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<1>
Accession Number
2011522420
Authors
Paulus F. Veelo D.P. de Nijs S.B. Beenen L.F.M. Bresser P. de Mol B.A.J.M.
Binnekade J.M. Schultz M.J.
Institution
(Paulus, Veelo, Binnekade, Schultz) Department of Intensive Care Medicine,
Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
(Veelo) Department of Anesthesiology, Academic Medical Center,
Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
(de Nijs, Bresser) Department of Respiratory Medicine, Academic Medical
Center, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
(Beenen) Department of Radiology, Academic Medical Center, Meibergdreef 9,
1105 AZ, Amsterdam, Netherlands
(Bresser) Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis,
Oosterpark 9 1091 AC, Amsterdam, Netherlands
(de Mol) Department of Cardiothoracic Surgery, Academic Medical Center,
Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
Title
Manual hyperinflation partly prevents reductions of functional residual
capacity in cardiac surgical patients - a randomized controlled trial.
Source
Critical Care. 15 (4) , 2011. Article Number: R187. Date of
Publication: 05 Aug 2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: Cardiac surgery is associated with post-operative reductions
of functional residual capacity (FRC). Manual hyperinflation (MH) aims to
prevent airway plugging, and as such could prevent the reduction of FRC
after surgery. The main purpose of this study was to determine the effect
of MH on post-operative FRC of cardiac surgical patients.Methods: This was
a randomized controlled trial of patients after elective coronary artery
bypass graft and/or valve surgery admitted to the intensive care unit
(ICU) of a university hospital. Patients were randomly assigned to a
"routine MH group" (MH was performed within 30 minutes after admission to
the ICU and every 6 hours thereafter, and before tracheal extubation), or
a "control group" (MH was performed only if perceptible (audible) sputum
was present in the larger airways causing problems with mechanical
ventilation, or if oxygen saturation (SpO₂) dropped below 92%).
The primary endpoint was the reduction of FRC from the day before cardiac
surgery to one, three, and five days after tracheal extubation. Secondary
endpoints were SpO₂(at similar time points) and chest
radiograph abnormalities, including atelectasis (at three days after
tracheal extubation).Results: A total of 100 patients were enrolled.
Patients in the routine MH group showed a decrease of FRC on the first
post-operative day to 71% of the pre-operative value, versus 57% in the
control group (P = 0.002). Differences in FRC became less prominent over
time; differences between the two study groups were no longer
statistically significant at Day 5. There were no differences in SpO₂between the study groups. Chest radiographs showed more
abnormalities (merely atelectasis) in the control group compared to
patients in the routine MH group (P = 0.002).Conclusions: MH partly
prevents the reduction of FRC in the first post-operative days after
cardiac surgery.Trial registration: Netherlands Trial Register (NTR):
NTR1384. http://www.trialregister.nl. 2011 Paulus et al.; licensee BioMed
Central Ltd.

<2>
Accession Number
2011520354
Authors
Maharaj R. Metaxa V.
Institution
(Maharaj, Metaxa) Kings College Hospital, Denmark Hill, London SE5 9RS,
United Kingdom
Title
Levosimendan and mortality after coronary revascularisation: A
meta-analysis of randomised controlled trials.
Source
Critical Care. 15 (3) , 2011. Article Number: R140. Date of
Publication: 08 Jun 2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: Patients undergoing coronary revascularization often require
inotropic support that has been associated with an increased risk for
death and morbidity. The purpose of this study was to evaluate the effect
of levosimendan versus control on survival after coronary
revascularization.Methods: A systemic review and meta-analysis of the
literature was carried out on published randomized controlled clinical
trials that investigated the efficacy of levosimendan compared to other
therapy in patients having coronary revascularisaion. The databases
searched were Pubmed, EMBASE, the Cochrane Registry of Clinical Trials and
the metaRegister of Controlled Trials. Studies that compared levosimendan
to any other therapy for coronary revascularisation in adult humans and
reported at least one outcome of interest were considered for inclusion.
Both percutaneous coronary intervention and cardiac surgery were included.
Data extraction was performed independently by two reviewers using
predefined criteria. Relevant outcomes included mortality, cardiac index,
cardiac enzymes, length of stay and post-procedural atrial
fibrillation.Results: The meta-analysis included 729 patients from 17
studies. Levosimendan was associated with a mortality reduction after
coronary revascularization, (19/386 in the levosimendan group vs 39/343 in
the control arm) odds ratio (OR) 0.40 (95% confidence interval (CI) 0.21
to 0.76, P for overall effect 0.005, P for heterogeneity = 0.33, I²= 12% with a total of 729 patients. Levosimendan also had a
favourable effect on cardiac index (standardised mean difference 1.63, 95%
CI 1.43 to 1.83, P for overall effect < 0.00001), length of intensive care
stay (random effects model, mean difference - 26.18 hours 95% CI 46.20 to
6.16, P for heterogeneity < 0.00001, I²= 95%, P for overall
effect P = 0.01), reductions in the rate of atrial fibrillation (OR 0.54,
95% CI 0.36 to 0.82, P for effect = 0.004, P for heterogeneity 0.84,
I²= 0% for 465 patients) and troponin I levels group (mean
difference -1.59, 95% CI 1.78 to 1.40, P for overall effect < 0.00001, P
for heterogeneity < 0.00001, I²= 95%). Limitations of this
analysis are discussed.Conclusions: Levosimendan is associated with a
significant improvement in mortality after coronary revascularization.
There are also improvements in several secondary endpoints. A suitably
powered randomised controlled trial is required to confirm these findings
and to address the unresolved questions about the timing and dosing of
levosimendan. 2011 Maharaj and Metaxa; licensee BioMed Central Ltd.

<3>
Accession Number
2011519227
Authors
Kuratani N. Bunsangjaroen P. Srimueang T. Masaki E. Suzuki T. Katogi T.
Institution
(Kuratani) Division of Pediatric Anesthesia, International University,
Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi 329-2763,
Japan
(Bunsangjaroen, Srimueang) Department of Anesthesiology, Khon Khan
University, Khon Khan, Thailand
(Masaki) Division of Dento-oral Anesthesiology, Tohoku University,
Graduate School of Dentistry, Miyagi, Japan
(Suzuki, Katogi) Department of Pediatric Cardiac Surgery, Saimata
International Medical Center, Saitama, Japan
Title
Modified versus conventional ultrafiltration in pediatric cardiac surgery:
A meta-analysis of randomized controlled trials comparing clinical outcome
parameters.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (4) (pp 861-867),
2011. Date of Publication: October 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Although previous studies have demonstrated that modified
ultrafiltration improves laboratory parameters in pediatric cardiac
surgery, the clinical outcome data have been inconsistent. We performed a
meta-analysis of randomized controlled trials comparing modified versus
conventional ultrafiltration. Methods: We conducted a comprehensive search
of the literature to identify clinical trials that met our inclusion
criteria. To be included, studies had to be prospective randomized trials
that compared modified ultrafiltration and conventional ultrafiltration in
pediatric cardiac surgery using cardiopulmonary bypass. We focused on the
following outcome variables: hematocrit and mean arterial blood pressure
after cardiopulmonary bypass, amount of chest tube drainage after surgery,
time to extubation, and length of stay in the intensive care unit. The
random effects model was used to determine the pooled effect estimates.
The estimators of treatment effects were expressed as the weighted mean
difference with 95% confidence intervals. The heterogeneity of collected
data was also evaluated. Results: We screened 54 studies, 8 of which
satisfied our inclusion criteria. Combined analysis revealed that modified
ultrafiltration resulted in significantly higher postbypass hematocrit and
higher mean arterial blood pressure. Benefits in postoperative blood loss,
ventilator time, and intensive care unit stay were not apparent. There was
significant heterogeneity among the studies surveyed. Conclusions: The
advantage of modified ultrafiltration over conventional ultrafiltration
consists of significant improvement of clinical conditions in the
immediate postbypass period. The postoperative outcome parameters were not
significantly influenced. We should also take into account possible
clinical or methodologic variations in the currently available
ultrafiltration studies. 2011 by The American Association for Thoracic
Surgery.

<4>
Accession Number
2011519208
Authors
Donndorf P. Kundt G. Kaminski A. Yerebakan C. Liebold A. Steinhoff G.
Glass A.
Institution
(Donndorf, Kaminski, Yerebakan, Liebold, Steinhoff) Department of Cardiac
Surgery, University of Rostock, Schillingallee 35, 18057 Rostock, Germany
(Kundt, Glass) Institute for Biostatistics and Informatics in Medicine and
Ageing, Research, University of Rostock, Rostock, Germany
Title
Intramyocardial bone marrow stem cell transplantation during coronary
artery bypass surgery: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (4) (pp 911-920),
2011. Date of Publication: October 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Experimental and clinical studies have suggested that
intramyocardial bone marrow stem cell transplantation combined with
coronary artery bypass grafting might improve left ventricular function in
the setting of chronic ischemic heart disease. We therefore conducted a
systematic review and meta-analysis of available publications regarding
the efficacy and safety of intramyocardial bone marrow stem cell
transplantation during coronary artery bypass grafting. Methods: The
databases PUBMED, MEDLINE, Cochrane Controlled Trials Register, and
ClinicalTrials.gov (all from their inception to May 2009) were searched
for randomized controlled trials and cohort studies of intramyocardial
bone marrow stem cell transplantation during coronary artery bypass
grafting to treat ischemic heart disease. Six studies were included.
Results: Compared with control groups, the bone marrow stem cell
transplantation group showed a significant improvement of left ventricular
ejection fraction from baseline to follow-up (5.40%; 95% confidence
interval, 1.36-9.44; P = .009). Moreover, the overall change of left
ventricular end-diastolic volume from baseline to follow-up favored the
bone marrow stem cell therapy group (9.55 mL; 95% confidence interval,
-2.82 to 21.92; P = .13). Major adverse cardiovascular events, including
ventricular arrhythmia and the composite of other cardiovascular events,
were not significantly different between the bone marrow stem cell therapy
group and controls (relative risk for ventricular arrhythmia = 0.951; 95%
confidence interval, 0.389-2.325; P = .913; relative risk for
cardiovascular event = 1.134; 95% confidence interval, 0.28-4.6; P = .86).
Conclusions: Clinical evidence suggests that intramyocardial bone marrow
stem cell transplantation in combination with coronary artery bypass
grafting is associated with improvements of functional parameters in
patients with chronic ischemic heart disease. Furthermore, surgical
intramyocardial bone marrow stem cell transplantation seems to be safe.
2011 by The American Association for Thoracic Surgery.

