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<1>
Accession Number
2011523112
Authors
Loomba R.S. Shah P.H. Chandrasekar S.
Institution
(Loomba) Department of Pediatrics, 9000 Wisconsin Avenue, Wauwatosa, WI
53226, United States
(Shah) Department of Medicine, 836 West Wellington Avenue, Chicago, IL,
United States
(Chandrasekar) Department of Pediatrics, 3333 N Green Bay Road, North
Chicago, IL, United States
Title
Short-term outcome comparison of Norwood procedures with right ventricle
to pulmonary artery conduit versus modified Blalock-Taussig shunt: A
meta-analysis.
Source
Annals of Pediatric Cardiology. 4 (2) (pp 145-149), 2011. Date of
Publication: 01 Jul 2011.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
A small number of nonrandomized and retrospective studies have compared
outcomes of classical Norwood procedures for hypoplasticleft-heart
syndrome and single ventricle lesions involving a Blalock-Taussig (BT)
shunt to the modified procedure using a right ventricle to pulmonary
artery conduit. Some of these studies reported data for the same outcomes
and a meta-analysis was done to analyze pooled outcomes comparing
in-hospital mortality, interstage mortality, cardiopulmonary bypass time,
systolic and diastolic blood pressures 24 h postoperatively, length of
intensive care and hospital stay, and need for postoperative
extracorporeal membrane oxygenation. Right ventricle to pulmonary artery
conduit was associated with an insignificant reduction of in-hospital
mortality (odds ratio, 0.674, 95% confidence interval, 0.367 to 1.238),
and in the length of hospital stay. There were significant reductions in
cardiopulmonary bypass time, length of intensive care unit stay, and need
for postoperative extracorporeal membrane oxygenation, postoperative
ventilation times, and interstage mortality (odds ratio, 0.191, confidence
interval, 0.0620 to 0.587). There was a significant increase in diastolic
blood pressure and an insignificant increase in systolic blood pressure 24
h postoperatively. This pooled analysis demonstrates potential advantages
associated with the right ventricle to pulmonary artery conduit when
compared to the modified BT shunt in palliation and demonstrates the need
for large randomized controlled trials that compare a number of outcomes
in both procedures.

<2>
Accession Number
2011521781
Authors
Masoumi G. Hidarpour E. Tabae A.S. Ziayeefard M. Azarasa A. Abneshahidi A.
Anbardan S.J. Kashefi P.
Institution
(Masoumi) Assistant Professor, Department of Cardiac Anesthesiology,
Shahid Rajaee Hospital, Isfahan University of Medical Science, Isfahan,
Iran, Islamic Republic of
(Hidarpour) Professor, Department of Cardiac Anesthesiology, Tehran
University of Medical Science, Tehran, Iran, Islamic Republic of
(Tabae) Assistant Professor, Department of Cardiac Surgery, Tehran
University of Medical Science, Tehran, Iran, Islamic Republic of
(Ziayeefard) Assistant Professor, Department Of Anesthesiology, Tehran
University of Medical Science, Tehran, Iran, Islamic Republic of
(Azarasa) Assistant Professor, Department of Cardiac Anesthesiology,
Ghazvin University of Medical Science, Ghazvin, Iran, Islamic Republic of
(Abneshahidi) Assistant Professor, Department of Anesthesiology, Isfahan
University of Medical Science, Isfahan, Iran, Islamic Republic of
(Anbardan) Medical Student, Tehran University of Medical Science, Tehran,
Iran, Islamic Republic of
(Kashefi) Asociated Professor, Department of anesthesiology, Isfahan
University of Medical Science, Isfahan, Iran, Islamic Republic of
Title
Evaluating hemodynamic outcomes of different dosages of intravenous
nitroglycerin after coronary artery bypass graft surgery.
Source
Journal of Research in Medical Sciences. 16 (7) (pp 910-915), 2011. Date
of Publication: July 2011.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Hemodynamic deterioration is a common postoperative problem.
Intravenous nitroglycerin (NTG) is used for prevention of this
complication. Nitroglycerin has different doses and is primarily a
vasodilator. Applying different doses of intravenous NTG can induce
different effects on post-operative cardiac instability, so we aimed to
investigate whether there was a difference need for administration of
inotrope drugs in patients undergoing CABG as indicators of cardiac
instability. METHODS: Sixty seven consecutive patients enrolled in this
double-blind clinical trial performed in Shahid Rajaee hospital, Shahid
Beheshti University of Medical Science, Tehran, Iran. RESULTS: The
decrease in blood pressure and the need for administration of epinephrine
was more prevalent in warming up period in all three groups. No need for
administration of epinephrine was detected before and during anesthesia in
groups receiving 100 and 150 mug/min intravenous nitroglycerin, but 6.6
percent (1 patient) of patients receiving 50 mug/min epinephrine,
demonstrated a decrease in blood pressure which necessitated the use of
epinephrine. CONCLUSIONS: It seemed that application of different doses of
intravenous nitroglycerin did not exert a significant influence on cardiac
instability and the need for use of inotrope drugs.

<3>
Accession Number
2011503533
Authors
Rossi M. Jayaram R. Sayeed R.
Institution
(Rossi, Sayeed) Department of Cardiothoracic Surgery, John Radcliffe
Hospital, Oxford OX3 9DU, United Kingdom
(Jayaram) Department of Cardiovascular Medicine, University of Oxford,
Oxford OX3 9DU, United Kingdom
Title
Do patients with haemophilia undergoing cardiac surgery have good surgical
outcomes?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (3) (pp 320-331),
2011. Date of Publication: September 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 patients with
haemophilia undergoing cardiac surgery have good surgical outcomes.
Haemophilia A and haemophilia B are sex-linked recessive inherited
diseases affecting males only, with females acting as carriers. The
conditions result in various degrees of factor VIII or factor IX
deficiency, respectively. The life expectancy of haemophilia patients is
increasing and now approaches that of the general male population, and
they are confronted with age-related co-morbidity, including ischaemic
cardiovascular disease. Replacement of the deficient factor (VIII for
haemophilia A and IX for haemophilia B) is the cornerstone of treatment;
other therapeutic options include tranexamic acid, desmopressin and
aprotinin. Recently, the advent of recombinant factor VIII and IX has
eliminated the infective risk of using factor concentrates, such as
prothrombin complex concentrate or fresh frozen plasma. A total of 84
papers were found using the reported search criteria, and out of this 25
papers, selected with reference to a more modern date range, provided 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 were tabulated. We conclude that there is lack of
good-quality evidence and that, in all probability, these papers are
subject to publication bias as poor outcomes are unlikely to have been
reported. However, all the reported series showed that good outcomes are
possible in this specific subgroup of patients given the correct approach.
The data accrued from these studies (a total of 30 adults and three
children) suggest that routine cardiac surgery can be performed safely in
patients with haemophilia, with minimal morbidity and mortality. We
identified the following key points to achieve this result: a team
approach, a factor replacement protocol and perioperative monitoring of
factor levels. Intraoperative plasma factor levels can be easily measured
before heparin and after protamine sulphate administration, whereas during
cardiopulmonary bypass this will require a chromogenic method. Exposure to
factor concentrates early in the life might predispose a patient with
severe haemophilia to the development of inhibitors. Moreover, the absence
of inhibitors should be confirmed before any surgical procedure. 2011 by
European Association for Cardio-thoracic Surgery. All rights reserved.

