EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 14

Results Generated From:
Embase <1980 to 2011 Week 41>
Embase (updates since 2011-10-06)

<1>
Accession Number
2011528606
Authors
Schoettler J. Jussli-Melchers J. Grothusen C. Stracke L. Schoeneich F.
Stohn S. Hoffmann G. Cremer J.
Institution
(Schoettler, Jussli-Melchers, Grothusen, Schoeneich, Stohn, Hoffmann,
Cremer) Department of Cardiovascular Surgery,
Christian-Albrechts-University of Kiel, Campus Kiel, Arnold-Heller-Strase
3, Haus 18, 24105 Kiel, Germany
(Stracke) Department of Internal Medicine III, Cardiology and Angiology,
Christian-Albrechts-University of Kiel, Kiel, Germany
Title
Highly flexible nitinol mesh to encase aortocoronary saphenous vein
grafts: First clinical experiences and angiographic results nine months
postoperatively.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (4) (pp 396-400),
2011. Date of Publication: September 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Saphenous vein graft patency is frequently limited by degeneration.
Experimental studies have indicated that rigid external support of venous
grafts by a flexible, tubular nitinol mesh may improve graft patency. The
study presented was part of a prospective, randomized, multicenter
first-in-man trial investigating the safety and effectiveness of
nitinol-supported venous grafts in coronary artery bypass graft (CABG)
surgery. From our clinic, 25 subjects with multivessel coronary artery
disease requiring saphenous vein graft CABG of the right coronary artery
(RCA) and the circumflex artery were entered into the trial. Subjects were
randomized to receive a mesh-supported graft on one of these arteries; the
other vessel received an untreated vein graft. Graft patency was assessed
by coronary angiography nine months after surgery. The implantation of
mesh grafts was simple and safe. In 10 cases, a nitinol mesh-supported
venous graft was anastomosed to the circumflex artery and in 15 cases to
the RCA. All patients survived the observation period. A total of 72% of
the patients underwent control coronary angiography. The patency rate of
mesh-supported grafts was 27.8% nine months postoperatively. Conventional
vein grafts showed an 85.7% patency, and arterial grafts had a 100%
patency. No complications directly related to the implantation of
mesh-supported grafts were observed. The promising experimental results of
mesh-supported venous grafts could not be reproduced in the study
presented. A critical item seems to be correct selection of nitinol mesh
diameter, the anastomotic method and fixation of the mesh tube to the
venous graft. 2011 Published by European Association for Cardio-Thoracic
Surgery. All rights reserved.

<2>
Accession Number
2011527981
Authors
Capodanno D. Stone G.W. Morice M.C. Bass T.A. Tamburino C.
Institution
(Capodanno, Tamburino) Ferrarotto Hospital, ETNA Foundation, Via Citelli
6, 95124 Catania, Italy
(Stone) Columbia University, Medical Center and Cardiovascular Research
Foundation, New York, NY, United States
(Morice) Institut Hospitalier Jacques Cartier, Massy, France
(Bass) University of Florida, Shands College of Medicine, Jacksonville,
FL, United States
Title
Percutaneous coronary intervention versus coronary artery bypass graft
surgery in left main coronary artery disease: A meta-analysis of
randomized clinical data.
Source
Journal of the American College of Cardiology. 58 (14) (pp 1426-1432),
2011. Date of Publication: 27 Sep 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to determine the safety and
efficacy of percutaneous coronary intervention (PCI) compared with
coronary artery bypass graft (CABG) in patients with left main coronary
artery (LMCA) disease. Background: Previous meta-analyses of PCI versus
CABG in LMCA disease mainly included nonprospective, observational
studies. Several new randomized trials have recently been reported.
Methods: We identified 1,611 patients from 4 randomized clinical trials
for the present meta-analysis. The primary endpoint was the 1-year
incidence of major adverse cardiac and cerebrovascular events (MACCE),
defined as death, myocardial infarction (MI), target vessel
revascularization (TVR), or stroke. Results: PCI was associated with a
nonsignificantly higher 1-year rate of MACCE compared with CABG (14.5% vs.