<5>
Accession Number
2011519214
Authors
Hlatky M.A. Shilane D. Boothroyd D.B. Boersma E. Brooks M.M. Carrie D.
Clayton T.C. Danchin N. Flather M. Hamm C.W. Hueb W.A. Kahler J. Lopes N.
Pocock S.J. Rodriguez A. Serruys P. Sigwart U. Stables R.H.
Institution
(Hlatky, Shilane, Boothroyd) Department of Health Research and Policy,
Stanford University, School of Medicine, Stanford, CA 94305-5405, United
States
(Boersma, Serruys) Department of Cardiology, Erasmus University,
Rotterdam, Netherlands
(Brooks) Departments of Epidemiology and Biostatistics, University of
Pittsburgh, Pittsburgh, PA, United States
(Carrie) Rangueil Hospital, Toulouse, France
(Clayton, Pocock) Department of Medical Statistics, London School of
Hygiene and Tropical Medicine, London, United Kingdom
(Danchin) Hopital Europeen Georges Pompidou, Universite Paris Descartes,
Paris, France
(Flather) Royal Brompton and Harefield NHS Trust, London, United Kingdom
(Hamm) Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany
(Hueb, Lopes) Department of Atherosclerosis, Heart Institute, University
of Sao Paulo, Sao Paulo, Brazil
(Kahler) Cardiology Clinic Hereford, Hereford, Germany
(Rodriguez) Sanatario Otamendi, Buenos Aires, Argentina
(Sigwart) University of Geneva, Geneva, Switzerland
(Stables) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Title
The effect of internal thoracic artery grafts on long-term clinical
outcomes after coronary bypass surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (4) (pp 829-835),
2011. Date of Publication: October 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: We sought to compare long-term outcomes after coronary bypass
surgery with and without an internal thoracic artery graft. Methods: We
analyzed clinical outcomes over a median follow-up of 6.7 years among
3,087 patients who received coronary bypass surgery as participants in one
of 8 clinical trials comparing surgical intervention with angioplasty. We
used 2 statistical methods (covariate adjustment and propensity score
matching) to adjust for the nonrandomized selection of internal thoracic
artery grafts. Results: Internal thoracic artery grafting was associated
with lower mortality, with hazard ratios of 0.77 (confidence interval,
0.62-0.97; P = .02) for covariate adjustment and 0.77 (confidence
interval, 0.57-1.05; P = .10) for propensity score matching. The composite
end point of death or myocardial infarction was reduced to a similar
extent, with hazard ratios of 0.83 (confidence interval, 0.69-1.00; P =
.05) for covariate adjustment to 0.78 (confidence interval, 0.61-1.00; P =
.05) for propensity score matching. There was a trend toward less angina
at 1 year, with odds ratios of 0.81 (confidence interval, 0.61-1.09; P =
.16) in the covariate-adjusted model and 0.81 (confidence interval,
0.55-1.19; P = .28) in the propensity score-adjusted model. Conclusions:
Use of an internal thoracic artery graft during coronary bypass surgery
seems to improve long-term clinical outcomes. 2011 by The American
Association for Thoracic Surgery.

<6>
Accession Number
21271360
Authors
Markar S.R. Karthikesalingam A. Vyas S. Hashemi M. Winslet M.
Institution
(Markar, Vyas, Hashemi, Winslet) Department of General Surgery, University
College London Hospital, 235 Euston Road, London, United Kingdom
(Karthikesalingam) Department of General Surgery, Chelsea and Westminster
NHS Foundation Trust, London, United Kingdom
(Winslet) Department of General Surgery, Royal Free Hampstead Hospital,
London, United Kingdom
Title
Hand-Sewn Versus Stapled Oesophago-gastric Anastomosis: Systematic Review
and Meta-analysis.
Source
Journal of Gastrointestinal Surgery. 15 (5) (pp 876-884), 2011. Date of
Publication: May 2011.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Objective: In this meta-analysis, data from relevant randomised controlled
trials has been pooled together to gain a consensus in the comparison of
outcome following hand-sewn versus stapled oesophago-gastric (OG)
anastomoses. Methods: Medline, Embase, Cochrane, trial registries,
conference proceedings and reference lists were searched for randomised
controlled trials comparing hand-sewn and stapled OG anastomoses. Primary
outcome measures were 30-day mortality, anastomotic leakage and stricture.
Secondary outcomes were operative time, cardiac complications and
pulmonary complications. Results: Nine randomised trials were included in
this meta-analysis. There was no significant difference between the groups
for 30-day mortality (pooled odds ratio = 1.71; 95% CI = 0.822 to 3.56; P
= 0.15) and anastomotic leakage (pooled odds ratio = 1.06; 95% CI = 0.62
to 1.80; P = 0.83). There was a significantly increased rate of
anastomotic stricture associated with stapled OG anastomosis (pooled odds
ratio = 1.76; 95% CI = 1.09 to 2.86; P = 0.02). Discussion: Meta-analysis
of randomised controlled trials comparing hand-sewn with stapled OG
anastomosis demonstrates that a stapled anastomosis is associated with a
shorter operative time but with an increased rate of post-operative
anastomotic stricture. 2011 The Society for Surgery of the Alimentary
Tract.

<7>
[Use Link to view the full text]
Accession Number
2011511490
Title
Circulation editors' picks: Most read articles in cardiovascular surgery
and transplantation.
Source
Circulation. 124 (11) (pp e283-e295), 2011. Date of Publication: 13 Sep
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
The optimal timing of surgical intervention in patients with asymptomatic
severe mitral regurgitation remains controversial, because the potential
benefits of early surgery need to be balanced against the operative risks.
As prediction of mitral valve repair has become clinically feasible, and
mitral valve repair has shown excellent long-term results, there is an
increasing need for direct comparison between watchful waiting and early
mitral valve repair. We prospectively evaluated 447 consecutive
asymptomatic patients with severe degenerative mitral regurgitation and
preserved left ventricular function to compare clinical outcomes of early
surgery with those of the conventional treatment strategy. Early surgery
was performed on 161 patients and the conventional treatment strategy on
286 patients. In the early surgery group, mitral valve repair and
replacement were performed successfully in 151 (94%) and 10 (6%) patients,
respectively, without operative mortality. This study demonstrates that in
asymptomatic patients with severe degenerative mitral regurgitation and
preserved left ventricular function, early surgery is associated with
improved long-term clinical outcomes compared with the conventional
treatment strategy by decreasing cardiac mortality and hospitalization due
to congestive heart failure. We therefore suggest that early surgery may
further improve clinical outcomes in asymptomatic severe mitral
regurgitation with a high likelihood of mitral valve repair. Further
prospective, randomized studies are needed to confirm the efficacy of
early surgery. Conclusions: Compared with conservative management, the
strategy of early surgery was associated with an improved long-term event
rate by decreasing cardiac mortality and congestive heart failure
hospitalization more effectively in patients with severe degenerative
mitral regurgitation. Early surgery may therefore further improve clinical
outcomes in asymptomatic severe mitral regurgitation with preserved left
ventricular systolic function and a high likelihood of mitral valve
repair.¹ coronary interventions (PCI), bypass surgery (CABG),
or a combination of these strategies. It is unknown which treatment
approach is best for specific patient subgroups. Here, we report 10-year
follow-up of the second Medicine, Angioplasty, or Surgery Study (MASS II),
a study that evaluated MT alone, PCI, or CABG among stable coronary
patients with multivessel disease. No differences were observed in overall
mortality in patients treated with CABG, PCI, or MT. Nevertheless,
compared with CABG, MT was associated with a significantly higher
incidence of cardiac death, subsequent myocardial infarction, and
additional revascularization. Overall, compared with CABG, MT was
associated with a 2.29-fold increased risk of combined events. Event rates
for PCI patients were intermediate between MT and CABG. Indeed, by finding
the lowest rate of further interventions in the CABG group, our results
support a strategy of revascularization, and in particular CABG, in
addition to MT for selected stable coronary patients with multivessel
disease. Conclusions: Compared with CABG, MT was associated with a
significantly higher incidence of subsequent myocardial infarction, a
higher rate of additional revascularization, a higher incidence of cardiac
death, and consequently a 2.29-fold increased risk of combined events. PCI
was associated with an increased need for further revascularization, a
higher incidence of myocardial infarction, and a 1.46-fold increased risk
of combined events compared with CABG. Additionally, CABG was better than
MT at eliminating anginal symptoms.². 2011 American Heart
Association. All rights reserved.