<4>
Accession Number
2011503532
Authors
Sadaba J.R. Urso S.
Institution
(Sadaba) Department of Cardiac Surgery, Hospital de Navarra, Irunlarrea 3,
31008 Pamplona, Spain
(Urso) Fundacion Jimenez Diaz, Madrid, Spain
Title
Does the introduction of duty-hour restriction in the United States
negatively affect the operative volume of surgical trainees?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (3) (pp 316-319),
2011. Date of Publication: September 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Over the last few years, both sides of the North Atlantic have witnessed
compulsory duty-hour restrictions for doctors. It has been suggested that
the reduction in working hours for surgeons in training may have a
negative impact on their exposure to surgical procedures and therefore, on
the quality of training. A best evidence topic in cardiac surgery was
written according to a structured protocol. The question addressed was:
among surgeons enrolled in a training program, does the introduction of
duty-hour restrictions have a negative impact on their exposure to
surgical procedures and therefore, on the quality of training? In total,
more than 74 papers were found using the reported search, of which 15
represented the best evidence to answer the question. All these
manuscripts came from the USA. The authors, journal, date and country of
publication, group studied, study type, relevant outcomes and results of
these papers are tabulated. Studies from different surgical disciplines,
such as general, orthopedic, pediatric, cardiothoracic and vascular
surgery were included. Among the studies analysed, eight revealed a
decrease, five showed no change, and two studies demonstrated an increase
in the operative experience of residents following the introduction of the
80-hour limit. The changes appear to have more negatively affected junior
residents in favor of more senior ones due to a shift in the surgical
workload to the latter. Interestingly, some studies demonstrated better
results in the in-training examinations (testing for clinical and basic
science knowledge) following the duty-hour restrictions. We conclude that
although most of the studies included in this review revealed that the
introduction of working-hour restrictions in the USA has produced a
decrease in number of cases performed by trainees, some have failed to do
so. Changes in the residents' working patterns, such as 'night float' and
'leave early' models, may be useful to preserve exposure to surgical
procedures. 2011 Published by European Association for Cardio-Thoracic
Surgery. All rights reserved.

<5>
Accession Number
2011503522
Authors
Brika A. Salema A.-M. Shoukryb A. Shoumanc W.
Institution
(Brika, Salema) Department of Cardiothoracic Surgery, Zagazig University
Hospital, 33 Port Said St, Belbies, Sharqia, Zagazig, Egypt
(Shoukryb) Department of Internal Medicine, Zagazig University Hospital,
Zagazig, Egypt
(Shoumanc) Department of Pulmonary Diseases, Zagazig University Hospital,
Zagazig, Egypt
Title
Surgery for hemoptysis in various pulmonary tuberculous lesions: A
prospective study.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (3) (pp 276-279),
2011. Date of Publication: September 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Hemoptysis due to pulmonary tuberculous lesions is a common cause of
morbidity, and occasionally mortality. The aim of this study is to
evaluate the surgical outcome of hemoptysis in patients with various
tuberculous pulmonary lesions. A total of 45 cases who underwent surgical
procedures for various pulmonary tuberculous lesions with hemoptysis were
included in this study. Sixteen patients underwent surgical management
within one week of the attack of hemoptysis (group A), the other 29
patients underwent surgery one week after the attack (group B). Hemoptysis
was classified into minor, major and massive hemoptysis. Major and massive
hemoptysis were the common presentation of group A and tuberculous
cavities were the most common lung lesions in both groups (37.7%).
Lobectomy was the main surgical procedure performed in both groups
(51.1%). Bronchopleural fistula occurred in one case in each group after
right pneumonectomy. There was one case (6.2%) of mortality in group A.
Tuberculous cavity is the common pulmonary lesion which can result in
major and massive hemoptysis, therefore, we recommend early surgical
resection of tuberculous cavities to avoid life-threatening hemoptysis.
Limited resection should be avoided to prevent recurrence. 2011 Published
by European Association for Cardio-Thoracic Surgery. All rights reserved.

<6>
Accession Number
2011526930
Authors
Turchetta A. Fintini D. Cafiero G. Calzolari A. Giordano U. Cutrera R.
Morini F. Braguglia A. Bagolan P.
Institution
(Turchetta, Fintini, Cafiero, Calzolari, Giordano) Cardiorespiratory and
Sport Medicine Unit, Cardiology and Cardiac Surgery Department, Bambino
Gesu Children's Hospital, Pzza S. Onofrio, 4, 00165 Rome, Italy
(Cutrera) Pneumology Unit, Pediatric Medicine Department, Bambino Gesu
Children's Hospital, Rome, Italy
(Morini, Braguglia, Bagolan) Neonatal Intensive Care and Surgery Unit,
Neonatology Department, Bambino Gesu Children's Hospital, Rome, Italy
Title
Physical activity, fitness, and dyspnea perception in children with
congenital diaphragmatic hernia.
Source
Pediatric Pulmonology. 46 (10) (pp 1000-1006), 2011. Date of
Publication: October 2011.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
We assessed whether physical activity could influence the performance and
perception of dyspnea in children who were operated on for high risk
congenital diaphragmatic hernia (CDH). We hypothesized that CDH children
with normal activity would have better lung function and exercise
performance level when compared to sedentary CDH subjects. We studied 18
children (11 males and 7 females, mean age 6.6+/-2.6 years) who were
surgically corrected. All children underwent physical examination, ECG at
rest, and a maximal exercise stress test on a treadmill to measure the
duration of exercise, maximal heart rate and blood pressure, maximal
oxygen uptake (VO₂max and VO ₂ml/kg/min). Lung
function testing to measure forced vital capacity (FVC), forced expiratory
volume in 1sec (FEV₁), and peak expiratory flow (PEF) was also
performed. Following the stress test, the Dalhousie dyspnea and effort
scale was shown to children as a pictorial panel with three groups of
increasing (from 1 to 7) levels of effort perception, throat discomfort,
and chest dyspnea. Children were divided into group A (sedentary) and
group B (regular physical participation). There was no difference in CDH
severity between the two groups. Group A had a statistically significant
lower duration of exercise (P<0.01), maximal oxygen consumption
(VO₂max P<0.0001), VO₂ml/kg/min (P<0.001), higher
throat closing feeling (P<0.004), chest dyspnea (P<0.001), and effort
perception (P<0.04) compared to group B. No differences were found in lung
function tests. In conclusion, our data may suggest that children with a
history of CDH who are active maintain a higher level of performance with
less perception of dyspnea and effort. Copyright 2011 Wiley-Liss, Inc.

