity on occasion but not
consistently. The overall postoperative morbidity of THM is not
signifcantly different from that of LHM. An advantage of LHM over THM that
is demonstrated is that LHM offers a shorter hospital stay and reduced
operative time. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
2011352983
Authors
Scarci M. Zahid I. Bille A. Routledge T.
Institution
(Scarci, Bille, Routledge) Department of Thoracic Surgery, Guy's Hospital,
Great Maze Pond, London SE1 9RT, United Kingdom
(Zahid) Imperial College Medical School, South Kensington Campus, London
SW7 2AZ, United Kingdom
Title
Is video-assisted thoracoscopic surgery the best treatment for paediatric
pleural empyema?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (1) (pp 70-76), 2011.
Date of Publication: June 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether video-assisted
thoracic surgery (VATS) is the best treatment for paediatric pleural
empyema. Altogether 274 papers were found using the reported search, of
which 15 represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group
studied, study type, relevant outcomes and results of these papers are
tabulated. We conclude that early VATS (or thoracotomy if VATS not
possible) leads to shorter hospitalisation. The duration of chest tube
placement and antibiotic use is variable and does not correlate with
treatment method. Patients who underwent primary operative therapy had a
lower aggregate in-hospital mortality rate (0% vs. 3.3%), re-intervention
rate (2.5% vs. 23.5%), length of stay (10.8 days vs. 20.0 days), duration
of tube thoracostomy (4.4 days vs. 10.6 days), and duration of antibiotic
therapy (12.8 days vs. 21.3 days), compared with patients who underwent
non-operative therapy. Similar complication rates were observed for the
two groups (5% vs. 5.6%). Moreover, median hospital charges for VATS were
$36,320 [interquartile range (IQR), $24,814-$62,269]. The median pharmacy
and radiological imaging charges were $5884 (IQR, $3142-$11,357) and $2875
(IQR, $1703-$4950), respectively, for VATS and tube drainage. Adjusting
for propensity score matching, costs for primary VATS were equivalent to
primary chest tube placement. Only one article found discordant results.
Ninety-fve children (52%) received antibiotics alone, and 87 (45%)
underwent drainage procedures (21 chest tube alone, 57 VATS/thoracotomy,
and eight chest tube followed by VATS/ thoracotomy); only four received
fibrinolytics. Mean (standard deviation) length of stay was significantly
shorter in the antibiotics alone group, 7.0 (3.5) days vs. 11 (4.0) days.
The strongest predictors of undergoing pleural drainage were admission to
the intensive care unit and large effusion size (> 1/2 thorax filled).
2011 Published by European Association for Cardio-Thoracic Surgery. All
rights reserved.

<8>
Accession Number
2011352982
Authors
Nagendran M. Pallis A. Patel K. Scarci M.
Institution
(Nagendran) Green Templeton College, University of Oxford, Woodstock Road,
Oxford OX2 6HG, United Kingdom
(Pallis) Department of Medical Oncology, University General Hospital of
Heraklion, Voutes-Stavrakion Embranchement, 71305 Heraklion, Greece
(Patel) King's College London School of Medicine, First Floor, Hodgkin
Building, Guy's Campus, London SE1 1UL, United Kingdom
(Scarci) Department of Cardio-thoracic Surgery, Guy's Hospital, Great Maze
Pond, London SE1 9RT, United Kingdom
Title
Should all patients who have mesothelioma diagnosed by video-assisted
thoracoscopic surgery have their intervention sites irradiated?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (1) (pp 66-69), 2011.
Date of Publication: June 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether patients diagnosed
with mesothelioma by video-assisted thoracoscopic surgery should have
their intervention sites irradiated to prevent metastatic seeding.
Altogether 334 papers were found using the reported search, of which nine
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
There is no general consensus in the literature. Four studies recommend
prophylactic irradiation therapy (PIT), while three studies stated that
PIT was unnecessary. A systematic review identifed only three suitable
randomized controlled trials (RCTs) from the literature. One trial found
that 23% of radiotherapy (RT) patients developed tract metastases compared
to 10% of control patients (P =0.748) with an estimated hazard ratio (RT
to control) of 1.28 (95% CI: 0.29-5.73). Time from procedure to tract
metastases was in fact shorter in patients treated with RT (2.4 months RT
vs. 6.4 months control, non-signifcant). Another trial found that seeding
of metastatic tumour to the intervention site occurred in 7% of RT sites
vs. 10% of control sites (P=0.53). Freedom from tract metastasis survival
was also non-signifcant between RT and control arms (P =0.82). However,
the third trial reported a signifcantly greater incidence of intervention
site metastases in control vs. RT patients (40% vs. 0%, respectively, P <
0.001). Non-randomised studies found mixed results. One reported that
median survival between patients with and without local metastases was not
significantly different (P =0.64) while another article described no local
metastases in PIT sites. None of the studies reported signifcant skin or
side reactions and treatment was generally well tolerated. Based on the
available evidence, we conclude that PIT is not currently justified. 2011
Published by European Association for Cardio-Thoracic Surgery. All rights
reserved.