11.8%; odds ratio [OR]: 1.28; 95% confidence interval [CI]: 0.95 to 1.72;
p = 0.11), driven by increased TVR (11.4% vs. 5.4%; OR: 2.25; 95% CI: 1.54
to 3.29; p < 0.001). Conversely, stroke occurred less frequently with PCI
(0.1% vs. 1.7%; OR: 0.15; 95% CI: 0.03 to 0.67; p = 0.013). There were no
significant differences in death (3.0% vs. 4.1%; OR: 0.74; 95% CI: 0.43 to
1.29; p = 0.29) or MI (2.8% vs. 2.9%; OR: 0.98; 95% CI: 0.54 to 1.78; p =
0.95). Conclusions: In patients with LMCA disease, PCI was associated with
nonsignificantly different 1-year rates of MACCE, death, and MI, a lower
risk of stroke, and a higher risk of TVR compared with CABG. 2011
American College of Cardiology Foundation.

<3>
Accession Number
2011546893
Authors
Navarese E.P. De Luca G. Castriota F. Kozinski M. Gurbel P.A. Gibson C.M.
Andreotti F. Buffon A. Siller-Matula J.M. Sukiennik A. De Servi S. Kubica
J.
Institution
(Navarese, Kozinski, Sukiennik, Kubica) Department of Cardiology and
Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus
University, Bydgoszcz, Poland
(De Luca) Department of Cardiology, Maggiore della Carita Hospital,
Eastern Piedmont University A. Avogadro, Novara, Italy
(Castriota) Interventional Cardio-Angiology Unit, GVM Care and Research,
Cotignola, Italy
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, MD, United States
(Gibson) Institute of Cardiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
(Andreotti, Buffon) Department of Cardiovascular Medicine, Catholic
University of the Sacred Heart, Rome, Italy
(Siller-Matula) Department of Cardiology, Medical University of Vienna,
Vienna, Austria
(De Servi) Department of Cardiovascular Diseases, Civic Hospital, Legnano,
Italy
Title
Low-molecular-weight heparins vs. unfractionated heparin in the setting of
percutaneous coronary intervention for ST-elevation myocardial infarction:
A meta-analysis.
Source
Journal of Thrombosis and Haemostasis. 9 (10) (pp 1902-1915), 2011. Date
of Publication: October 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background: The aim of the current study was to perform two separate
meta-analyses of available studies comparing low-molecular-weight heparins
(LMWHs) vs. unfractionated heparin (UFH) in ST-elevation myocardial
infarction (STEMI) patients treated (i) with primary percutaneous coronary
intervention (pPCI) or (ii) with PCI after thrombolysis. Methods:
All-cause mortality was the pre-specified primary endpoint and major
bleeding complications were recorded as the secondary endpoints. Relative
risk (RR) with a 95% confidence interval (CI) and absolute risk reduction
(ARR) were chosen as the effect measure. Results: Ten studies comprising
16286 patients were included. The median follow-up was 2months for the
primary endpoint. Among LMWHs, enoxaparin was the compound most frequently
used. In the pPCI group, LMWHs were associated with a reduction in
mortality [RR (95% CI)=0.51 (0.41-0.64), P<0.001, ARR=3%] and major
bleeding [RR (95% CI)=0.68 (0.49-0.94), P=0.02, ARR=2.0%] as compared with
UFH. Conversely, no clear evidence of benefits with LWMHs was observed in
the PCI group after thrombolysis. Meta-regression showed that patients
with a higher baseline risk had greater benefits from LMWHs (r=0.72,
P=0.02). Conclusions: LMWHs were associated with greater efficacy and
safety than UFH in STEMI patients treated with pPCI, with a significant
relationship between risk profile and clinical benefits. Based on this
meta-analysis, LMWHs may be considered as a preferred anticoagulant among
STEMI patients undergoing pPCI. 2011 International Society on Thrombosis
and Haemostasis.

<4>
Accession Number
2011542274
Authors
Vhsilta T. Malmberg M. Saraste A. Koskenvuo J.W. Prkk J.P. Valtonen M.
Leino K. Nuutila K. Saukko P. Kuttila K. Savunen T.