<7>
Accession Number
2011522954
Authors
Rideg O. Komcsi A. Magyarlaki T. Tkes-Fuzesi M. Miseta A. Kovcs G.L. Aradi
D.
Institution
(Rideg, Magyarlaki, Tkes-Fuzesi, Miseta, Kovcs) Institute of Laboratory
Medicine, University of Pecs, 13 Ifjsg Street, H-7624, Pecs, Hungary
(Komcsi, Aradi) Department of Interventional Cardiology, Heart Institute,
University of Pecs, Pecs, Hungary
Title
Impact of genetic variants on post-clopidogrel platelet reactivity in
patients after elective percutaneous coronary intervention.
Source
Pharmacogenomics. 12 (9) (pp 1269-1280), 2011. Date of Publication:
September 2011.
Publisher
Future Medicine Ltd. (2nd Albert Place, Finchley Central, London N3 1QB,
United Kingdom)
Abstract
Aim: To determine the effect of various SNPs on post-clopidogrel platelet
reactivity and clinical outcome. Materials & methods: Cytochrome 2C19
(CYP2C19) loss-of-function (LOF; *2, *3) and gain-of-function (GOF; *17)
allelic variants, together with ABCB1 (3435 C->T and 2677 G->T/A) and
paraoxonase-1 (PON-1; 192 Q->R) SNPs were analyzed in 189 patients after
elective stent implantation who participated in a randomized,
placebo-controlled trial (NCT00638326). Platelet reactivity was determined
with light transmission aggregometry and vasodilator stimulated
phosphoprotein phosphorylation (VASP-PRI) 12-24 h after 600 mg
clopidogrel. High on-treatment platelet reactivity (HTPR) was defined
according to the consensus definition (ADP 5 M >46%; VASP-PRI>50%).
Results: In the case of CYP2C19 genotypes, a gene-dose effect was observed
in ADP reactivity with the lowest values in GOF homozygotes and the
highest degree in patients carrying two LOF alleles. The odds for HTPR
also increased with the number of LOF alleles. There were no significant
differences in platelet reactivity according to PON-1 or ABCB1 genotypes.
In multivariate analysis, the presence of a CYP2C19 LOF allele turned out
to be the independent determinant of HTPR. Although the study was not
powered to clinical outcome (not LOF heterozygotes), only patients with
two LOF alleles had a significantly higher risk for cardiovascular death,
myocardial infarction or unplanned target vessel revascularization at 1
year compared with non-LOF carriers. Conclusion: Genetic variants in
CYP2C19 have a gene-dose effect on post-clopidogrel platelet reactivity,
with homozygote LOF carriers having the highest risk for HTPR and for
adverse ischemic events. Neither ABCB1 nor PON-1 genotypes significantly
influenced platelet reactivity or outcome. Original submitted 28 February
2011; Revision submitted 5 May 201. 2011 Future Medicine Ltd.

<8>
Accession Number
2011532024
Authors
Baradari A.G. Habibi M.R. Khezri H.D. Aarabi M. Khademloo M. Jalali Z.
Ghafari R.
Institution
(Baradari, Habibi) Department of CardicAnestesia, Mazandaran University of
Medical Sciences, Sari, Iran, Islamic Republic of
(Khezri) Faculty of Nursing and Midwif y, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Aarabi) Cardiovascular Research Center, Golestan University of Medical
Sciences, Gorgan, Iran, Islamic Republic of
(Khademloo, Jalali) Faculty of Medicine, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Ghafari) Department of Cardiac Surgery, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Title
Does high-dose metformin cause lactic acidosis in type 2 diabetic patients
after CABG surgery? A double blind randomized clinical trial.
Source
Heart International. 6 (1) (pp 26-30), 2011. Date of Publication: 2011.
Publisher
PAGEPress (4,Giuseppe Belli, Pavia 27100, Italy)
Abstract
Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic
acidosis due to metformin is a fatal metabolic condition that limits its
use in patients in poor clinical condition, consequently reducing the
number of patients who benefit from this medication. In a double blind
randomized clinical trial, we investigated 200 type 2 diabetic patients
after coronary artery bypass surgery in the open heart ICU of the
Mazandaran Heart Center, and randomly assigned them to equal intervention
and control groups. The intervention group received regular insulin
infusion along with 2 metformin 500 mg tablets every twelve hours, while
the control group received only intravenous insulin with 2 placebo tablets
every twelve hours. Lactate level, pH, base excess, blood glucose and
serum creatinine were measured over five 12 h periods, with data averaged
for each period. The primary outcome in this study was high lactate
levels. Comparison between the 2 groups was made by independent Student's
t-test. To compare changes in multiple measures in each group and analysis
of group interaction, a repeated measurement ANOVA test was used. There
was no significant difference between the 2 groups regarding pH, base
excess, or bicarbonate intake (P>0.05). No patient showed lactic acidosis
in either group. Lactate levels were 23.0 vs 23.4 in the insulin-metformin
and insulin only groups when the study was started, respectively. At the
end of the study, those levels were 18.7 vs 18.9, respectively. In
addition, the ANOVA repeated measurement test did not show a significant
difference in terms of changes in the amount of lactate level between the
2 groups during the five measurement tests of the study period (P>0.05).
High-dose metformin (1,000 mg twice daily with insulin) does not cause
lactic acidosis in type 2 diabetic patients after coronary artery bypass
surgery. A.G. Baradari et al., 2011.

<9>
Accession Number
2011529072
Authors
Garcia Franco C.E. Perez-Cajaraville J. Guillen-Grima F. Espana A.
Institution
(Garcia Franco) General Thoracic Surgery Department, Hospital
Universitario Nuestra Senora de Candelaria, Tenerife, Spain
(Perez-Cajaraville, Espana) Hyperhidrosis and Facial Blushing Unit,
Clinica Universidad de Navarra, Navarra, Spain
(Guillen-Grima) Department of Preventive Medicine, Clinica Universidad de
Navarra, Navarra, Spain
Title
Prospective study of percutaneous radiofrequency sympathicolysis in severe
hyperhidrosis and facial blushing: Efficacy and safety findings.
Source
European Journal of Cardio-thoracic Surgery. 40 (4) (pp e146-e151), 2011.
Date of Publication: October 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Hyperhidrosis (Hh) and facial blushing (Fb) are conditions
caused by hyperactivity of the sympathetic system; they affect around 2%
of the population. Severe cases have been typically treated with thoracic
sympathectomy through a minimally invasive approach. We sought to
determine if severe Hh and/or Fb patients, who are reluctant to go through
an operation with general anaesthesia, could benefit from receiving
percutaneous radiofrequency ablation of the sympathetic chain. Methods:
Prospectively collected data obtained from May 2007 to May 2010 were
analysed to compare the treatment efficacy and effects on quality of life
of the two procedures. Results: From a total of 58 patients enrolled in
the study, 31 were treated with radiofrequency procedures, whereas 27
received surgical sympathectomy. Patients with Hh had better results with
surgery than with radiofrequency sympathicolysis in terms of efficacy
(p=0.0001) and quality of life (p=0.0002). However, there was still a
significant improvement in quality of life in the group of patients
treated with radiofrequency sympathicolysis (p=0.004). Patients with Fb
had good results with surgical procedures and poor outcomes with
radiofrequency ablation, resulting in significant differences in treatment
efficacy (p=0.005) and in quality of life (p=0.003). Fb patients treated
with radiofrequency procedures had no improvement in quality of life after
the intervention (p=0.28). Conclusion: Our results support the view of
surgical sympathectomy as the gold-standard treatment in severe cases of
Hh and Fb. Radiofrequency sympathicolysis is useful as a second-treatment
choice for Hh patients. Fb patients do not benefit from radiofrequency
sympathicolysis. 2011 European Association for Cardio-Thoracic Surgery.