<8>
Accession Number
2011511230
Authors
Font M.A. Krupinski J. Arboix A.
Institution
(Font) Institut d'Investigacions Biomdiques de Bellvitge (IDIBELL),
Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907
Barcelona, Spain
(Font) Department of Neurology, Hospital Sant Joan de Deu de Manresa
(Fundaci Althaia), Catalonia 08243 Manresa, Spain
(Krupinski) Department of Neurology Cerebrovascular Diseases Unit,
Hospital Universitari Mutua de Terrassa, Catalonia, 08227 Terrassa, Spain
(Arboix) Department of Neurology Hospital, University of Barcelona,
Hospital Universitari Sagrat Cor, C/Viladomat 288, Catalonia, 08029
Barcelona, Spain
Title
Antithrombotic medication for cardioembolic stroke prevention.
Source
Stroke Research and Treatment. , 2011. Article Number: 607852. Date
of Publication: 2011.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Embolism of cardiac origin accounts for about 20 of ischemic strokes.
Nonvalvular atrial fibrillation is the most frequent cause of
cardioembolic stroke. Approximately 1 of population is affected by atrial
fibrillation, and its prevalence is growing with ageing in the modern
world. Strokes due to cardioembolism are in general severe and prone to
early recurrence and have a higher long-term risk of recurrence and
mortality. Despite its enormous preventive potential, continuous oral
anticoagulation is prescribed for less than half of patients with atrial
fibrillation who have risk factors for cardioembolism and no
contraindications for anticoagulation. Available evidence does not support
routine immediate anticoagulation of acute cardioembolic stroke.
Anticoagulation therapy's associated risk of hemorrhage and monitoring
requirements have encouraged the investigation of alternative therapies
for individuals with atrial fibrillation. New anticoagulants being tested
for prevention of stroke are low-molecular-weight heparins (LMWH),
unfractionated heparin, factor Xa inhibitors, or direct thrombin
inhibitors like dabigatran etexilate and rivaroxaban. The later exhibit
stable pharmacokinetics obviating the need for coagulation monitoring or
dose titration, and they lack clinically significant food or drug
interaction. Moreover, they offer another potential that includes fixed
dosing, oral administration, and rapid onset of action. There are several
concerns regarding potential harm, including an increased risk for
hepatotoxicity, clinically significant bleeding, and acute coronary
events. Therefore, additional trials and postmarketing surveillance will
be needed. Copyright 2011 M. ngels Font et al.

<9>
Accession Number
2011497148
Authors
Singh S. Kapoor P. Chowdhury U. Kiran U.
Institution
(Singh, Kapoor, Kiran) Departments of Cardiac Anaesthesia, CN Centre, All
India Institute of Medical Sciences, New Delhi, India
(Chowdhury) Departments of Cardiothoracic and Vascular Surgery, CN Centre,
All India Institute of Medical Sciences, New Delhi, India
(Singh) Doctors Hostel, Trauma Center, All India Institute of Medical
Sciences, New Delhi-110029, India
Title
Comparison of S100 levels, and their correlation with hemodynamic indices
in patients undergoing coronary artery bypass grafting with three
different anesthetic techniques.
Source
Annals of Cardiac Anaesthesia. 14 (3) (pp 197-202), 2011. Date of
Publication: September-December 2011.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Cardiac surgery with aid of cardiopulmonary bypass (CPB) is associated
with neurological dysfunction. The presence of cerebrospecific protein
S100 in serum is an indicator of cerebral damage. This study was designed
to evaluate the influence of three different anesthesia techniques, on
S100 levels, in patients undergoing coronary artery bypass grafting on
CPB. A total of 180 patients were divided into three groups-each of who
received sevoflurane, isoflurane and total intravenous anesthesia as part
of the anesthetic technique, respectively. S100 were evaluated from venous
sample at following time intervals-prior to induction of anesthesia (T1),
after coming off CPB (T2); 12 h after aortic cross clamping (T3) and 24 h
after aortic cross clamping (T4). In all three groups, maximal rise in
S100 levels occurred after CPB which gradually declined over next 24 h,
the levels at 24 h post-AOXC being significantly higher than baseline
levels. Significantly low levels of S100 were noted at all postdose hours
in the sevoflurane group, as compared to the total intravenous anesthesia
(TIVA) group, and at 12 and 24 h postaortic cross clamp, in comparison to
the isoflurane group. Comparing the isoflurane group with the TIVA group,
the S100 levels were lower in the isoflurane group only at 24 h postaortic
cross clamp. It was concluded that maximum rise in S100 levels occurs
immediately after CPB with a gradual decline in next 24 h. The rise in
S100 levels is significantly less in patients administered sevoflurane in
comparison to isoflurane or TIVA. Hemodynamic parameters had no influence
on the S100 levels during the first 24 h after surgery.

<10>
Accession Number
2011497422
Authors
Patel N.N. Rogers C.A. Angelini G.D. Murphy G.J.
Institution
(Patel, Rogers, Angelini, Murphy) Queen's Building, Bristol Heart
Institute, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW,
United Kingdom
Title
Pharmacological therapies for the prevention of acute kidney injury
following cardiac surgery: A systematic review.
Source
Heart Failure Reviews. 16 (6) (pp 553-567), 2011. Date of Publication:
November 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Post-cardiac surgery acute kidney injury (AKI) is common and is associated
with a significant increase in morbidity and mortality. We aimed to
systematically review randomised trials that assessed the renoprotective
utility of pharmacological agents in patients undergoing cardiac surgery.
We searched PubMed, Embase and the Cochrane Central Register of Controlled
Trials for randomised controlled trials comparing renoprotective
pharmacological interventions with control in adult patients undergoing
cardiac surgery with cardiopulmonary bypass. We extracted data for
mortality, need for renal replacement therapy (RRT), incidence of AKI, and
creatinine clearance at 24-48 h. About 49 randomised controlled trials
involving 4605 patients were included. Pharmacological interventions
included dopamine, fenoldopam, calcium channel antagonists, natriuretic
peptides, diuretics, and N-acetylcysteine. Most trials were of poor
quality, with small sample sizes, under-reporting of randomisation
procedure, allocation concealment and method of blinding. No
pharmacological intervention significantly reduced mortality. Fenoldopam
and Atrial Natriuretic Peptide (ANP) reduced the need for renal
replacement therapy by 5% (NNT 20, 95% CI 11.3, 83.0) and 3.5% (NNT 29,
95% CI 17.1, 84.4), respectively. Brain Natriuretic Peptide resulted in a
10% reduction in the incidence of AKI (NNT 11, 95% CI 6.2, 32.0). Dopamine
caused a significant reduction in creatinine clearance (-4.26 ml/min, 95%
CI -7.14, -1.39). The quality of studies that have assessed
pharmacological renoprotective agents in cardiac surgery is generally
poor. Fenoldopam, ANP and BNP show evidence of renoprotection. Randomised
studies evaluating the effect of novel renoprotective agents that are
powered to detect clinically relevant differences in outcomes are
required. 2011 Springer Science+Business Media, LLC.

<11>
Accession Number
2011496354
Authors
Ahmed S. Gibson C.M. Cannon C.P. Murphy S.A. Sabatine M.S.
Institution
(Ahmed, Gibson, Cannon, Murphy, Sabatine) Department of Medicine,
Cardiovascular Division, Brigham Women's Hospital and Harvard Medical
School, 350 Longwood Avenue, First Floor, Boston, MA 02115, United States
Title
Impact of reduced glomerular filtration rate on outcomes in patients with
ST-segment elevation myocardial infarction undergoing fibrinolysis: A
CLARITY-TIMI 28 analysis.
Source
Journal of Thrombosis and Thrombolysis. 31 (4) (pp 493-500), 2011. Date
of Publication: May 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Reduced glomerular filtration rate (GFR) is associated with adverse
outcomes in patients with cardiovascular disease. We explored the
relationship between GFR and angiographic and clinical outcomes in
ST-segment elevation myocardial infarction (STEMI) patients receiving
pharamacologic reperfusion, with or without clopidogrel. Data were
available to estimate GFR in 3,252 STEMI patients undergoing fibrinolysis,
randomized to clopidogrel versusplacebo in the CLARITY-TIMI 28 trial.
Patients with a creatinine >2.5 mg/dl were excluded from the trial. We
compared outcomes between patients with no, mild or moderate reductions in
baseline estimated GFR (ml/min/1.73 m²) of >=90, 60-89, and
<60, respectively. Compared to patients with no (n = 841) or mildly
reduced GFR (n = 1897), those with moderately reduced GFR (n = 514) were
older, more often female, and were more likely to have diabetes and
hypertension (P <= 0.001 for all). The risk of the primary endpoint (an
occluded infarctrelated artery on angiography or death/myocardial
infarction by day 8), 30 day cardiovascular events (death, myocardial
infarction, or urgent revascularization for recurrent ischemia) and 30 day
Thrombolysis in Myocardial Infarction (TIMI) major or minor
bleedingincreased as GFR declined (P for trend 0.003,<0.0001, and 0.0008
respectively). The adjusted risk of 30 day ischemic complications remained
higher in patients with moderately reduced versus normal GFR (OR 1.5, 95%
CI 1.0-2.1, P = 0.04). Treatment with clopidogrel tended to yield greater
benefit in patients with normal or mildly reduced GFR versus in patients
with moderately reduced GFR. In conclusion, STEMI patients with reduced
GFR treated with medical reperfusion, including dual antiplatelet therapy,
have higher rates of adverse clinical outcome. Further research on optimal
STEMI therapy in this high-risk group is warranted. Springer
Science+Business Media, LLC 2011.