Institution
(Vhsilta, Malmberg, Kuttila, Savunen) Department of Surgery, Turku
University Hospital, University of Turku, Munkkiniemen Puistotie 18B 46,
Helsinki 00330, Finland
(Saraste) Department of Medicine, Turku University Hospital, University of
Turku, Turku, Finland
(Koskenvuo, Prkk) Department of Clinical Physiology, Nuclear Medicine,
Turku University Hospital, University of Turku, Turku, Finland
(Valtonen, Leino) Department of Anesthesiology, Intensive Care ,Emergency
Care, and Pain Medicine, Turku University Hospital, Turku, Finland
(Nuutila, Saukko) Department of Forensic Medicine, University of Turku,
Turku, Finland
Title
Cardiomyocyte apoptosis after antegrade and retrograde cardioplegia during
aortic valve surgery.
Source
Annals of Thoracic Surgery. 92 (4) (pp 1351-1357), 2011. Date of
Publication: October 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Retrograde delivery is associated with inadequate perfusion of
cardioplegia to all regions of the heart, but the effects on cardiomyocyte
death and functional outcome remain unknown. We compared antegrade and
retrograde cardioplegia in a randomized clinical trial to see whether it
has effect on cardiomyocyte apoptosis and left ventricular function.
Methods: Patients underwent elective aortic valve replacement surgery due
to aortic valve stenosis. They were randomly allocated to receive
antegrade (n = 10) or retrograde (n = 10) cardioplegia. Apoptotic
cardiomyocytes (terminal transferase-mediated dUTP nick end labeling,
caspase activation) and RNA levels of apoptosis-regulating proteins were
studied in transmyocardial biopsies obtained before and after the
operation. Magnetic resonance imaging and transesophageal echocardiography
were performed, and cardiac enzymes were measured. Results: Clinical
outcome and cardiac enzyme release were comparable between the groups.
Cardiomyocyte apoptosis was significantly increased (terminal
transferase-mediated dUTP nick end labeling) in the left ventricle after
the operation in the retrograde, but not in the antegrade group
(respectively, 0.00% [0.039%] versus 0.092% [0.205%], p = 0.01; and 0.00%
[0.00%] versus 0.023% [0.054%], p = 0.14). Expression of
apoptosis-regulating proteins BAX, BAD, and BCL-2 were comparable between
groups. By transesophageal echocardiography, the systolic mitral annulus
movement was decreased immediately after the operation in the retrograde
group. By magnetic resonance imaging, the left ventricle mass index was
reduced preoperatively to 9 months postoperatively in the antegrade group.
Conclusions: In contrast to antegrade cardioplegia, retrograde
cardioplegia is associated with increased cardiomyocyte apoptosis,
impaired immediate postoperative systolic function, and lack of long-term
favorable left ventricle remodeling after aortic valve replacement,
suggesting inadequate myocardial protection. 2011 The Society of Thoracic
Surgeons.

<5>
Accession Number
2011542264
Authors
Li J. Zheng J. Bai T. Liu Y. Wang X. Liu N. Cheng L. Chen Y. Zhang H.
Institution
(Li, Liu, Zheng, Bai, Liu, Wang, Liu, Cheng, Chen, Zhang) Department of
Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University,
Anzhenli of Chaoyang District, Beijing 100029, China
Title
The patency of sequential and individual vein coronary bypass grafts: A
systematic review.
Source
Annals of Thoracic Surgery. 92 (4) (pp 1292-1298), 2011. Date of
Publication: October 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Saphenous vein grafts continue to be the backbone of daily
coronary revascularization practice, but controversy still exists about
whether to use them as an individual or sequential graft. We undertook a
systematic review and meta-analysis of cohort studies to compare the
midterm or long-term patency of sequential vein coronary bypass grafts
with those of vein grafts. Methods: A comprehensive search strategy was
run in PubMed, Embase, the Cochrane Library, and the Chinese Biomedical
Literature Database. Inclusion criteria were the following: (1) two
cohorts of patients received sequential and single saphenous vein coronary
bypass grafting, respectively; (2) prospective or retrospective cohort
design; and (3) graft patency examined by angiography or ultrafast
computed tomography. Two researchers independently performed the
literature search, data extraction, and quality assessment. Results: We
identified 1,385 titles, reviewed 38 articles for inclusion criteria, and
included 12 studies in the meta-analysis. The risk of occlusion in
sequential grafts was lower (risk ratio [RR] = 0.67, 95% confidence
interval [CI] 0.60 to 0.74) than that in single grafts. The risk of
occlusion in side-to-side anastomoses was lower (RR = 0.52; 95% CI, 0.34
to 0.80) than that of end-to-side anastomoses for sequential vein grafts.