<10>
Accession Number
2011524800
Authors
Byrne R.A. Kastrati A. Massberg S. Wieczorek A. Laugwitz K.-L. Hadamitzky
M. Schulz S. Pache J. Fusaro M. Hausleiter J. Schomig A. Mehilli J.
Institution
(Byrne, Kastrati, Massberg, Wieczorek, Hadamitzky, Schulz, Pache, Fusaro,
Hausleiter, Schomig, Mehilli) ISARESEARCH Centre, Deutsches Herzzentrum,
Technische Universitat, Lazarettstrasse 36, 80636 Munich, Germany
(Laugwitz, Schomig) Medizinische Klinik, Klinikum Rechts der Isar,
Technische Universitat, Munich, Germany
Title
Biodegradable polymer versus permanent polymer drug-eluting stents and
everolimus- versus sirolimus-eluting stents in patients with coronary
artery disease: 3-year outcomes from a randomized clinical trial.
Source
Journal of the American College of Cardiology. 58 (13) (pp 1325-1331),
2011. Date of Publication: 20 Sep 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The aim of this study was to compare the 3-year efficacy and
safety of biodegradable polymer with permanent polymer stents and of
everolimus-eluting stents (EES) with sirolimus-eluting stents (SES).
Background: Biodegradable polymer drug-eluting stents (DES) offer
potential for enhanced late outcomes in comparison with permanent polymer
stents. In addition, there is increasing interest in the comparison of EES
(Xience, Abbott Vascular, Abbott Park, Illinois) versus SES (Cypher,
Cordis Corporation, Miami Lakes, Florida). Methods: The ISAR-TEST 4
(Intracoronary Stenting and Angiographic Results: Test Efficacy of 3
Limus-Eluting Stents-4) was a randomized clinical trial with broad
inclusion criteria, enrolling 2,603 patients at 2 clinics in Munich,
Germany. Patients were randomized to either biodegradable polymer (n =
1,299) or permanent polymer stents (n = 1,304); patients treated with
permanent polymer stents were randomly allocated to EES (n = 652) or SES
(n = 652). The primary endpoint was the composite of cardiac death, target
vessel-related myocardial infarction, or target lesion revascularization.
Results: Clinical events continued to accrue at a low rate out to 3 years
in all groups. Overall, there was no significant difference between
biodegradable polymer and permanent polymer DES with regard to the primary
endpoint (20.1% vs. 20.9%, hazard ratio [HR]: 0.95, 95% confidence
interval [CI]: 0.80 to 1.13; p = 0.59). Rates of definite/probable stent
thrombosis were also similar in both groups (1.2% vs. 1.7%, respectively;
HR: 0.71, 95% CI: 0.37 to 1.39; p = 0.32). In patients treated with
permanent polymer stents, EES were comparable to SES with regard to the
primary endpoint (19.6% vs. 22.2%, respectively; HR: 0.87, 95% CI: 0.68 to
1.11; p = 0.26) as well as definite/probable stent thrombosis (1.4% vs.
1.9%, HR: 0.75, 95% CI: 0.32 to 1.78; p = 0.51). Conclusions:
Biodegradable polymer and permanent polymer DES are associated with
similar clinical outcomes at 3 years. In addition, EES are comparable to
SES in terms of overall clinical efficacy and safety. (Intracoronary
Stenting and Angiographic Results: Test Efficacy of 3 Limus-Eluting STents
[ISAR-TEST 4]: Prospective, Randomized Trial of 3-limus Agent-eluting
Stents With Different Polymer Coatings; NCT00598676) 2011 American
College of Cardiology Foundation.

<11>
Accession Number
2011526140
Authors
Mehilli J. Pache J. Abdel-Wahab M. Schulz S. Byrne R.A. Tiroch K.
Hausleiter J. Seyfarth M. Ott I. Ibrahim T. Fusaro M. Laugwitz K.-L.
Massberg S. Neumann F.-J. Richardt G. Schomig A. Kastrati A.
Institution
(Mehilli, Pache, Schulz, Byrne, Hausleiter, Ott, Fusaro, Massberg,
Schomig, Kastrati) Deutsches Herzzentrum, Technische Universitat, 80636
Munich, Germany
(Ibrahim, Laugwitz, Schomig) 1 Medizinische Klinik, Klinikum Rechts der
Isar, Technische Universitat, Munich, Germany
(Tiroch, Seyfarth) Medizinische Klinik 3, Helios Kliniken Wuppertal,
Wuppertal, Germany
(Abdel-Wahab, Richardt) Herzzentrum der Segeberger Kliniken, Bad Segeberg,
Germany
(Neumann) Herz-Zentrum, Bad Krozingen, Germany
Title
Drug-eluting versus bare-metal stents in saphenous vein graft lesions
(ISAR-CABG): A randomised controlled superiority trial.
Source
The Lancet. 378 (9796) (pp 1071-1078), 2011. Date of Publication: 17 Sep
2011.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Background Comparative assessment of clinical outcomes after use of
drug-eluting stents versus bare-metal stents for treatment of
aortocoronary saphenous vein graft lesions has not been undertaken in
large randomised trials. We aimed to undertake a comparison in a
randomised trial powered for clinical endpoints. Methods In this
randomised superiority trial, patients with de-novo saphenous vein graft
lesions were assigned by computer-generated sequence (1:1:1:3) to receive
either drug-eluting stents (one of three types: permanent-polymer
paclitaxel-eluting stents, permanent-polymer sirolimus-eluting stents, or
biodegradable-polymer sirolimus-eluting stents) or bare-metal stents.
Randomisation took place immediately after crossing of the lesion with a
guidewire, and was stratifi ed for each participating centre.
Investigators assessing data were masked to treatment allocation; patients
were not masked to allocation. The primary endpoint was the combined
incidence of death, myocardial infarction, and target lesion
revascularisation at 1 year. Analysis was by intention to treat. This
trial is registered at ClinicalTrials.gov, number NCT00611910. Findings
610 patients were allocated to treatment groups (303 drug-eluting stent,
307 bare-metal stent). Drug-eluting stents reduced the incidence of the
primary endpoint compared with bare-metal stents (44 [15%] vs 66 [22%]
patients; hazard ratio [HR] 0*64, 95% CI 0*44-0*94; p=0*02). Target lesion
revascularisation rate was reduced by drug-eluting stents (19 [7%] vs 37
[13%] patients; HR 0*49, 95% CI 0*28-0*86; p=0*01). No signifi cant diff
erences were seen between drug-eluting stents and bare-metal stents
regarding all-cause mortality (15 [5%] vs 14 [5%] patients; HR 1*08, 95%
CI 0*52-2*24; p=0*83), myocardial infarction (12 [4%] vs 18 [6%]; HR 0*66,
95% CI 0*32-1*37; p=0*27), or defi nite or probable stent thrombosis (2
[1%] in both groups; HR 1*00, 95% CI 0*14-7*10; p=0*99). Interpretation In
patients undergoing percutaneous coronary intervention for de-novo
saphenous vein graft lesions, drug-eluting stents are the preferred
treatment option because they reduce the risk of adverse events compared
with bare-metal stents. Funding Deutsches Herzzentrum. 2011 Elsevier Ltd.