<12>
Accession Number
2011510669
Authors
Colby J.A. Chen W.T. Baker W.L. Coleman C.I. Reinhart K. Kluger J. White
C.M.
Institution
(Colby, Chen) Hartford Hospital (HH), Hartford, CT, United States
(Baker) School of Pharmacy, University of Connecticut (UC), Farmington,
CT, United States
(Baker) Department of Medicine, School of Medicine, University of
Connecticut (UC), Farmington, CT, United States
(Coleman) Department of Pharmacy Practice, School of Pharmacy, UC,
Hartford, United States
(Coleman, White) UC/HH Evidence-Based Practice Center, Hartford, United
States
(Reinhart) Department of Pharmacy, School of Pharmacy, Wingate University,
Asheville, NC, United States
(Kluger) Arrhythmia Services, United States
(White) Department of Pharmacy, School of Pharmacy, UC, United States
Title
Effect of ascorbic acid on inflammatory markers after cardiothoracic
surgery.
Source
American Journal of Health-System Pharmacy. 68 (17) (pp 1632-1639), 2011.
Date of Publication: 01 Sep 2011.
Publisher
American Society of Health-Systems Pharmacy (7272 Wisconsin Ave., Bethesda
MD 20814, United States)
Abstract
Purpose. The effect of ascorbic acid on inflammatory markers after
cardiothoracic surgery (CTS) was studied. Methods. In this randomized,
doubleblind, placebo-controlled trial, patients undergoing cardiopulmonary
bypass graft surgery or valve replacement surgery from April 2009 through
March 2010 at Hartford Hospital were randomized to receive ascorbic acid
(2-g loading dose followed by 500 mg every 12 hours) or matching placebo
the evening before surgery and for four days postoperatively. Inflammatory
mediators were measured preoperatively and on postoperative days 1-4.
Intergroup comparisons were performed using two-tailed t tests and
Fisher's exact test. Multiple comparisons were conducted using repeated
analyses of variance with Bonferroni tests. Results. Of the 62 patients
screened, 24 met the study inclusion criteria. Of these, 13 were assigned
to receive ascorbic acid and 11 received placebo. Ascorbic acid did not
affect the natural course of inflammatory marker rise for C-reactive
protein (CRP)concentration, white blood cell (WBC) count, or fibrinogen
concentration versus placebo at any evaluated time point (p > 0.05 for all
intergroup comparisons). Intragroup analyses demonstrated significant
differences among baseline and postoperative measures of all inflammatory
mediators (p < 0.05). No significant differences were noted in
inflammatory markers between patients undergoing cardiothoracic surgery
with or without cardiopulmonary bypass, regardless of treatment group.
Conclusion. Ascorbic acid did not attenuate the rise in inflammatory
markers after CTS when compared with placebo. The use of off-pump surgery
did not significantly change the levels of CRP and fibrinogen or the WBC
count postoperatively when compared with on-pump surgery with a
biocompatible polymer coating. Copyright 2011, American Society of
Health-System Pharmacists, Inc. All rights reserved.

<13>
Accession Number
2011521771
Authors
Zerafa N. Adami M.Z. Galea J.
Institution
(Zerafa, Adami) Department of Pharmacy, University of Malta, Msida, Malta
(Galea) Department of Surgery, University of Malta and Consultant
Cardiothoracic Surgeon Mater Dei Hospital, B'Kara, Malta
Title
Impact of drugs counselling by an undergraduate pharmacist on cardiac
surgical patient's compliance to medicines.
Source
Pharmacy Practice. 9 (3) (pp 156-161), 2011. Date of Publication:
July-September 2011.
Publisher
Grupo de Investigacion en Atencion Farmaceutica (Campus de la Cartuja,
Granada 18071, Spain)
Abstract
Open heart surgery is a procedure which warrants patient education about
the complexity of drug regimens and lifestyle modifications. Patient
nonadherence is likely to have a considerable negative impact on the
patients' quality of life postcardiac surgery. Objective: To evaluate the
impact of pharmacist intervention on patients' adherence to medication and
lifestyle changes. Method: This case-controlled study was conducted at the
Cardiac Surgical Ward and Outpatients Clinic of Mater Dei Hospital, Malta.
Eighty consecutive patients who underwent coronary artery bypass or heart
valve surgery were interviewed on their day of discharge using the 'Past
Medical History Questionnaire'. The patients were then randomized to
receive pharmacist intervention or usual care. Those who received
intervention (40 patients) were given a chart with pictorial explanation
of the time of day together with a colorful photograph of each tablet
prescribed. This group of patients was also counselled to comply to oral
analgesia and exercise and also on the avoidance of alcohol and smoking
during the recovery period. The control patients received usual care
without the pharmacist intervention. All patients were re-interviewed
eight weeks after discharge using the 'Assessing Patient Compliance
Questionnaire'. Any differences between the control and experimental
groups were analysed using Chi-square, Three-Way Cross tabulation One-Way
ANOVA and Two-Way ANOVA tests using the SPSS software version 17.0.
Results: A statistically significant difference between the two groups in
the mean percentage compliance was registered following pharmacist
intervention (p<0.05). Patients in the experimental group had a higher
mean percentage compliance score (88%) than patients in the control group
(66%). Conclusion: The statistically significant difference in the mean
percentage compliance between the two groups following pharmacist
intervention shows conclusive evidence of the advantage patients gain when
offered this intervention. The pharmacist intervention provides patients
with sufficient information to help them achieve optimal benefit from the
medication prescribed.

<14>
Accession Number
2011504023
Authors
Kaygin M.A. Dag O. Gunes M. Senocak M. Limandal H.K. Aslan U. Erkut B.
Institution
(Kaygin, Dag, Gunes, Senocak, Limandal, Aslan, Erkut) Department of
Cardiovascular Surgery, Erzurum Regional Training and Research Hospital,
Erzurum, Turkey
Title
Posterior pericardiotomy reduces the incidence of atrial fibrillation,
pericardial effusion, and length of stay in hospital after coronary artery
bypasses surgery.
Source
Tohoku Journal of Experimental Medicine. 225 (2) (pp 103-108), 2011.
Date of Publication: 2011.
Publisher
Tohoku University Medical Press (2-1 Seiryomachi, Aoba-ku, Sendai
980-8575, Japan)
Abstract
Artrial fbrillation is the most common arrhythmia that occurs after
coronary bypass grafting operation with the rate of 30%. Atrial
fibrillation is associated with hemodynamic instability, strokes, and
prolonged hospital stay. Pericardial effusion is a risk factor for atrial
fbrillation after cardiac surgery, and it occurs commonly in the posterior
area during the post-operative period. The aim of this prospective study
was to demonstrate the effectiveness of posterior pericardiotomy in
reducing the incidence of atrial fibrillation. This prospective randomized
study was carried out on 425 patients undergoing a coronary artery bypass
grafting in our clinic between August 2009 and February 2011. There were
276 male patients and 149 female patients. These patients were randomly
divided into two groups; posterior pericardial incision was performed in
213 patients (pericardiotomy group), while any pericardial incision was
not performed in 212 patients (control group). Atrial fbrillation occurred
more frequently in control group (62 patients, 14.6%), compared to the
pericardiotomy group (14 patients, 3.1%; p < 0.0001). The incidences of
early pericardial effusion, late pericardial effusion, and tamponade were
also signifcantly higher in control group. Moreover, posterior
pericardiotomy was associated with the decreases in the duration of stay
in hospital and intensive care unit. In fact, the total hospital costs
were lower in the pericardiotomy group. In conclusion, posterior
pericardiotomy is an effective and safe technique that reduces early
pericardial effusion, atrial fbrillation, length of stay in hospital, and
hospital costs after the coronary artery bypasses grafting.

<15>
Accession Number
21863652
Authors
Gersak B. Gartner U. Antonic M.
Institution
(Gersak) Department of Cardiovascular Surgery, University Medical Center,
Ljubljana, Slovenia.
Title
Thrombocytopenia following implantation of the stentless biological sorin
freedom SOLO valve.
Source
The Journal of heart valve disease. 20 (4) (pp 401-406), 2011. Date of
Publication: Jul 2011.
Abstract
Stentless biological valves have proven advantages in hemodynamic
performance and left ventricular function compared to stented biological
valves. Following a marked postoperative fall in the platelet count of
patients after implantation of the Freedom SOLO valve, the study aim was
to confirm clinical observations that this effect was more severe in
patients receiving Freedom SOLO valves than in those receiving St. Jude
Medical (SJM) mechanical aortic valves. Preoperative and postoperative
platelet counts were compared in two groups of patients who underwent
aortic valve replacement (AVR) without any concomitant procedures between
January and December 2007. Patients received either a Freedom SOLO valve
(n = 28) or a SJM mechanical valve (n = 41). Mean values of platelet
counts were compared using three multiple linear regression models.
Platelet counts were significantly lower in the Freedom SOLO group than in
the SJM group from the first postoperative day (POD 1) up to POD 6 (p
<0.001). In three patients of the Freedom SOLO group the platelet count
fell below 30x10(9)/l, while the lowest level in the SJM group was
75x10(9)/l. Based on multiple linear regression models, the type of valve
implanted had a statistically significant influence on postoperative
platelet counts on POD 1, POD 3, and POD 5 (p <0.001). Whilst the reason
for this phenomenon is unknown, the use of consistent monitoring should
prevent severe falls in platelet count from becoming dangerous for the
patient. Further studies are required to investigate the phenomenon since,
despite a shorter cardiopulmonary bypass time, the fall in platelet count
was more profound in the Freedom SOLO group.