There was no difference in occlusion between the distal end-to-side
anastomoses of sequential vein grafts and those of single vein grafts (RR
= 0.85; 95% CI, 0.68 to 1.06). Conclusions: The midterm and long-term
patency of sequential vein grafts appears to be better than that of single
vein grafts and the patency of side-to-side anastomoses appears to be
better than that of end-to-side anastomoses for sequential vein grafts.
2011 The Society of Thoracic Surgeons.

<6>
Accession Number
2011540281
Authors
Zhou Y.-H. Tang J.-Y. Wu M.-J. Lu J. Wei X. Qin Y.-Y. Wang C. Xu J.-F. He
J.
Institution
(Zhou, Wu, Lu, Qin, Wang, Xu, He) Department of Health Statistics, Second
Military Medical University, Shanghai, China
(Tang) Office of Compliance and Development, Center for Drug Evaluation,
SFDA, Beijing, China
(Wei) Shanghai Jiao Tong University School of Medicine, Shanghai, China
Title
Effect of folic acid supplementation on cardiovascular outcomes: A
systematic review and meta-analysis.
Source
PLoS ONE. 6 (9) , 2011. Article Number: e25142. Date of Publication: 28
Sep 2011.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: Folic acid is widely used to lower homocysteine concentrations
and prevent adverse cardiovascular outcomes. However, the effect of folic
acid on cardiovascular events is not clear at the present time. We carried
out a comprehensive systematic review and meta-analysis to assess the
effects of folic acid supplementation on cardiovascular outcomes.
Methodology and Principal Findings: We systematically searched Medline,
EmBase, the Cochrane Central Register of Controlled Trials, reference
lists of articles, and proceedings of major meetings for relevant
literature. We included randomized placebo-controlled trials that reported
on the effects of folic acid on cardiovascular events compared to placebo.
Of 1594 identified studies, we included 16 trials reporting data on 44841
patients. These studies reported 8238 major cardiovascular events, 2001
strokes, 2917 myocardial infarctions, and 6314 deaths. Folic acid
supplementation as compared to placebo had no effect on major
cardiovascular events (RR, 0.98; 95% CI, 0.93-1.04), stroke (RR, 0.89; 95%
CI,0.78-1.01), myocardial infarction (RR, 1.00; 95% CI, 0.93-1.07), or
deaths from any cause (RR, 1.00;95% CI, 0.96-1.05). Moreover, folic acid
as compared to placebo also had no effect on the following secondary
outcomes: risk of revascularization (RR, 1.05; 95%CI, 0.95-1.16), acute
coronary syndrome (RR, 1.06; 95%CI, 0.97-1.15), cancer (RR, 1.08; 95%CI,
0.98-1.21), vascular death (RR, 0.94; 95%CI,0.88-1.02), or non-vascular
death (RR, 1.06; 95%CI, 0.97-1.15). Conclusion/Significance: Folic acid
supplementation does not effect on the incidence of major cardiovascular
events, stroke, myocardial infarction or all cause mortality. 2011 Zhou
et al.

<7>
Accession Number
2011537753
Authors
Ucak A. Ugur M. Onan B. Arslan G. Alp I. Ulusoy E. Yilmaz A.T.
Institution
(Ucak, Ugur, Onan, Arslan, Alp, Yilmaz) Department of Cardiovascular
Surgery, GATA Haydarpasa Education Hospital, Kalp ve Damar Cerrahisi
Klinigi, Tibbiye Caddesi, Uskudar, Istanbul, 34668, Turkey
(Ulusoy) Department of Cardiology, GATA Haydarpasa Education Hospital,
Istanbul, Turkey
Title
Conventional versus complete chordal-sparing mitral valve replacement: Eff
ects on left ventricular function and end-systolic stress.