<12>
[Use Link to view the full text]
Accession Number
2011527534
Authors
Lahtinen P. Pitkanen O. Polonen P. Turpeinen A. Kiviniemi V. Uusaro A.
Institution
(Lahtinen, Pitkanen, Polonen, Uusaro) Departments of Anesthesiology and
Intensive Care, Kuopio University Hospital, Kuopio, Finland
(Kiviniemi) Departments of Internal Medicine, Kuopio University Hospital,
Kuopio, Finland
(Turpeinen) IT-Centre, University of Kuopio, Kuopio, Finland
Title
Levosimendan reduces heart failure after cardiac surgery: A prospective,
randomized, placebo-controlled trial.
Source
Critical Care Medicine. 39 (10) (pp 2263-2270), 2011. Date of
Publication: October 2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Objective: To investigate whether levosimendan diminishes the incidence of
heart failure after cardiac surgery. Design: Prospective, randomized,
placebo-controlled clinical study. Setting: Cardiac surgery operating room
and postanesthesia care unit in a university hospital. Patients: Two
hundred patients assigned to undergo heart valve or combined heart valve
and coronary artery bypass grafting surgery. Interventions: Patients were
randomized to receive a 24-hr infusion of placebo or levosimendan
administered as a 24 mug/kg bolus over 30-mins and thereafter at a dose of
0.2 mug/kg/min. Measurements and Main Results: Heart failure was defined
as cardiac index <2.0 L/min/m or failure to wean from cardiopulmonary
bypass necessitating inotrope administration for at least 2 hrs
postoperatively. Heart failure was less frequent in the levosimendan
compared to the placebo group: 15 patients (15%) in the levosimendan and
59 patients (58%) in the placebo group experienced heart failure
postoperatively (risk ratio 0.26; 95% confidence interval 0.16-0.43; p <
.001). Accordingly, a rescue inotrope (adrenaline) was needed less
frequently in the levosimendan compared to the placebo group (risk ratio
0.11; 95% confidence interval 0.01-0.89), p = .005. Intra-aortic balloon
pump was utilized in one patient (1%) in the levosimendan and in nine
patients (9%) in the placebo group (risk ratio 0.11; 95% confidence
interval 0.01-0.87), p = .018. The hospital and the 6-month mortality were
comparable between groups. There were no significant differences in major
organ failures postoperatively. Eighty-three patients were hypotensive and
needed noradrenaline in the levosimendan compared to 52 patients in the
placebo group, p < .001. The cardiac enzymes (creatine kinase MB isoenzyme
mass) indicating myocardial damage were lower in the levosimendan group on
the first postoperative day, p = .011. Conclusions: In the present study,
levosimendan infusion reduced the incidence of heart failure in cardiac
surgery patients but was associated with arterial hypotension and
increased requirement of vasopressor agents postoperatively. Improved
mortality or morbidity was not demonstrated. 2011 by the Society of
Critical Care Medicine and Lippincott Williams & Wilkins.

<13>
Accession Number
2011529036
Authors
Helms O. Mariano J. Hentz J.-G. Santelmo N. Falcoz P.-E. Massard G. Steib
A.
Institution
(Helms, Mariano, Hentz, Steib) Department of Anaesthesia and Intensive
Care Medicine, Strasbourg University Hospital, Strasbourg, France
(Santelmo, Falcoz, Massard) Department of Thoracic Surgery, Strasbourg
University Hospital, Strasbourg, France
Title
Intra-operative paravertebral block for postoperative analgesia in
thoracotomy patients: A randomized, double-blind, placebo-controlled
study.
Source
European Journal of Cardio-thoracic Surgery. 40 (4) (pp 902-906), 2011.
Date of Publication: October 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Epidural analgesia is the gold standard for post-thoracotomy
pain relief but is contraindicated in certain patients. An alternative is
paravertebral block. We investigated whether ropivacaine, administered
through a paravertebral catheter placed by the surgeon, reduced
postoperative pain. Methods: In a randomized double-blind study, adult
patients with a paravertebral catheter placed by the thoracic surgeon
after thoracotomy were randomly assigned to receive through this catheter,
either a 0.1mlkg^-1 bolus of 0.5% ropivacaine, followed by a
continuous infusion of 0.1mlkg^-1h^-1 for 48h, or
saline at the same scheme of administration. Patients also benefited from
patient-controlled analgesia with intravenous morphine (bolus 1mg, lockout
time 7min), paracetamol, and nefopam. The primary endpoint was pain
intensity on a visual analog scale at rest and on coughing. Secondary
endpoints were total morphine consumption and side effects during the
first 48 postoperative hours. Surgeons, anesthesiologists, and all the
nurses and caring staff involved in this study were blinded. Solutions of
saline and ropivacaine were prepared identically by the central pharmacy,
without any possible identification of the product. Results: Forty-seven
patients with contraindications to epidural anesthesia were included.
There were no significant differences between the groups receiving
ropivacaine and saline in terms of pain severity at rest and on coughing,
mean postoperative morphine consumption (45.7mg for ropivacaine, 43.2mg in
controls), and incidence of morphine-related side effects (nausea and
vomiting, urinary retention, pruritus, respiratory rate, and sedation).
Conclusions: Paravertebral block using a catheter placed by the thoracic
surgeon was ineffective on postoperative pain after thoracotomy and did
not confirm the analgesic effect that has been observed after percutaneous
catheter placement. A direct comparison of these two placement methods is
required. 2011 European Association for Cardio-Thoracic Surgery.