<16>
Accession Number
70537316
Authors
Benck U. Schemmer P. Stockle A. Hoeger S. Yard B.A. Kramer B. Schnuelle P.
Institution
(Benck, Stockle, Hoeger, Yard, Kramer, Schnuelle) University Medical
Centre Mannheim, 5th Department of Medicine, Mannheim, Germany
(Schemmer) Heidelberg University Hospital, Clinic for Surgery, Liver
Transplant Center, Heidelberg, Germany
Title
Donor dopamine does not affect graft survival after liver transplantation:
Data from a randomized controlled trial.
Source
Transplant International. Conference: 20th Annual Congress of the German
Transplantation Society Regensburg Germany. Conference Start: 20111006
Conference End: 20111008. Conference Publication: (var.pagings). 24 (pp
19), 2011. Date of Publication: October 2011.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Treatment of the deceased heart-beating donor with low-dose
dopamine results in less dialysis requirement after kidney transplantation
and appears to improve the outcome after heart transplantation. This study
investigates the clinical course of liver allografts from multi-organ
donors that were enrolled in the randomized dopamine trial
(clinicaltrials.gov Identifier: NCT00115115). Methods: Between March 2004
and August 2007, 264 brain-dead donors were randomly assigned to receive
or to not receive low-dose dopamine. Elmugibility criteria included
circulatory stability under low-dose norepinephrine. The present study is
nested in the randomized controlled trial of donor pre-treatment with
dopamine. We assessed the outcomes of 197 liver transplants performed at
32 European centers. Results: Dopamine was infused at 4 mug/kg/min for a
median duration of 362 min (IQR 182 min). Donors and recipients were very
similar in baseline characteristics. Thirty-four recipients (16.8%) were
transplanted with high urgency and 23 (11.7%) received a repeat
transplant. Pretransplant MELD score was not different in recipients of a
dopamine treated versus untreated graft (18 +/- 8 vs. 19 +/- 9, P = 0.28).
Mean cold ischemic time was 632 +/- 172 vs. 600 +/- 170 min (P =0.20).
Following transplantation, no differences occurred in biopsy-proven
rejection episodes (15.3% vs. 17.2%, P =0.85), requirement of
hemofiltration (27.6% vs. 27.3%, P =0.99), and in-hospital mortality
(13.3% vs. 12.1%, P = 0.85). Graft survival was 72.5% vs. 74.8% and 61.2%
vs. 63.6% at 1 and 3 years. Conclusion: Contrasting heart and kidney
transplantation, donor pre-treat-ment with dopamine does not improve the
outcome after liver transplantation. Since liver cells specifically
express s-COMT with high activity, dopamine is rapidly degraded in-vivo,
which most likely abrogates its potential to protect the liver graft from
oxidative stress under cold storage conditions.

<17>
Accession Number
70535831
Authors
Nijjer S.S. Watson G. Athanasiou T. Malik I.
Institution
(Nijjer, Watson, Athanasiou, Malik) Imperial College Healthcare NHS Trust,
London, United Kingdom
Title
Clopidogrel can be safely continued until coronary artery bypass grafting
in patients with acute coronary syndrome: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2011 Paris France. Conference Start: 20110827 Conference End:
20110831. Conference Publication: (var.pagings). 32 (pp 740), 2011.
Date of Publication: August 2011.
Publisher
Oxford University Press
Abstract
Aims: Guidelines suggest patients should discontinue clopidogrel with a
washout of 5 days prior to coronary artery bypass grafting (CABG).
Concerns have focused on postoperative bleeding, transfusion requirements
and the need for reoperation. However, those with acute coronary syndrome
(ACS) are at elevated risk of further myocardial infarction and death
without clopidogrel while awaiting CABG. Therefore, operating on
clopidogrel is a necessary practice in many patients. This meta-analysis
aims to determine the risk of CABG specifically in ACS patients while
continuing clopidogrel. Method and results: 33 studies with 22,242
patients undergoing CABG were assessed. The majority were retrospective
with variable reporting of outcomes and demonstrated heterogeneity in
meta-analysis. ACS patients with recent clopidogrel exposure (CL) were
compared to those without recent clopidogrel (NC). Although mortality is
increased in CL compared to NC (OR 1.6, 95% CI 1.30-1.96, p<0.00001), it
is influenced by the ACS status of the patient in these mainly
nonrandomised studies. When ACS patients are specifically assessed, there
is no significant increase in mortality (OR 1.44,95% CI 0.97-2.1, p=0.07)
or in postoperative myocardial infarction (OR 0.57,95% CI 0.31-1.07,
p=0.08) and stroke rates (OR 1.23, 95% CI 0.66-2.29, p=0.52). Combined
MACE (stroke, MI and death) were not different in the two groups (OR 1.10,
95% CI 0.87-1.41, p=0.43). Transfusion rates showed marked heterogeneity
but more recent surgical cohorts demonstrate a reduction in post-operative
chest drain output and reoperation rates compared to earlier cohorts.
Reoperation rates were not specifically raised in ACS patients on
clopidogrel (OR 1.5, 95% CI 0.88-2.54, p=0.13 Conclusion: This
meta-analysis challenges our interpretation of previous studies that
suggest clopidogrel should be stopped prior to CABG. A washout period
delays surgery, and whilst warranted in elective patients, might be
detrimental in patients with ACS. Heterogeneity limits strong conclusions
but there is sufficient equipoise to suggest that clopidogrel should not
be discontinued in patients with ACS requiring urgent CABG, except in
those at highest operative bleeding risk. Importantly major endpoints were
not worse on clopidogrel. Heterogeneity in transfusion rates suggest it is
a weak outcome marker. Instead, improved reoperation rates over time
suggest there is improving skill in operating on clopidogrel. These
findings support the current practice of continuing clopidogrel until CABG
in many centres.

<18>
Accession Number
70535403
Authors
Wu F.Q. Wu Y. Tao W.Y. Zhao H.B. Zhang H.Y. Shen D.Y.
Institution
(Wu, Wu, Tao) Capital University of Medical Sciences, Beijing, China
(Zhao, Zhang) Beijing Chao-Yang Hospital Affiliated, Capital University of
Medical Sciences, Heart Center, Beijing, China
(Shen) Beijing Jian-Gong Hospital, Heart Center, Beijing, China
Title
Preoperative P-wave predicts atrial fibrillation after coronary artery
bypass graft: Results from Beijing China and a combination of
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2011 Paris France. Conference Start: 20110827 Conference End:
20110831. Conference Publication: (var.pagings). 32 (pp 622), 2011.
Date of Publication: August 2011.
Publisher
Oxford University Press
Abstract
Purpose: About 30% patients after coronary artery bypass graft (CABG)
developed atrial fibrillation (AF). Preoperative P-wave duration (POPWD)
has been suggested to be predictive of postoperative AF (POAF). It is
still controversial, however, regarding how well the POPWD predicts POAF.
We set out to examine the value of POPWD in predicting POAF among other
characteristics and combined our results with others in a meta-analysis.
Method: We prospectively studied 263 consecutive patients with normal
sinus rhythm (NSR) undergoing first-time elective isolated CABG. 12-lead
electrocardiogram was obtained preoperatively. Patients' demographic,
clinical and surgical characteristics were collected prospectively. The
main endpoint was the occurrence of first AF lasting >5 min. The patients
were classified as either NSR or AF group according to their postoperative
rhythm, which was continuously monitored for the first 7 postoperative
days. POPWD was analyzed with a commercial software by a research member
who was blinded to the patients' classification. Explanatory variables
with p<0.1 upon univariate analysis were entered into the logistic
regression model to assess the independent predictors of POAF. In
addition, we performed a meta-analysis to assess the combined effect of
POPWD in predicting POAF. Result: AF occurred in 85 (32.3%) of the 263
patients. With univariate analysis, older age (66.1+/-8.0 versus
60.6+/-9.4 years; p<0.001), prolonged POPWD (111.62+/-11.68 versus
101.16+/-10.79 ms; p<0.001), hypertension (p<0.05), aortic regurgitation
(p<0.01), and mitral regurgitation (p<0.05) were associated with POAF.
Multivariate analysis showed that only older age (odds ratio [OR] 1.06 per
year increment, 95% confidence intervals [CI] 1.02 - 1.10, p<0.01) and
POPWD >105 ms (OR 9.23, 95% CI 4.83 - 17.84, p<0.001) were independently
associated with the occurrence of POAF. Patients with AF could be
predicted by POPWD of longer than 105 ms, with specificity, positive and
negative predictive values of 72%, 76%, and 72%, respectively. The
meta-analysis combined our study with 10 other similar studies with a
total of 3207 patients. Overall, prolonged POPWD was associated with
greater risk of POAF, with a weighed mean difference of 4.76 ms (95% CI
2.62 - 6.90, p<0.01). Although there was significant heterogeneity across
the studies, after performing several sensitivity and subgroup analyses,
the analysis did not find a significant influence on the results.
Conclusion: This study confirmed that POPWD was a powerful independent
predictor of POAF among other predictive characteristics.