Source
Acta Cardiologica. 66 (5) (pp 627-634), 2011. Date of Publication: 2011.
Publisher
Acta Cardiologica (Weldadigheidsstraat 49, Leuven B-3000, Belgium)
Abstract
Background This study aims to assess the eff ects of bileafl et
preservation versus conventional technique during mitral valve replacement
(MVR) on left ventricular functions and end-systolic stress (ESS). Methods
Between September 2005 and January 2009, sixty-fi ve patients with mitral
regurgitation underwent MVR surgery. In a non-randomized fashion, 34
patients had conventional MVR without chordal/leafl et preservation (group
I, c-MVR), and 31 had MVR with total chordal/bileafl et preservation
(group II, b-MVR). A prospective clinical and echocardiographic follow-up
of patients was performed preoperatively, at 3 months and by 1 year
postoperatively. Results Left ventricular end-systolic/end-diastolic
dimensions and volumes decreased by 1 year in the b-MVR group. Left
ventricular ESS decreased only in the bileafl et sparing MVR group after
surgery, and this decrease was signifi cant by 1 year, compared with the
c-MVR group (P = 0.008). Left atrial diameter signifi cantly decreased in
both groups. Only one patient died, due to posterior wall rupture after a
c-MVR procedure. One patient undergoing a b-MVR procedure needed
re-operation because of prosthetic valve endocarditis. Conclusion Bileafl
et preservation during MVR has a benefi cial eff ect on left ventricular
function, compared with conventional MVR. Left ventricular ESS improves
after bileafl et-sparing MVR and may be an important indicator of
myocardial function after mitral valve surgery.

<8>
Accession Number
2011534697
Authors
Gibbons C. Bruce J. Carpenter J. Wilson A.P. Wilson J. Pearson A. Lamping
D.L. Krukowski Z.H. Reeves B.C.
Institution
(Gibbons, Carpenter, Lamping) London School of Hygiene and Tropical
Medicine, London, United Kingdom
(Bruce) University of Aberdeen, Aberdeen, United Kingdom
(Wilson) University College London, London, United Kingdom
(Wilson) Imperial College Healthcare NHS Trust, London, United Kingdom
(Pearson) Health Protection Agency, London, United Kingdom
(Krukowski) Aberdeen Royal Infirmary, Aberdeen, United Kingdom
(Reeves) University of Bristol, Bristol, United Kingdom
Title
Identification of risk factors by systematic review and development of
risk-adjusted models for surgical site infection.
Source
Health Technology Assessment. 15 (30) (pp 3-156), 2011. Date of
Publication: September 2011.
Publisher
National Co-ordinating Centre for HTA (Bouldrewood, Mail Point 728,
Highfield, Southhampton, United Kingdom)
Abstract
Background: Surgical site infections (SSIs) are complications of surgery
that cause significant postoperative morbidity. SSI has been proposed as a
potential indicator of the quality of care in the context of clinical
governance and monitoring of the performance of NHS organisations against
targets. Objectives: We aimed to address a number of objectives. Firstly,
identify risk factors for SSI, criteria for stratifying surgical
procedures and evidence about the importance of postdischarge surveillance
(PDS). Secondly, test the importance of risk factors for SSI in
surveillance databases and investigate interactions between risk factors.
Thirdly, investigate and validate different definitions of SSI. Lastly,
develop models for making risk adjusted comparisons between hospitals.