<9>
Accession Number
2011352977
Authors
Marchenko A. Chernyavsky A. Efendiev V. Volokitina T. Karaskov A.
Institution
(Marchenko, Chernyavsky, Efendiev, Volokitina, Karaskov) Department of
Aortic and Coronary Artery Surgery, Research Institute of Circulation
Pathology, Rechkunovskaya 15, 630055 Novosibirsk 55, Russian Federation
Title
Results of coronary artery bypass grafting alone and combined with
surgical ventricular reconstruction for ischemic heart failure.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (1) (pp 46-51), 2011.
Date of Publication: June 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
In this study, we included 236 patients with ischemic heart failure and
ejection fraction (EF) < 35% who underwent surgical treatment. Patients
were randomized in two groups. There were 116 patients who underwent
coronary artery bypass grafting (CABG) with surgical ventricular
reconstruction (SVR) and 120 patients who underwent CABG alone. The
hospital mortality rate was 5.8% after isolated CABG and 3.5% after CABG
combined with SVR. All survivors had follow-up investigation from four
months to five years, with a mean follow-up time of 31 +/- 13 months. The
mean New York Heart Association (NYHA) functional class decreased from 2.9
+/- 0.5 to 2.2 +/- 0.7 one year after CABG and from 3.1 +/- 0.4 to 2.0 +/-
0.6 one year after CABG with SVR. We showed that left ventricular
reconstruction significantly decreased EDV from 237 +/- 52 to 176 +/- 30
and correspondingly increased EF from 32 +/- 6 to 39 +/- 9. However, after
isolated CABG EF did not increase significantly (32 +/- 7 preoperatively
and 34 +/- 11 postoperatively). One- and three-year rates were 95% and 78%
after SVR with CABG and 83% and 78% after CABG alone. Despite the more
aggressive surgical strategy, left ventricular reconstruction did not
increase operative mortality and early results were significantly
effective compared with coronary artery bypass grafting alone. 2011
Published by European Association for Cardio-Thoracic Surgery. All rights
reserved.

<10>
Accession Number
21383391
Authors
Coura L.E. Manoel C.H. Poffo R. Bedin A. Westphal G.A.
Institution
(Coura) Centro Hospitalar Unimed Joinville, Rua Blumenau 314,
Joinville-SC, Brazil.
Title
Randomised, controlled study of preoperative electroacupuncture for
postoperative pain control after cardiac surgery.
Source
Acupuncture in medicine : journal of the British Medical Acupuncture
Society. 29 (1) (pp 16-20), 2011. Date of Publication: Mar 2011.
Abstract
This study aims to evaluate the effects of preoperative electroacupuncture
(EA) on the need for opioids in the postoperative stage of conventional
cardiac surgery. A prospective, randomised and controlled study was
conducted at Unimed Hospital Centre in Joinville, SC, Brazil. The day
before the surgery, 32 patients undergoing cardiac surgery were randomised
into two groups: patients from the treatment group received preoperative
EA at bilateral points (LI4-LI11, LR3-ST36, PC6-TE5) for 30 min with
alternating frequencies of 3 and 15 Hz. Patients from the control group
received sham transcutaneous electrical nerve stimulation (TENS). Use of
fentanyl during the postoperative period was measured. 10 patients were
excluded because of hemodynamic and ventilatory instability leaving 13 (10
male) in the treatment group and 9 (4 male) in the control group. The
average total doses of fentanyl given were 13.1+/-2.2 and 16.3+/-1.6
mug/kg in the treatment and control groups respectively (p<0.002). The
doses of patient controlled analgesia were 4.1+/-2.0 and 6.9+/-1.7 mug/kg
in the treatment and control groups respectively (p<0.003). The number of
boluses issued also differed (treatment 13.9+/-7.0 vs control 24.8+/-7.0,
p<0.002). Pain intensity scores differed between the groups (treatment
2.5+/-1.1 vs control 4.0+/-2.0, p<0.04). One patient from the control
group experienced drowsiness that justified a change in fentanyl infusion,
as decided by the anaesthetist. Preoperative electro-acupuncture in
conventional cardiac surgery may reduce the postoperative consumption of
fentanyl.