<19>
Accession Number
70534813
Authors
Wu F.Q. Wu Y. Tao W.Y. Zhao H.B. Zhang H.Y. Shen D.Y.
Institution
(Wu, Wu, Tao) Capital University of Medical Sciences, Beijing, China
(Zhao, Zhang) Beijing Chao-Yang Hospital Affiliated to Capital University
of Medical Sciences, Heart Center, Beijing, China
(Shen) Beijing Jian-Gong Hospital, Heart Center, Beijing, China
Title
Preoperative P-wave predicts atrial fibrillation after coronary artery
bypass graft: Results from Beijing, China and a combination of
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2011 Paris France. Conference Start: 20110827 Conference End:
20110831. Conference Publication: (var.pagings). 32 (pp 469), 2011.
Date of Publication: August 2011.
Publisher
Oxford University Press
Abstract
Purpose: About 17.5% to 43% patients after coronary artery bypass graft
(CABG) deveoped atrial fibrillation (AF). Preoperative P-wave duration has
been suggested to predict the development of postoperative AF (POAF). It
is still controversial, however, regarding how well the P-wave duration
predicts POAF among other clinical characteristics. We evaluated the value
of preoperative Pwave duration in predicting AF and combined our results
with others in a metaanalysis study. Method: 263 consecutive patients with
sinus rhythm before surgery and scheduled to undergo CABG. 12-lead ECG,
echocardiogram and coronary angiography were obtained in all patients
before surgery. P-wave duration was analyzed with a commercially software
from the preoperative 12-lead ECG. ECGs were continuously monitored for
one week after CABG. The main endpoint of the study was the occurrence of
first AF lasting >=5 min. Patients were divided into two groups on the
basis of whether or not they developed POAF. All variables whose
univariate tests with a p value less than 0.1 were entered to a logistic
regression model to assess the independent predictors of AF. In addition,
we performed a meta-analysis to assess the combined value of P-wave
duration in predicting POAF. Result: AF occurred in 85 of the 263 patients
(32.3%), the average time from the operation to the first POAF episode was
2.4+/-1.5 days. With univariate analysis, older age (66.1+/-8.0 versus
60.6+/-9.4 years; p<0.001), prolonged P-wave duration (111.62+/-11.68
versus 101.16+/-10.79ms; p<0.001), hypertension (p<0.05), aortic
regurgitation (p<0.01) and mitral regurgitation (p<0.05) were associated
with POAF. Multivariate analysis showed that only older age (odds ratio
[OR] 1.06 per year increment, 95% confidence intervals [CI] 1.02 to 1.10,
p<0.01) and Pwave duration >105 milliseconds (ms; OR 9.23, 95% CI 4.83 to
17.84, p<0.001) were independently associated with the occurrence of POAF.
Patients with AF could be predicted by preoperative P-wave duration of
longer than 105ms, with a specificity of 72%, positive predictive value of
76%, and negative predictive value of 72%. The meta-analysis combined our
study with 8 other similar studies with a total of 1160 patients, using
random effects test. The 9 studies were heterogeneous (heterogeneity test:
Q2 = 45.98; p<0.001). The weighed mean difference in P-wave duration
between the patients with, and without POAF was 5.38 ms (95% CI 2.07 to
8.68, p<0.01). Conclusion: This study confirmed that preoperative P-wave
duration was a powerful independent predictor of POAF among other
predictive clinical characteristics.

<20>
Accession Number
70534621
Authors
Yetgin T. Manintveld O.C. Duncker D.J. Boersma E. Van Der Giessen W.J.
Institution
(Yetgin, Manintveld, Duncker, Boersma, Van Der Giessen) Erasmus Medical
Center, Thoraxcenter, Department of Cardiology, Rotterdam, Netherlands
Title
Remote ischaemic conditioning in percutaneous coronary intervention and
coronary artery bypass grafting: A meta-analysis of randomised trials.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2011 Paris France. Conference Start: 20110827 Conference End:
20110831. Conference Publication: (var.pagings). 32 (pp 420), 2011.
Date of Publication: August 2011.
Publisher
Oxford University Press
Abstract
Purpose: Remote ischaemic conditioning (RIC) induced by transient upper
limb ischaemia attenuates myocardial injury in patients undergoing
percutaneous coronary intervention (PCI) and coronary artery bypass
grafting (CABG). Although the clinical trials examining RIC in these
settings have shown similar reductions in myocardial injury, there are
trials providing somewhat inconsistent results. Our aim is to assess the
effect of RIC in patients undergoing PCI and CABG. Methods: Medline,
Embase, and conference reports were searched for randomised trials of RIC
(defined as remote pre-, per- and postconditioning) in the setting of PCI
and CABG and were included if they reported on biomarkers of myocardial
injury (creatine kinase isoform-MB, troponin T or troponin I). From each
trial data were extracted using standardized forms where after
standardized mean differences (SMDs) were calculated for biomarkers of
myocardial injury using the Hedges g statistic. Results: Meta-analysis of
4 studies on PCI, comprising 557 patients, indicated reduced biomarkers
for myocardial injury in patients treated with RIC compared to control
(random effects model: SMD -0.21, 95% CI -0.66 to 0.24, P=0.36). The 8
CABG studies taken together, comprising 621 patients, revealed a
significant effect of RIC on myocardial injury (SMD -0.35, 95% CI -0.64 to
-0.05, P=0.02). The statistical tests indicated moderate to high
heterogeneity across the studies (Q-statistic: P=0.0006, I²=83%
and P=0.005, I²=66% for PCI and CABG, respectively). (Graph
presented) Conclusions: RIC with transient episodes of limb ischaemia in
patients undergoing PCI or CABG exhibits lower biomarkers of myocardial
injury compared to control. However, this effect failed to reach
statistical significance in the PCI analysis.

<21>
Accession Number
70534480
Authors
Carvalho T. Bonorino K.C. Panigas T.F.
Institution
(Carvalho, Bonorino, Panigas) State University of Santa Catarina,
Florianopolis, Brazil
Title
Preoperative respiratory muscle training reduces complications in coronary
artery bypass surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2011 Paris France. Conference Start: 20110827 Conference End:
20110831. Conference Publication: (var.pagings). 32 (pp 382), 2011.
Date of Publication: August 2011.
Publisher
Oxford University Press
Abstract
Background: Coronary artery bypass graft (CABG) affects the functional
capacity, resulting in pulmonary complications. Respiratory Muscle
Training (IMT) in the preoperative period could be an effective
prophylactic feature. This controlled clinical trial intends to analyze
the effect of IMT on the functional capacity (FC), respiratory muscle
strength (RMS) and postoperative pulmonary complications. Method: Were
selected consecutively 32 individuals of both genders (65.6%men) referred
for CABG, with a high risk for pulmonary complications. The individuals
were randomized into Intervention Group (IG) and Control Group (CG).
Groups not differed by gender (IG 62.5% and CG 68.8%men), age (62+/-9.9 IG
and CG 62.0+/-10.9 years), LVEF (IG 87.5% and CG 75% >=50%), functional
class (IG 68.8% and CG 81.3% classified as NYHA II) and time of surgery
(IG 352.5 and CG 320.9minutes) (p=NS for all). There were four time
assessments: two weeks and one day before surgery, at three and seven days
after surgery. RMS was determined through manovacuometry analog, graduated
-120 to +120cmH2O, verified by maximum aspiratory and expiratory pressures
(MIP and MEP); FC was measured by the six-minute walk test (6MWT);
pulmonary complications was determined by Hulzebos' scale of risk (2006).
The IMT in IG was performed with the set ThresholdIMT, with workload 30%
of the MIP, during the two weeks prior to surgery, seven days a week,
twice a day, three sets of ten repetitions. Following descriptive
analysis, the results were compared by means of specific statistical
tests: chi-square, Fisher, Mann-Whitney test and MANOVA for repeated
measures. Results: During the preoperative period the MIP and FC in IG
increased 24.5% (70.0+/-19.7 and 92.7+/-26.8cmH2O, p<0.05) and 17% (6MWT
361.9+/-92.6 and. 434.4+/-89m, p<0.001) respectively, while in CG the MIP
decreased 12.3% (75.9+/-25.6 and 66.6+/-23,6cmH2O, p<0.001) and FC in 13%
(6MWT 384.8+/-136.3 and 333.7+/-116m, p<0.05), with significant difference
between groups (p<0.001). In relation to MEP was not observed significant
difference between groups (p=0.28). Postoperative MIP values (IG
63.4+/-14.3 and 74.1+/-20.3cmH2O, CG 58.7+/-15.7 and 64.1+/-19.2cmH2O,
p<0,001) and FC (IG 298.2+/-76.8 and 359.1+/-80.5m, CG 223.7+/-87.4 and
257.8+/-98.9m, p<0,001) showed less decreased and better recovery in IG.
In IG, pneumonia (IG 5.3% and CG 12.3%, p=0.04) and atelectasis (IG 18.7%
and CG 43.2%, p=0.02) occurred less. Conclusion: Preoperative IMT was
efficient in increasing respiratory muscle strength and FC, reducing the
incidence of postoperative pulmonary complications in patients undergoing
CABG.

<22>
Accession Number
70534243
Authors
O'Donnell S. O'Brien F. Mooney M. Mckee G. Moser D.
Institution
(O'Donnell, O'Brien, Mooney, Mckee) Trinity College Dublin, School of
Nursing and Midwifery, Dublin, Ireland
(Moser) University of Kentucky, Lexington, United States
Title
Symptom presentation in women with acute coronary syndrome: A new
perspective on help-seeking delays.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2011 Paris France. Conference Start: 20110827 Conference End:
20110831. Conference Publication: (var.pagings). 32 (pp 320), 2011.
Date of Publication: August 2011.
Publisher
Oxford University Press
Abstract
Purpose: It has been reported that women experience longer pre-hospital
delays for symptoms of acute coronary syndrome (ACS), than their male
counterparts. One xplanation for this delay is the suggestion that women
experience a different set of symptoms than men, some of which include
"atypical" symptoms. The purpose of this tudy was to examine whether
gender differences exist in the symptom experiences of women and men with
ACS. Methods: Symptom experience and medical profiles were ecorded for all
patients who participated in a large multi-centered randomized controlled
trial. Patients with ACS who were admitted to one of five major academic
teaching ospitals in Dublin, Ireland, with a diagnosis of ACS, were
enrolled in the study. Each patient was interviewed 2-4 days following
their admission and provided full details about the presence,
localization, onset and nature of their experienced symptoms. Details of
patients' medical profiles were obtained from patients' verbal reports and
edical chart review. Results: A total of 2037 patients, were initially
enrolled into the study. Of these, 1947 patients, 28% of whom were women
(N=545), met the criterion of aving a recent ACS event. Using logistic
regression and adjusting for age, body mass index, and history of
myocardial infarction, angioplasty, coronary artery bypass grafting,
iabetes, hypertension, current smoking or hypercholesterolemia, women had
greater odds of experiencing shortness of breath (50% vs 43% multivariate
adjusted odds atio [OR]=1.32; 95% CI, 1.08-1.62; p=0.006) palpitations
(5.5% vs 2.8%, OR=2.17; CI=1.31-3.62; p=0.003) left arm pain (34% vs
30.5%; OR=1.27; CI=1.02-1.58; p=0.03) ack ain (7.5% vs 4.8%; OR=1.56;
CI=1.03-2.37; p=0.034) neck or jaw pain (21.5% vs 13.8%; OR=1.84; CI=1.41-
2.40; p=0.001) stomach upset (28% vs 24%; OR=1.30; CI=1.03- .65; p=0.024)
and fatigue (29% vs 21.5%; OR=1.64; CI=1.29-2.07; p=0.001) than their male
counterparts. There were no gender differences in the occurrence of the
emaining symptoms such as chest pain or discomfort, shoulder pain,
indigestion, arm numbness, weakness or light-headedness. Conclusion: Women
with ACS appear to xperience a difference symptom set to that experienced
by their male counterparts. As many of these symptoms are considered
"atypical" ACS symptoms these findings may o some way towards explaining
the help-seeking delays so often reported in this group. It is essential
that educational initiatives directed towards reducing pre-hospital elays
in women with ACS, include specific information pertaining to these
gendered symptoms.