Data sources: A single hospital surveillance database was used to address
objectives 2 and 3 and the UK Surgical Site Infection Surveillance Service
database to address objective 4. Study design: There were four elements to
the research: (1) systematic reviews of risk factors for SSI (two
reviewers assessed titles and abstracts of studies identified by the
search strategy and the quality of studies was assessed using the
Newcastle Ottawa Scale); (2) assessment of agreement between four SSI
definitions; (3) validation of definitions of SSI, quantifying their
ability to predict clinical outcomes; and (4) development of
operation-specific risk models for SSI, with hospitals fitted as random
effects. Results: Reviews of SSI risk factors other than established SSI
risk indices identified other risk; some were operation specific, but
others applied to multiple operations. The factor most commonly identified
was duration of preoperative hospital stay. The review of PDS for SSI
confirmed the need for PDS if SSIs are to be compared meaningfully over
time within an institution. There was wide variation in SSI rate (SSI%)
using different definitions. Over twice as many wounds were classified as
infected by one definition only as were classified as infected by both.
Different SSI definitions also classified different wounds as being
infected. The two most established SSI definitions had broadly similar
ability to predict the chosen clinical outcomes. This finding is
paradoxical given the poor agreement between definitions. Elements of each
definition not common to both may be important in predicting clinical
outcomes or outcomes may depend on only a subset of elements which are
common to both. Risk factors fitted in multivariable models and their
effects, including age and gender, varied by surgical procedure. Operative
duration was an important risk factor for all operations, except for hip
replacement. Wound class was included least often because some wound
classes were not applicable to all operations or were combined because of
small numbers. The American Association of Anesthesiologists class was a
consistent risk factor for most operations. Conclusions: The research
literature does not allow surgery-specific or generic risk factors to be
defined. SSI definitions varied between surveillance programmes and
potentially between hospitals. Different definitions do not have good
agreement, but the definitions have similar ability to predict outcomes
influenced by SSI. Associations between components of the National
Nosocomial Infections Surveillance risk index and odds of SSI varied for
different surgical procedures. There was no evidence for effect
modification by hospital. Estimates of SSI% should be disseminated within
institutions to inform infection control. Estimates of SSI% across
institutions or countries should be interpreted cautiously and should not
be assumed to reflect quality of medical care. Future research should
focus on developing an SSI definition that has satisfactory psychometric
properties, that can be applied in everyday clinical settings, includes
PDS and is formulated to detect SSIs that are important to patients or
health services. Queen's Printer and Controller of HMSO 2011.

<9>
Accession Number
2011531756
Authors
Lee J.S. Ahn S.W. Song J.W. Shim J.K. Yoo K.-J. lan Kwak Y.
Institution
(Lee, Song, Shim, Yoo, lan Kwak) Department of Anesthesiology and Pain
Medicine, South Korea
(Yoo) Department of Thoracic and Cardiovascular Surgery, South Korea
(Shim, lan Kwak) Anesthesia and Pain Research, South Korea
(Shim, Yoo, lan Kwak) Cardiovascular Research Institute, South Korea
(lan Kwak) Severance Biomedical Science Institute, South Korea
(Ahn) Yonsei University College of Medicine, Seoul, Department of
Anesthesiology and Pain Medicine, Kwangdong University College of
Medicine, Goyang, South Korea
Title
Effect of Hydroxyethyl Starch 130/0.4 on Blood loss and Coagulation in
patients with recent exposure to dual antiplatelet Therapy undergoing
off-pump Coronary artery bypass graft surgery.
Source
Circulation Journal. 75 (10) (pp 2397-2402), 2011. Date of Publication:
October 2011.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Hydroxyethyl starch (HES) solutions are often used for
maintaining intravascular volume and improving microperfusion, while a
large amount of HES can cause adverse effects on coagulation. As the
indications for clopidogrel expand, an increasing number of patients
undergoing off-pump coronary artery bypass surgery (OPCAB) are also
undergoing dual antiplatelet therapy (DAPT), with its higher risk of
bleeding complications. The aim of the present study was to determine
whether a moderate dose of 6% HES 130/0.4 significantly increases
perioperative blood loss in patients with continued DAPT within 5 days of
OPCAB. Methods and Results: Patients who received clopidogrel and aspirin
within 5 days of OPCAB were randomly allocated to receive HES 130/0.4
(<=30 ml/kg) followed by crystalloid infusion (HES group, n=53), or
crystalloid only (crystalloid group, n=53) perioperatively. The amount of
perioperative blood loss (sum of bleeding during the intraoperative and
postoperative 24-h period), transfusion requirements, modified
thromboelastography and coagulation variables, hemodynamic parameters, and
fluid balance were recorded. Perioperative blood loss and coagulation
profiles were similar between the groups, but the postoperative hemoglobin
level was higher in the crystalloid group. Conclusions: Up to 30
ml.kg^-1 day^-1 of 6% HES 130/0.4 did not increase
the perioperative blood loss compared to crystalloid in patients with
recent exposure to DAPT undergoing OPCAB. HES 130/0.4 caused a similar
degree and duration of coagulation impairment as observed when only
crystalloid was given. All rights are reserved to the Japanese
Circulation Society.