<11>
Accession Number
2011414160
Authors
Leiter L.A. Fitchett D.H. Gilbert R.E. Gupta M. Mancini G.B.J. McFarlane
P.A. Ross R. Teoh H. Verma S. Anand S. Camelon K. Chow C.-M. Cox J.L.
Despres J.-P. Genest J. Harris S.B. Lau D.C.W. Lewanczuk R. Liu P.P. Lonn
E.M. McPherson R. Poirier P. Qaadri S. Rabasa-Lhoret R. Rabkin S.W. Sharma
A.M. Steele A.W. Stone J.A. Tardif J.-C. Tobe S. Ur E.
Institution
(Leiter, Fitchett, Gilbert, Gupta, McFarlane, Teoh, Verma, Chow) Keenan
Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital,
Toronto, ON, Canada
(Leiter, Fitchett, Gilbert, Gupta, McFarlane, Verma, Chow, Liu, Tobe)
University of Toronto, Toronto, ON, Canada
(Gupta) Brampton Civic Hospital, Brampton, ON, Canada
(Gupta, Anand) McMaster University, Hamilton, ON, Canada
(Mancini, Liu, Lonn, Rabkin, Ur) University of British Columbia,
Vancouver, BC, Canada
(Ross) Queen's University, Kingston, ON, Canada
(Camelon) University Health Network, Toronto, ON, Canada
(Cox, Poirier) Dalhousie University, Halifax, NS, Canada
(Despres, Lau) Universite Laval, Quebec City, QC, Canada
(Genest) McGill University, Montreal, QC, Canada
(Harris) University of Western Ontario, London, ON, Canada
(Stone) University of Calgary, Calgary, AB, Canada
(Lewanczuk, Sharma) University of Alberta, Edmonton, AB, Canada
(McPherson) University of Ottawa, Ottawa, ON, Canada
(Rabasa-Lhoret) Institut de Recherches Cliniques de Montreal, Montreal,
QC, Canada
(Steele) Lakeridge Health Corporation, Oshawa, ON, Canada
(Tardif) Universite de Montreal, Montreal, QC, Canada
(Tobe) Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Title
Cardiometabolic risk in Canada: A detailed analysis and position paper by
the Cardiometabolic risk working group.
Source
Canadian Journal of Cardiology. 27 (2) (pp e1-e33), 2011. Date of
Publication: March/April 2011.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
The concepts of "cardiometabolic risk," "metabolic syndrome," and "risk
stratification" overlap and relate to the atherogenic process and
development of type 2 diabetes. There is confusion about what these terms
mean and how they can best be used to improve our understanding of
cardiovascular disease treatment and prevention. With the objectives of
clarifying these concepts and presenting practical strategies to identify
and reduce cardiovascular risk in multiethnic patient populations, the
Cardiometabolic Working Group reviewed the evidence related to emerging
cardiovascular risk factors and Canadian guideline recommendations in
order to present a detailed analysis and consolidated approach to the
identification and management of cardiometabolic risk. The concepts
related to cardiometabolic risk, pathophysiology, and strategies for
identification and management (including health behaviours,
pharmacotherapy, and surgery) in the multiethnic Canadian population are
presented. "Global cardiometabolic risk" is proposed as an umbrella term
for a comprehensive list of existing and emerging factors that predict
cardiovascular disease and/or type 2 diabetes. Health behaviour
interventions (weight loss, physical activity, diet, smoking cessation) in
people identified at high cardiometabolic risk are of critical importance
given the emerging crisis of obesity and the consequent epidemic of type 2
diabetes. Vascular protective measures (health behaviours for all patients
and pharmacotherapy in appropriate patients) are essential to reduce
cardiometabolic risk, and there is growing consensus that a
multidisciplinary approach is needed to adequately address cardiometabolic
risk factors. Health care professionals must also consider risk factors
related to ethnicity in order to appropriately evaluate everyone in their
diverse patient populations. 2011 Elsevier Inc.

<12>
Accession Number
2011414119
Authors
Howlett J.G.
Institution
(Howlett) Department of Cardiac Sciences, University of Calgary, Libin
Cardiovascular Institute, Calgary, AB, Canada
Title
Acute heart failure: Lessons learned So Far.