<14>
Accession Number
2011529037
Authors
Fibla J.J. Molins L. Mier J.M. Sierra A. Carranza D. Vidal G.
Institution
(Fibla, Molins, Mier, Carranza, Vidal) Department of Thoracic Surgery,
Hospital Universitari Sagrat Cor, C/Viladomat 288, 08029 Barcelona, Spain
(Sierra) Department of Anaesthesia, Hospital Universitari Sagrat Cor,
C/Viladomat 288, 08029 Barcelona, Spain
Title
The efficacy of paravertebral block using a catheter technique for
postoperative analgesia in thoracoscopic surgery: A randomized trial.
Source
European Journal of Cardio-thoracic Surgery. 40 (4) (pp 907-911), 2011.
Date of Publication: October 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: The analgesic scheme combining paravertebral block (PVB) and
intravenous non-steroidal anti-inflammatory drug (NSAID) has proven to be
effective for postoperative pain control after thoracotomy. The hypothesis
tested in this study was that this policy was also suitable to improve
pain control after video-assisted thoracic surgery (VATS). Methods: This
was a prospective randomized study on 40 patients submitted to
three-ports' VATS for pneumothorax or solitary pulmonary nodule. The
sample size was calculated to detect one point of minimum pain score
difference with 80% statistical power. Patients were randomly assigned to
two groups: (1) paravertebral block group (PVB) (n=20) - At the end of
surgery, a catheter was placed in patients in the thoracic paravertebral
space under camera control; they received a bolus of 15. ml of local
anesthetic (ropivacaine 0.2%) every 6. h, combined with endovenous
metamizol (1. g); and (2) alternate NSAIDs group (AN) (n=20) - They were
treated with paracetamol (1. g) combined with metamizol (1. g) every 6. h.
Subcutaneous meperidine (synthetic opioid) was employed as rescue drug.
Both groups were comparable in terms of age, sex, pathology, and
co-morbidity. Pain level was measured with the visual analog scale (VAS)
at 1, 6, 24, and 48. h. Results: No side effects related to any of the two
analgesic techniques were noted. Two patients needed rescue meperidine in
the AN group, and none in the PVB group. VAS scores were the following:
PVB group, VAS 1. h: 1.4 +/- 0.8, VAS 6. h: 3.4 +/- 1.2, VAS 24. h: 2.6
+/- 1.0, VAS 48. h: 2.2 +/- 0.9, and mean VAS: 2.4 +/- 1.3; AN group, VAS
1. h: 2.8 +/- 1.0, VAS 6. h: 4.9 +/- 1.3, VAS 24. h: 3.9 +/- 1.4, VAS 48.
h: 3.3 +/- 1.0, and mean VAS: 3.8 +/- 1.4. VAS scores were significantly
lower at any time in the PVB patients (p<0.01). Conclusions: The analgesic
regimen combining PVB and NSAID provided an excellent level of pain
control. Thoracoscopy assisted positioning of the paravertebral catheter
is simple and effective, and allows direct visualization of correct
delivery of local anesthetic. It represents a valuable addition to any
VATS procedure. 2011 European Association for Cardio-Thoracic Surgery.

<15>
Accession Number
2011511974
Authors
Lam O.L.T. Zhang W. Samaranayake L.P. Li L.S.W. McGrath C.
Institution
(Lam) Oral Rehabilitation 4/F, Prince Philip Dental Hospital, 34 Hospital
Road, Sai Ying Pun, Hong Kong
(Zhang, McGrath) Periodontology and Public Health 3/F, Prince Philip
Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong
(Samaranayake) Faculty Office 6/F, Prince Philip Dental Hospital, 34
Hospital Road, Sai Ying Pun, Hong Kong
(Li) Department of Rehabilitation Medicine, Tung Wah Hospital, 12 Po Yan
Street, Sheung Wan, Hong Kong
Title
A systematic review of the effectiveness of oral health promotion
activities among patients with cardiovascular disease.
Source
International Journal of Cardiology. 151 (3) (pp 261-267), 2011. Date of
Publication: 15 Sep 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Aims: This study aimed to review the effectiveness of oral health
promotion activities conducted among patients with cardiovascular disease.
Methods and results: Three electronic databases were searched for
effective papers using standardized search methods, and key findings of
effective studies were summarized. The initial search yielded 3101 papers
but only 8 studies met the criteria for this review: 3 were randomized
controlled studies, 3 were pre-/post group interventions, 1 was a
randomized split-mouth study, and 1 was a quasi-experimental study.
Studies retrieved concerned oral health promotion activities in patients
with coronary heart disease, hypertension, heart transplantation, and
stroke. Interventions comprised periodontal treatment performed by dental
personnel, and oral hygiene interventions provided by nursing home care
assistants. Outcomes included improvements in periodontal health, and
modifications of systemic inflammatory markers. No studies, however,
evaluated the effects of oral health promotion interventions on oral
microflora. Conclusion: There are limited studies on the efficacy of oral
health promotion activities in patients with cardiovascular disease,
particularly stroke patients. Oral health promotion activities appear to
produce improvements in periodontal health, and also result in changes to
systemic markers of inflammation and endothelial function (at least) in
the short term. Whether these effects can ultimately lower the risk of
secondary cardiovascular events has not yet been determined. 2010
Elsevier Ireland Ltd. All rights reserved.

<16>
Accession Number
2011528610
Authors
Camm C.F. Nagendran M. Xiu P.Y. Maruthappu M.
Institution
(Camm) New College, University of Oxford, Holywell Street, Oxford OX1 3BN,
United Kingdom
(Nagendran, Maruthappu) Green Templeton College, University of Oxford,
Woodstock Road, Oxford OX2 6HG, United Kingdom
(Xiu) School of Clinical Medicine, Cambridge University, Addenbrookes
Hospital, Cambridge CB2 0QQ, United Kingdom
Title
How effective is cryoablation for atrial fibrillation during concomitant
cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (4) (pp 410-414),
2011. Date of Publication: September 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether performing
cryoablative procedures during concomitant cardiac surgical procedures is
effective for the treatment of atrial fibrillation (AF). Altogether 291
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. All studies showed
that cryoablation during concomitant surgery had a significant effect on
return to sinus rhythm (SR) conversion rate. One study showed that
cryoablation was significantly more effective than mitral valve surgery
alone at a 12-month follow-up (73.3% vs. 42.9%, respectively, P=0.013).
The use of a concomitant cryoablative procedure has also been shown to be
far superior to subsequent catheter based cryoablation in returning
patients to SR at a 12-month follow-up (82% and 55.2%, respectively,
P<0.001). Another study showed a significant return to AF over a
three-year period (91.8% and 84.1% at discharge and three years,
respectively). Return to SR was significantly decreased in those patients
suffering from permanent rather than paroxysmal AF (47% vs. 85%, P<0.001).
Paucity of level 1 evidence was a major limitation to this analysis. All
nine papers were either small randomised controlled trials or
retrospective studies with small sample sizes (57-521) and varied
follow-up regimens. Six of nine studies suggested that cryoablation is
most successful in patients suffering from paroxysmal rather than
permanent AF. A lack of 24-h monitoring in seven of nine studies prevented
effective elucidation of the rate of paroxysmal AF following cryoablation.
Only one study suggested an increased complication rate from cryoablation,
however, none suggested any negative impact on mortality or morbidity. We
conclude that cryoablation during concomitant surgery is a safe and
acceptable intervention for the treatment of AF with an SR conversion rate
of between 60% and 82% at 12-months postsurgery. 2011 Published by
European Association for Cardio-Thoracic Surgery. All rights reserved.