<23>
Accession Number
70533589
Authors
Lenarczyk R. Kowalski O. Sredniawa B. Pruszkowska-Skrzep P. Pluta S. Sokal
A. Szulik M. Kukulski T. Zielinska T. Kalarus Z.
Institution
(Lenarczyk, Kowalski, Sredniawa, Pruszkowska-Skrzep, Pluta, Sokal, Szulik,
Kukulski, Zielinska, Kalarus) Silesian Medical University, Center for
Heart Disease, Zabrze, Poland
Title
Triple-site cardiac resynchronization therapy in patients with heart
failure - the prospective, randomized trial.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2011 Paris France. Conference Start: 20110827 Conference End:
20110831. Conference Publication: (var.pagings). 32 (pp 145), 2011.
Date of Publication: August 2011.
Publisher
Oxford University Press
Abstract
Purpose: We hypothesized that triple-site (double-left single-right)
stimulation will result in a higher response-rate than conventional
biventricular pacing in candidates for cardiac resynchronization therapy
(CRT). Methods: This prospective, single-center, single-blinded, parallel,
controlled trial randomized a hundred consecutive patients with moderate
to severe heart failure (HF-NYHA III-IV), LV ejection fraction <=35%,
electrical and mechanical dyssynchrony and sinus rhythm in a 1:1 fashion
to triple-site or conventional CRT-D. In the triple-site group two LV
leads were implanted into two separate coronary sinus branches and
connected in parallel to the LV port of the device. Patients were followed
1 week, 1, 3 and 6 months after randomization during the blinded phase.
All potential adverse events were adjudicated by a blinded committee to
verify if the criteria for major adverse cardiovascular event
(MACE-any-cause death/heart transplant/hospitalization for HF) were
fulfilled. The primary objective evaluated response-rate, defined as the
6-month's combined endpoint of alive status, freedom from hospitalization
for HF or heart transplantation, relative>=10% increase in LV ejection
fraction, >=10% in peak oxygen consumption, and >=10% in 6-minute walking
distance. Results: Data suitable for per-protocol analysis were available
for 98 patients, 98% of those in conventional and 93.8% in triple-site
group were implanted successfully with the target device (P=NS).
Intention-to-treat analysis revealed higher response-rate in triple-site
than conventional CRT group (51.1 vs. 26.5%, P=0.014). The proportion of
triple-site patients who achieved >=10% increase in 6-minute walking
distance was higher with borderline significance (74 vs 54%, P=0.05),
proportions of subjects with >=10% increase in peak oxygen consumption (67
vs. 59% in triple-site and conventional group, respectively) and in LV
ejection fraction (77 vs. 78%, both P=NS) were similar. In the triple-site
group two patients underwent HF hospitalization, in conventional group 1
patient died from progressive HF and 7 underwent HF hospitalization.
MACE-rate was higher in conventional than triple-site group with the
borderline significance (16 vs. 4.2%, P=0.05). Conclusions: Triple-site
resynchronization results in a higher response-rate than conventional CRT.
This effect can be attributed mainly to the more pronounced functional
improvement and greater reduction of MACE events mediated by triplesite
pacing.

<24>
Accession Number
70533336
Authors
Desch S. Boudriot E. Schuler G. Thiele H.
Institution
(Desch, Boudriot, Schuler, Thiele) University of Leipzig, Heart Centre,
Department of Internal Medicine/Cardiology, Leipzig, Germany
Title
Bypass surgery versus percutaneous coronary intervention for the treatment
of unprotected left main disease - A meta-analysis of randomised
controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2011 Paris France. Conference Start: 20110827 Conference End:
20110831. Conference Publication: (var.pagings). 32 (pp 78-79), 2011.
Date of Publication: August 2011.
Publisher
Oxford University Press
Abstract
Purpose: Current guidelines state that percutaneous coronary intervention
(PCI) with stents may be considered in patients with unprotected left main
stenosis (LM) as an lternative to coronary artery bypass surgery (CABG) in
the presence of anatomic conditions that are associated with a low risk of
PCI procedural complications and clinical onditions that predict an
increased risk of adverse surgical outcomes. However, there is still
considerable debate and ongoing controversy concerning the choice of
treatment or a given patient. We performed a meta-analysis of randomised,
controlled trials comparing CABG and PCI for the treatment of unprotected
LM disease. Methods: The lectronic databases MEDLINE, EMBASE and CENTRAL
(The Cochrane Controlled Clinical Trials Register) were searched for
randomised, controlled trials comparing CABG and CI or the treatment of
unprotected LM disease. Clinical events (death, non-fatal myocardial
infarction, stroke and repeat revascularization) occurring during the
first year after andomisation were analyzed. Results: The search strategy
identified 3 randomised controlled trials eligible for inclusion enrolling
a total of 1011 patients (Buszman 2008; orice 010; Boudriot/Thiele 2011).
There was no relevant heterogeneity across trials. No significant
differences between the treatment groups could be found for the risk of
death risk ratio [RR] 1.35 [95% CI 0.74 to 2.47], p=0.32) and non-fatal
myocardial infarction (RR 1.07 [95% CI 0.58 to 1.98], p=0.83). The risk of
stroke was significantly higher with ABG (RR 7.06 [95% CI 1.62 to 30.82],
p=0.009) whereas the risk of repeat revascularization was higher with PCI
(RR 0.48 [95% CI 0.32 to 0.70], p<0.001). Conclusion: In this argest
series of randomised patients with unprotected LM stenosis to date, the
risk of death and myocardial infarction during the first year of follow-up
was comparable etween CABG and PCI. However, patients undergoing CABG had
a higher risk of stroke whereas patients undergoing PCI were at a higher
risk for repeat revascularization.