Source
Canadian Journal of Cardiology. 27 (3) (pp 284-295), 2011. Date of
Publication: May/June 2011.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
Acute heart failure (AHF) affects nearly every Canadian with heart failure
(HF) at least once. Despite several attempts, no medical therapies have
been shown to improve the natural history of AHF. In addition, the place
of diagnosis of AHF is increasingly made in the outpatient setting. In
this view, AHF is a moving target, and from recent registry data and from
clinical trials, 5 critical lessons regarding the syndrome of AHF emerge:
(1) The period of clinical instability preceding AHF may be much longer
than previously thought. (2) Refinement of tools used to aid the early and
accurate diagnosis of AHF will impact patient outcomes. (3) Standard
supportive care of patients with AHF includes early use of diuretics with
frequent reassessment in nearly all patients and supplemental vasodilators
and oxygen therapy in selected cases. (4) Patients who survive
presentation of AHF continue to suffer high rates of re-presentation,
death, and rehospitalization following discharge from either hospital or
emergency department. (5) Interventions shown to improve patient outcomes
for AHF to date are related to process of care rather than new medications
or devices. This report reviews the recent literature regarding the
presentation, diagnosis, management, and prognosis of AHF. Areas of future
research priority are indicated and guidelines for improving treatment are
provided. AHF is an important clinical area that has not been as
intensively studied as chronic HF; it presents both important needs and
exciting opportunities for research and innovation. 2011 Canadian
Cardiovascular Society.

<13>
Accession Number
2011396163
Authors
El Azab S.R. Doha N. Rady A. El-Sayed A.E. Abd-Rabo M.
Institution
(El Azab) Department of Anaesthesiology and Intensive Care, King Fahd
Specialist Hospital, Burraydah, Saudi Arabia
(El Azab) Department of Anaesthesiology and Intensive Care, Al Azhar
University for Girls, Cairo, Egypt
(Doha, Rady) Department of Anaesthesiology, Al Monofia University, Egypt
(El-Sayed) Department of Microbiology and Immunology, Faculty of Medicine,
Suez Canal University, Egypt
(Abd-Rabo) Department of Cardiothoracic Surgery, Zagazig University, Egypt
Title
The cytokine balance during CABG surgery with and without cardiopulmonary
bypass.
Source
Egyptian Journal of Anaesthesia. 26 (4) (pp 281-286), 2010. Date of
Publication: October 2010.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background: We investigated the cytokine response during coronary artery
bypass grafting (CABG) surgery with and without cardiopulmonary bypass
(off-pump) and the effect on patient's outcome in the early postoperative
period. Methods: Eighteen patients were studied, 9 patients undergoing
off-pump surgery (group 1) and 9 patients with CPB (group 2). Demographic
and preoperative characteristics were comparable in both groups. Plasma
levels of TNF-alpha, IL-6, IL-8, IL-10, IL-4, tumour necrosis soluble
receptors-1 (TNFsr-1) and tumour necrosis soluble receptors-2 (TNFsr-2)
were measured before skin incision (T0), before revascularization (T1),
after revascularization (T2), 2 h (T3) and 24 (T4) hours after skin
closure. Levels of myocardial enzymes were also measured in the first
postoperative morning. Results: Serum levels of TNF-alpha and IL-8
increased in group 2 at T3 and T4 more than at T0 (p < 0.05). IL-6
increased in both groups with higher levels in group 2 than in group 1 at
T3 (773 +/- 331 vs 315 +/- 189 pg/ml; p < 0.05). IL-10 was higher in group
2 than in group 1 at T2 (115 +/- 119 vs 13 +/- 4 pg/ml; p < 0.001) and at
T3 (212 +/- 171 vs 31 +/- 29 pg/ml; p < 0.05). At T3 levels of TNFsr-1 and
TNFsr-2 were higher in group 2 than in group 1 (TNFsr-1 4858 +/- 1325 vs
2089 +/- 584 pg/ml; p < 0.01 and TNFsr-2 4971 +/- 63 vs 3801 +/- 738
pg/ml; p < 0.05). Production of IL-4 did not increase in neither group.
The length of ICU stay was less in group 1 than in group 2 (52 +/- 33 vs
26 +/- 11 h; p < 0.05) as well as was the length of hospital stay (7.1 +/-
0.4 vs 5.3 +/- 0.5 days; p < 0.001). Conclusion: Off-pump procedure evoked
a lower cytokine response than CABG with CPB. This minimised myocardial
damage and shorten the stay in the ICU and the hospital. 2010 Egyptian
Society of Anesthesiologists. Production and hosting by Elsevier B.V. All
rights reserved.

<14>
Accession Number
70480233
Authors
Wright G.
Institution
(Wright) Surgical Oncology, St. Vincent's Hospital, Fitzroy, VIC,
Australia
Title
Lymph node dissection after ACOSOG-z30: What should surgeons do now?.