<17>
Accession Number
2011528609
Authors
Urban M. Pirk J. Dorazilova Z. Netuka I.
Institution
(Urban, Pirk, Netuka) Department of Cardiac Surgery, Institute for
Clinical and Experimental Medicine, Videnska 1958/9, 14021 Prague, Czech
Republic
(Dorazilova) Department of Cardiology, Institute for Clinical and
Experimental Medicine, Videnska 1958/9, 14021 Prague, Czech Republic
Title
How does successful bridging with ventricular assist device affect cardiac
transplantation outcome?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (4) (pp 405-409),
2011. Date of Publication: September 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 issue was to determine the impact of
bridge-to-transplant ventricular assist device support on survival after
cardiac transplantation. Altogether 428 papers were found using the
reported search, of which 12 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. The treatment options for patients with advanced
heart failure or those with deteriorating end-organ function on maximal
medical therapy are limited to intravenous inotropes and mechanical
assistance with intra-aortic balloon pump (IABP) or ventricular assist
device (VAD). Studies exploring the effect of VADs on post-transplant
mortality have yielded conflicting results. The Registry of the
International Society for Heart and Lung Transplantation continues to
identify mechanical support as a risk factor for decreased survival after
transplantation. A limitation of this report is that the multivariable
adjustment uses variables recorded not at the time of device implant but
at the time of transplant. Some of the recipient characteristics thus may
be altered by the device implant. Compared with the previous reports the
latest data show improvement in post-transplant survival in the recent
era. In addition, the excess risk appears to be limited to the early
post-transplant period. Experienced centers consistently report
outstanding post-transplant results with left ventricular assist device
(LVAD) bridging. Of the 12 papers seven showed no difference in survival,
and five showed a reduced survival. In the papers showing no difference,
one year survival averaged from 85% in supported patients to 87% in
non-supported patients. In papers reporting a difference in outcome, one
year averaged survival was 74% in LVAD recipients compared to 90% in
non-bridged patients. Decreased survival is associated with patients
suffering from dilated cardiomyopathy, transplanted within two weeks of
LVAD implantation and bridged to transplantation before 2003 as opposed to
patients transplanted more recently. Based on the available evidence we
conclude that in selected patients survival after heart transplantation in
patients bridged with VAD is comparable to those who did not receive the
device. 2011 Published by European Association for Cardio-Thoracic
Surgery. All rights reserved.

<18>
Accession Number
2011533519
Authors
Aune E. Roislien J. Mathisen M. Thelle D.S. Otterstad J.E.
Institution
(Aune, Otterstad) Department of Cardiology, Vestfold Hospital Trust,
Tonsberg, Norway
(Roislien, Thelle) Department of Biostatistics, Institute of Basic Medical
Sciences, University of Oslo, Oslo, Norway
(Roislien) Morbid Obesity Centre, Vestfold Hospital Trust, Tonsberg,
Norway
(Mathisen) Medical Library, Vestfold Hospital Trust, Tonsberg, Norway
Title
The "smoker's paradox" in patients with acute coronary syndrome: A
systematic review.
Source
BMC Medicine. 9 , 2011. Article Number: 97. Date of Publication: 23
Aug 2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Smokers have been shown to have lower mortality after acute
coronary syndrome than non-smokers. This has been attributed to the
younger age, lower co-morbidity, more aggressive treatment and lower risk
profile of the smoker. Some studies, however, have used multivariate
analyses to show a residual survival benefit for smokers; that is, the
"smoker's paradox". The aim of this study was, therefore, to perform a
systematic review of the literature and evidence surrounding the existence
of the "smoker's paradox".Methods: Relevant studies published by September
2010 were identified through literature searches using EMBASE (from 1980),
MEDLINE (from 1963) and the Cochrane Central Register of Controlled
Trials, with a combination of text words and subject headings used.
English-language original articles were included if they presented data on
hospitalised patients with defined acute coronary syndrome, reported at
least in-hospital mortality, had a clear definition of smoking status
(including ex-smokers), presented crude and adjusted mortality data with
effect estimates, and had a study sample of > 100 smokers and > 100
non-smokers. Two investigators independently reviewed all titles and
abstracts in order to identify potentially relevant articles, with any
discrepancies resolved by repeated review and discussion.Results: A total
of 978 citations were identified, with 18 citations from 17 studies
included thereafter. Six studies (one observational study, three
registries and two randomised controlled trials on thrombolytic treatment)
observed a "smoker's paradox". Between the 1980s and 1990s these studies
enrolled patients with acute myocardial infarction (AMI) according to
criteria similar to the World Health Organisation criteria from 1979.
Among the remaining 11 studies not supporting the existence of the
paradox, five studies represented patients undergoing contemporary
management.Conclusion: The "smoker's paradox" was observed in some studies
of AMI patients in the pre-thrombolytic and thrombolytic era, whereas no
studies of a contemporary population with acute coronary syndrome have
found evidence for such a paradox. 2011 Aune et al; licensee BioMed
Central Ltd.

<19>
Accession Number
2011537667
Authors
Guasti L. Dentali F. Castiglioni L. Maroni L. Marino F. Squizzato A. Ageno
W. Gianni M. Gaudio G. Grandi A.M. Cosentino M. Venco A.
Institution
(Guasti, Dentali, Castiglioni, Maroni, Marino, Squizzato, Ageno, Gianni,
Gaudio, Grandi, Cosentino, Venco) Department of Clinical Medicine,
University of Insubria, Varese, Italy
Title
Neutrophils and clinical outcomes in patients with acute coronary
syndromes and/or cardiac revascularization: A systematic review on more
than 34,000 subjects.
Source
Thrombosis and Haemostasis. 106 (4) (pp 591-599), 2011. Date of
Publication: Oct 2011.
Publisher
Schattauer GmbH (Hoelderlinstr 3 Stuttgart D-70174, Germany)
Abstract
Some studies have suggested that high levels of total white blood cell
(WBC) count and C-reactive protein (CRP) may be considered as independent
prognostic factors in patients with acute coronary syndromes (ACS) and/or
after cardiac revascularisation by percutaneous coronary intervention or
coronary artery bypass grafting surgery. Evidence on the role of
neutrophils in cardiovascular disease is less compelling. Therefore, we
conducted a systematic review of the literature with the aim of
identifying all the available evidence to clarify the role of neutrophils
(absolute or relative count, neutrophil/lymphocyte ratio) as a prognostic
risk factor in patients with ACS and/or cardiac revascularisation. All
published studies evaluating the role of neutrophils as a risk factor for
clinical outcomes were assessed using the MEDLINE and EMBASE databases.
Study selection, data extraction and validity assessment was performed
independently by two reviewers. Twenty-one studies (17 of which had
positive results) for a total of more than 34,000 patients were included.
Ten of 13 studies in ACS patients found that neutrophils measured
on-admission are related to mortality rate and/or to major adverse
clinical events. A predictive value of neutrophils after cardiac
revascularisation procedures was reported in seven out of eight studies.
Most of the studies showed that neutrophils were independent predictors of
cardiovascular outcomes when analysed concomitantly with other markers of
inflammation (WBC, CRP). The findings of our systematic review highlight
the potential application of this inexpensive and readily available
inflammatory marker for risk stratification in patients with ACS and/or
cardiac revascularisation. Schattauer 2011.