<25>
Accession Number
70539812
Authors
Haase M. Haase-Fielitz A.
Institution
(Haase, Haase-Fielitz) Department of Nephrology and Hypertension, Medical
Faculty of the Otto-von-Guericke, University Magdeburg, Leipziger Str. 44,
Magdeburg 39120, Germany
Title
NGAL-From discovery to a new era of "Acute Renal Disease" diagnosis?.
Source
Clinical Biochemistry. Conference: 12th International Congress of
Pediatric Laboratory Medicine, ICPLM 2011 Berlin Germany. Conference
Start: 20110513 Conference End: 20110515. Conference Publication:
(var.pagings). 44 (7) (pp 499-500), 2011. Date of Publication: May 2011.
Publisher
Elsevier Inc.
Abstract
Introduction The term "acute renal disease" encompasses several conditions
of abruptly reducing renal excretory function or histopathology changes.
Acute renal disease is a major clinical issue in hospitalised patients
with persistently high morbidity and mortality rates, causing 1
substantial economic burden. It carries the risk for demand of chronic
renal replacement therapy due to irreversible loss of renal function.
While recent advances have suggested causal therapeutic approaches in
experimental models, clinical studies have not yielded convincing results.
Failure of pharmacological interventions to reverse acute human renal
disease may relate, at least in part, to delayed diagnosis, as current
clinical tests rely on functional markers of the glomerular filtration
rate that are neither sensitive nor specific for renal injury. Serum
creatinine levels are dependent on numerous non-renal factors and increase
late, often 24-48 hours after the injurious event to the kidney-a time
point considered too late for "early" intervention. 1 variety of novel
renal injury biomarkers, among them, Neutrophil Gelatinase-Associated
Lipocalin (NGAL), is emerging that may enable 1 timely diagnosis of
subclinical tubular injury, which precedes clinically manifest acute renal
disease by several days to weeks. This has been suggested to be a top
research priority by major renal societies. Methods Here we focus on
recent studies examining the biological characteristics and the diagnostic
and prognostic value of NGAL in patients at risk for acute renal disease
including advancing chronic renal disease related to autoimmune disease
(lupus nephritis, IgA nephritis, ANCA-vasculitis), specific infections
(diarrhoea-associated haemolytic uremic syndrome) and acute kidney injury
(AKI) related to sepsis/ critical illness, cardiac surgery, renal
transplantation or the use of nephrotoxic medications. Results Although
already known as a polypeptide bound with matrix metalloproteinase in
neutrophils, NGAL is now given priority as 1 promising biomarker of acute
renal disease. NGAL was (re)discovered to be expressed after renal injury.
It is rapidly induced and released from the injured renal distal nephrons
in experimental studies and various human diseases. Urinary and plasma
concentrations of NGAL increase proportionally to severity and duration of
renal injury and rapidly decrease with its attenuation. However, NGAL
release is not specific to the kidney. Measurements may be readily and
easily performed in urine and plasma using clinical laboratory platforms
or point of care devices. Currently two automated laboratory-diagnostic
systems for NGAL measurements are available. Triage NGAL (Biosite/
Inverness/Alere) is a "point-of-care" fluorescence immunoassay for the
quantitative determination of NGAL from EDTA-anticoagulated specimens of
whole blood or plasma. According to information from the manufacturer no
relevant interferences are detectable between plasma NGAL and haemoglobin
(to 5 mg/mL), lipids, rheumatoid factors, bilirubin (to 0.15 mg/mL) or
drugs like ceftriaxon, furosemid, heparin or contrast media. The
ARCHITECTUrinary-NGAL (AbbottDiagnostics) is a chemiluminescence
microparticle-immunoassay for the quantitative determination ofNGAL in
human urine. According to the manufacturers the measuring ranges of the
Triage or the ARCHITECT NGAL test are from 60 to 1300 ng/mL or from20 to
1500 ng/mL, respectively. Each specimen volume consists of a few hundred
microlitres and the measuring time of both systems is about 15min.
Summarising the relevant literature, NGAL was measured in 325 patients
with autoimmune or specific infectious diseases and in N4000 patients at
risk of AKI. Whenever renal injury occurred, as evidenced by
histopathology or subsequent increase in serum creatinine levels, NGAL
levels were higher than in patients without acute renal disease. An
increase in NGAL substantially preceded clinical diagnosis of acute renal
disease from 1 to 3 days in AKI to 12 weeks in chronically active renal
disease. Specifically, NGAL levels strongly to moderately correlated with
renal damage but not with extra-renal disease activity and a relevant
increase in NGAL levels was detected up to 3 months before worsening of
lupus nephritis diagnosed by established kidney tests [1,2]. Also, the
majority of children with diarrhoea-associated haemolytic uremic syndrome
have renal tubular epithelial cell injury as evidenced by increased
urinary NGAL concentrations compared to controls and they required renal
replacement therapy more frequently (9 out of 20 children with NGAL N200
ng/mL vs. 1 out of 14 with NGAL b200 ng/mL [3]). In a recent
meta-analysis, the sensitivity and (Figure presented) specificity of NGAL
for AKI - measured several days prior to clinical diagnosis - ranged on
average between 75% and 95% in critical illness or after exposure to
contrast media [4]. In this study, the need for the initiation of
subsequent renal replacement therapy was predicted by NGAL with a
sensitivity of 76% and a specificity of 80% (AUC-ROC 0.78, diagnostic OR
12.9); Fig. 1. In the absence of diagnostic increases in serum creatinine,
NGAL detected patients with subclinical AKI who have an increased risk of
adverse clinical outcomes [5]. The concept and definition of AKI may need
re-assessment. Discussion With the help of a predictive renal biomarker a
paradigm shift in acute renal disease diagnosis may soon develop. Early
information about acute structural kidney damage should direct the
physician's attention to the timely avoidance of a manifest and possibly
irreversible loss of renal function. NGAL-positive patients may benefit
from the earlier initiation of causal treatment for reversible factors
depending on the setting of acute renal disease. Early termination of
nephrotoxic medications and the cautious or delayed use of contrast media
would be appropriate measures. Complementation of classical renal
evaluation methods, with novel renal biomarkers may allow faster
preclinical drug development, potentially reducing drug toxicity and
nephron loss. A negative biomarker result may carry valuable information
for improved patient management and planning of hospital resources. Early
identification of acute renal disease with rapid and robust biomarkers is
a critical first step towards improvement of patient outcomes. NGAL
appears to fulfil many characteristics of an appropriate "real-time"
biomarker for detection of acute renal disease. The development of NGAL as
biomarker in clinical studies is advanced. NGAL may be used as entry
criterion for randomised controlled trials in acute renal disease.

<26>
Accession Number
70538914
Authors
Cholette J.M. Henrichs K.F. Alfieris G.M. Phipps R.P. Spinelli S.L.
Gensini F.J. Blumberg N.
Institution
(Cholette) Pediatrics, University of Rochester Medical Center, Rochester,
NY, United States
(Henrichs, Phipps, Spinelli, Blumberg) Pathology and Laboratory Medicine,
University of Rochester Medical Center, Rochester, NY, United States
(Alfieris, Gensini) Surgery, University of Rochester Medical Center,
Rochester, NY, United States
(Phipps) Environmental Medicine, University of Rochester Medical Center,
Rochester, NY, United States
Title
Washed red cells reduce the inflammatory response to transfusion in
pediatric cardiac surgery: Results of a randomized clinical trial.
Source
Transfusion. Conference: AABB Annual Meeting and CTTXPO 2011 San Diego,
CA United States. Conference Start: 20111022 Conference End: 20111025.
Conference Publication: (var.pagings). 51 (pp 18A), 2011. Date of
Publication: September 2011.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Children undergoing cardiac surgery with
cardiopulmonary bypass (CPB) are susceptible to additional inflammatory
and immunogenic insults from blood transfusions. We hypothesize that
washing red blood cells (RBC) and platelets transfused to these patients
will reduce post-operative transfusion-related immune modulation and
inflammation. Study Design/Methods: Prospective, randomized, controlled
clinical trial in a University hospital pediatric cardiac intensive care
unit. Children from birth to 17 years old undergoing cardiac surgery with
CPB were randomized to an unwashed or washed RBC and platelet transfusion
protocol for their surgery and postoperative care. All blood was
leukoreduced, irradiated, and ABO identical. Plasma was obtained for
laboratory analysis: pre-op, immediately, six and 12 hours after CPB.
Primary outcome was the 12-hour post-CPB IL-6 : IL-10 ratio. Secondary
measures were post-op levels of IL-6, IL-10, C-reactive protein (CRP) and
clinical outcomes. Analysis was by intention to treat limited to patients
actually receiving transfusions. Results/ Findings: 162 subjects were
studied, 81 per group. 34 subjects (17 per group) did not receive any
blood transfusions. Storage duration of blood products was similar between
groups. Among transfused subjects, the 12-hour IL6 : IL10 ratio was
significantly lower in the washed group (3.8 v. 4.8; p = 0.04) secondary
to lower IL-6 levels (post-CPB: 65 v.100 pg/ml; p = 0.06; 6 hour: 89 v.152
pg/ml; p = 0.02; 12-hour: 84 v.122 pg/ml; p = 0.09). Day 1 post-operative
CRP was decreased in subjects receiving washed red cells (38 v. 43 mg/L; p
= 0.03). There was a numerical, but not statistically significant decrease
in total blood component transfusions (203 v. 260) and mortality (2 [3%]
v. 6 [9%] deaths) in the washed group compared to the unwashed group.
Fewer than 5% of patients received any plasma or platelet transfusions in
either arm of the study. Conclusion: Washed transfusions in cardiac
surgery reduced inflammatory biomarkers, number of transfusions, donor
exposures, and were associated with a nonsignificant trend towards reduced
mortality. These findings are the first proof that the inflammatory
response to transfusion can be mitigated by washed red cell transfusions.
In addition, these data demonstrate that routine transfusion of plasma and
platelets in neonates and children undergoing cardiac surgery with bypass
is not needed to achieve low rates of mortality. A larger study powered to
test for clinical outcomes is needed to determine whether these laboratory
findings are clinically significant.

<27>
Accession Number
70538865
Authors
Doronzio A. Stazi E. Titi L. Cianchi A. Rosa G. Bilotta F.
Institution
(Doronzio, Stazi, Titi, Cianchi, Rosa, Bilotta) Sapienza University of
Rome, Policlinico Umberto I, Rome, Italy
Title
Pharmacologic perioperative brain neuroprotection: A systematic review and
meta-Analysis of randomized clinical trials.
Source
Journal of Neurosurgical Anesthesiology. Conference: 39th Annual Meeting
of the Society for Neuroscience in Anesthesiology and Critical Care
Chicago, IL United States. Conference Start: 20111014 Conference End:
20111014. Conference Publication: (var.pagings). 23 (4) (pp 451-452),
2011. Date of Publication: October 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Perioperative cerebral damage may be associated with surgery
and anesthesia. Several pharmacological and nonpharmacological therapies
for perioperative brain neuroprotection have been tested in clinical
trials with conflicting results. Objective: To assess the efficacy of
tested therapies in terms of reduction of new neurologic deficit and/or
cognitive decline and mortality rate. Methods: We searched the Cochrane
Library; Ovid MEDLINE; Ovid EMBASE (1980 to December 2010) and reference
lists of all retrieved articles. Prospective randomized controlled
clinical trials using any pharmacologic therapies for perioperative brain
neuroprotection were selected. Results: Of 5904 identified studies, 25
randomized trials met our inclusion criteria. Tested therapies were:
lidocaine, thiopental, S(+)- ketamine, propofol, nimodipine, GM1
ganglioside, lexipafant, glutamate/ aspartate and xenon remacemide,
atorvastatin, magnesium, erythropoietin, piracetam, rivastigmine,
pegorgotein and 17b-estrdiol. Global RR analysis showed no differences in
the rate of new neurologic deficit/cognitive decline between treated and
nontreated patients. Drugbased RR analysis showed that magnesium sulfate
effectively reduces postoperative neurologic deficit/cognitive decline
(RR: 0.48 95%CI 0.27- 0.85, I2=0%, P=0.01). According to the results
reported in the original studies, evidences of benefits are reported for 5
out of the 17 drugs tested: lidocaine, remacemide, erythropoietin,
piracetam and atorvastatin. Thiopental, ketamine, propofol, nimodipine,
GM1Ganglioside,lexipafant, glutamate/ aspartate enriched crystalloid
cardioplegia, xenon-based anesthesia, rivastigmine, pegorgotein and
17b-estrdiol have not shown neuroprotectant effects. Conclusions:
Magnesium sulfate can effectively reduces perioperative cerebral damage
and some studies support a neuroprtotectant effect of lidocaine,
remacemide, erythropoietin, piracetam and atorvastatin. More extensive
research and wider consensus on the methodological approach for
perioperative neurocognitive functional evaluation is needed.