Source
Journal of Thoracic Oncology. Conference: 3rd Australian Lung Cancer
Conference, ALCC 2010 Melbourne, VIC Australia. Conference Start: 20101006
Conference End: 20101009. Conference Publication: (var.pagings). 6 (3
SUPPL. 1) (pp S5), 2011. Date of Publication: March 2011.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: Lymph node dissection practice varies significantly, ranging
from no sampling to systematic mediastinal lymph node dissection (SMLND).
Prior to 2002 no statistically significant survival benefit had been
demonstrated for SMLND. Hence the only benefit appeared to be accurate
staging. From 1999-2004, the American College of Surgeons Oncology Group
accrued 1111 patients for the ACOSOG-Z30 trial, which compared node
sampling to SMLND in proven N0 and non-hilar N1 disease. The trial
demonstrated no survival advantage of SMLND, seeming to contradict a 2006
meta-analysis, which demonstrated a significant advantage in stage I-IIIA.
Aim: To interpret and update current evidence for lymph node dissection
for incorporation into intra-operative strategy. Methods: Results from
ACOSOG-Z30 were analysed in conjunction with the meta-analysis of three
randomized trials comparing node sampling to SMLND. Results: For proven
node negative patients, SMLND does not confer a survival advantage. For
all other situations, there remains a significant survival advantage for
SMLND. Discussion: The standard of care for resectable lung cancer
includes systematic node sampling. This ensures accurate staging and
appropriate administration of adjuvant chemotherapy. It should be noted
that ACOSOG-Z30 closed prior to the advent of routine adjuvant
chemotherapy, so overall survival must be interpreted in that setting.
Patients should have sampling of all mediastinal node stations and any
suspicious hilar station, either by endobronchial ultrasound,
mediastinoscopy and/or intra-operative frozen section. If any nodes are
found to be positive then SMLND is indicated. The cost implications may
result in thoracic surgeons continuing to perform routine SMLND, as there
were no significant deleterious effects in ACOSOG-Z30.

<15>
Accession Number
70480862
Authors
Cholette J.M. Henrichs K. Alfieris G.M. Phipps R. Blum-Berg N.
Institution
(Cholette) Department of Pediatrics, University of Rochester, Rochester,
NY, United States
(Henrichs, Blum-Berg) Pathology and Laboratory Medicine, University of
Rochester, Rochester, NY, United States
(Alfieris) Cardiac Surgery, University of Rochester, Rochester, NY, United
States
(Phipps) Environmental Medicine, University of Rochester, Rochester, NY,
United States
Title
Washing blood transfused in pediatric open heart surgery reduces
post-operative inflammation and im-munomodulation: Results of a
prospective, randomized controlled trial.
Source
Pediatric Critical Care Medicine. Conference: 8th International
Conference of the Pediatric Cardiac Intensive Care Society, PCICS 2010
Miami Beach, FL United States. Conference Start: 20101207 Conference End:
20101210. Conference Publication: (var.pagings). 12 (4 SUPPL. 1) (pp
S83), 2011. Date of Publication: July 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Children undergoing cardiac surgery with cardiopulmonary
bypass (CPB) are susceptible to additional inflammatory and immunogenic
insults from blood transfusions. Our hypothesis is that washing red blood
cell (RBC) and platelet products transfused to these patients will reduce
post-operative transfusion-related immune modulation and may improve
clinical outcomes. Methods: Children < 18 years of age undergoing open
heart surgery were randomized to either an unwashed or a washed RBC and
platelet transfusion protocol for the entirety of their hospitalization,
including CPB prime. All blood was pre-storage leukoreduced, irradiated,
and ABO matched. Plasma was obtained: pre-op; immediately, six and 12
hours after coming off CPB. The primary outcome variable was the 12 hour
post-CPB interleukin (IL)-6:IL-10 ratio. Secondary measures were IL-6 and
10 levels, C-reactive protein (CRP) and clinical outcomes. Results: 162
subjects were studied, 81 per group. Thirty-four (21%) subjects were not
transfused; 17 per group. Number and storage age of RBC transfusions were
similar between groups. Eleven subjects received plasma products; five in
the washed group. Twelve hour IL-6:IL-10 ratio was lower in the washed
group (4.8 v. 12.5; p=0.01). Post-operative day 1 CRP was significantly
higher in the unwashed group. There were no significant clinical
differences. Conclusion: Washing transfused blood cells to children having
cardiac surgery appears to incur a more favorable pro and compensatory
inflammatory profile, which may be amplified with larger numbers of plasma
and RBC transfusions. A larger study adequately powered to test for
clinical outcomes is needed to determine whether this laboratory signal is
clinically significant. (Figure presented).