<20>
Accession Number
2011538524
Authors
Kirov M.Y. Eremeev A.V. Smetkin A.A. Bjertnaes L.J.
Institution
(Kirov, Smetkin) Department of Anesthesiology and Intensive Care Medicine,
Northern State Medical University, Troitsky avenue 51, Arkhangelsk,
163000, Russian Federation
(Kirov, Eremeev, Smetkin) Department of Anesthesiology and Intensive Care
Medicine, City Hospital #1, Suvorov Street 1, Arkhangelsk, 163001, Russian
Federation
(Kirov, Bjertnaes) Department of Clinical Medicine (Anesthesiology),
Faculty of Medicine, University of Tromso, MH-Breivika, Tromso, 9038,
Norway
(Kirov, Bjertnaes) Department of Anesthesiology, University Hospital of
North Norway, Sykehusveien 38, Tromso, 9038, Norway
Title
Epidural anesthesia and postoperative analgesia with ropivacaine and
fentanyl in off-pump coronary artery bypass grafting: A randomized,
controlled study.
Source
BMC Anesthesiology. 11 , 2011. Article Number: 17. Date of
Publication: 18 Sep 2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Our aim was to assess the efficacy of thoracic epidural
anesthesia (EA) followed by postoperative epidural infusion (EI) and
patient-controlled epidural analgesia (PCEA) with ropivacaine/fentanyl in
off-pump coronary artery bypass grafting (OPCAB).Methods: In a prospective
study, 93 patients were scheduled for OPCAB under propofol/fentanyl
anesthesia and randomized to three postoperative analgesia regimens aiming
at a visual analog scale (VAS) score < 30 mm at rest. The control group (n
= 31) received intravenous fentanyl 10 mug/ml postoperatively 3-8 mL/h.
After placement of an epidural catheter at the level of
Th₂-Th₄before OPCAB, a thoracic EI group (n = 31)
received EA intraoperatively with ropivacaine 0.75% 1 mg/kg and fentanyl 1
mug/kg followed by continuous EI of ropivacaine 0.2% 3-8 mL/h and fentanyl
2 mug/mL postoperatively. The PCEA group (n = 31), in addition to EA and
EI, received PCEA (ropivacaine/fentanyl bolus 1 mL, lock-out interval 12
min) postoperatively. Hemodynamics and blood gases were measured
throughout 24 h after OPCAB.Results: During OPCAB, EA decreased arterial
pressure transiently, counteracted changes in global ejection fraction and
accumulation of extravascular lung water, and reduced the consumption of
propofol by 15%, fentanyl by 50% and nitroglycerin by a 7-fold, but
increased the requirements in colloids and vasopressors by 2- and 3-fold,
respectively (P < 0.05). After OPCAB, PCEA increased
PaO₂/FiO₂at 18 h and decreased the duration of
mechanical ventilation by 32% compared with the control group (P <
0.05).Conclusions: In OPCAB, EA with ropivacaine/fentanyl decreases
arterial pressure transiently, optimizes myocardial performance and
influences the perioperative fluid and vasoactive therapy. Postoperative
EI combined with PCEA improves lung function and reduces time to
extubation.Trial Registration: NCT01384175. 2011 Kirov et al; licensee
BioMed Central Ltd.

<21>
Accession Number
21034476
Authors
Futier E. Robin E. Jabaudon M. Guerin R. Petit A. Bazin J.E. Constantin
J.M. Vallet B.
Institution
(Futier) Department of Anaesthesiology and Critical Care Medicine, Estaing
Hospital, University Hospital of Clermont-Ferrand, 1 Place Lucie Aubrac,
Clermont-Ferrand, 63000, France.
Title
Central venous O saturation and venous-to-arterial CO difference as
complementary tools for goal-directed therapy during high-risk surgery.
Source
Critical care (London, England). 14 (5) (pp R193), 2010. Date of
Publication: 2010.
Abstract
Central venous oxygen saturation (ScvO2) is a useful therapeutic target in
septic shock and high-risk surgery. We tested the hypothesis that central
venous-to-arterial carbon dioxide difference (P(cv-a)CO2), a global index
of tissue perfusion, could be used as a complementary tool to ScvO2 for
goal-directed fluid therapy (GDT) to identify persistent low flow after
optimization of preload has been achieved by fluid loading during
high-risk surgery. This is a secondary analysis of results obtained in a
study involving 70 adult patients (ASA I to III), undergoing major
abdominal surgery, and treated with an individualized goal-directed fluid
replacement therapy. All patients were managed to maintain a respiratory
variation in peak aortic flow velocity below 13%. Cardiac index (CI),
oxygen delivery index (DO2i), ScvO2, P(cv-a)CO2 and postoperative
complications were recorded blindly for all patients. A total of 34% of
patients developed postoperative complications. At baseline, there was no
difference in demographic or haemodynamic variables between patients who
developed complications and those who did not. In patients with
complications, during surgery, both mean ScvO2 (78 +/- 4 versus 81 +/- 4%,
P = 0.017) and minimal ScvO2 (minScvO2) (67 +/- 6 versus 72 +/- 6%, P =
0.0017) were lower than in patients without complications, despite
perfusion of similar volumes of fluids and comparable CI and DO2i values.
The optimal ScvO2 cut-off value was 70.6% and minScvO2 < 70% was
independently associated with the development of postoperative
complications (OR = 4.2 (95% CI: 1.1 to 14.4), P = 0.025). P(cv-a)CO2 was
larger in patients with complications (7.8 +/- 2 versus 5.6 +/- 2 mmHg, P
< 10-6). In patients with complications and ScvO2 >= 71%, P(cv-a)CO2 was
also significantly larger (7.7 +/- 2 versus 5.5 +/- 2 mmHg, P < 10-6) than
in patients without complications. The area under the receiver operating
characteristic (ROC) curve was 0.785 (95% CI: 0.74 to 0.83) for
discrimination of patients with ScvO2 >= 71% who did and did not develop
complications, with 5 mmHg as the most predictive threshold value. ScvO2
reflects important changes in O2 delivery in relation to O2 needs during
the perioperative period. A P(cv-a)CO2 < 5 mmHg might serve as a
complementary target to ScvO2 during GDT to identify persistent inadequacy
of the circulatory response in face of metabolic requirements when an
ScvO2 >= 71% is achieved. Clinicaltrials.gov Identifier: NCT00852449.