<10>
Accession Number
2011540483
Authors
Forouzannia S.K. Abdollahi M.H. Mirhosseini S.J. Hosseini H. Moshtaghion
S.H. Golzar A. Naserzadeh N. Ghoraishian S.M. Meybodi T.E.
Institution
(Forouzannia, Abdollahi, Mirhosseini, Hosseini, Moshtaghion, Golzar,
Naserzadeh, Ghoraishian, Meybodi) Cardiovascular Research Center, Afshar
Hospital, Shahid Sadooghi University of Medical Sciences, Yazd, Iran,
Islamic Republic of
Title
Clinical outcome and cost in patients with off-pump vs. On-pump coronary
artery bypass surgery.
Source
Acta Medica Iranica. 49 (7) (pp 414-419), 2011. Date of Publication:
2011.
Publisher
Medical Sciences University of Teheran (Poursina St, Teheran 14-174, Iran,
Islamic Republic of)
Abstract
General concept and major emphasis on off-pump coronary artery bypass
surgery (OPCAB) is maintaining quality of care and patient safety while
reducing cost and resource utilization. OPCAB probably avoids the
potential complications of cardiopulmonary bypass. However its acceptance
depends on clinical and economic outcome. The aim of this study is to
compare clinical and economic outcome of off-pump and on pump coronary
artery bypass surgery. This is a report of an analytic cross-sectional
study on 304 patients underwent coronary artery bypass surgery that were
randomized into conventional on pump and off-pump groups. Variables and
costs were obtained for each group and these data were analyzed using
parametric methods. There was no difference between the two groups with
respect to perioperative and intraoperative patient's variables. OPCAB
reduced the need for postoperative transfusion requirement (P<0.05) which
was statistically significant and showed a trend towards reduction of
morbidity although didn't reach statistical significance (P>0.05). There
were no statistically significant differences in surgical re exploration
and length of stay between the two groups. The mean cost for an on pump
surgery was 8312000 +/- 2859 Rials per patient that was significantly
higher than an off-pump surgery. Based on the findings of this study,
clinical outcome has no statistically significant difference between on
pump and off-pump CABG but the costs are significantly higher in the on
pump group. 2011 Tehran University of Medical Sciences.

<11>
Accession Number
2011537310
Authors
Harling L. Rasoli S. Vecht J.A. Ashrafian H. Kourliouros A. Athanasiou T.
Institution
(Harling, Rasoli, Vecht, Ashrafian, Kourliouros, Athanasiou) Department of
Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2
1NY, United Kingdom
Title
Do antioxidant vitamins have an anti-arrhythmic effect following cardiac
surgery? A meta-analysis of randomised controlled trials.
Source
Heart. 97 (20) (pp 1636-1642), 2011. Date of Publication: October 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: Postoperative atrial fibrillation (POAF) affects approximately
30% of patients undergoing elective cardiac surgery. While its
pathogenesis is multifactorial, increasing evidence supports a role for
oxidative stress in the electrophysiological remodelling associated with
AF. Although prophylactic antioxidants appear to be a potentially
attractive pharmacotherapy, there is still uncertainty regarding their
efficacy. This study aims to provide a quantitative summary of the current
evidence surrounding antioxidant vitamins and POAF prevention. Methods: A
systematic literature review identified five randomised controlled trials
incorporating 567 patients (n=284 antioxidant, n=283 control). These were
metaanalysed using random effects modelling. Heterogeneity, subgroup
analysis, quality scoring and risk of bias were assessed. Primary
endpoints were the incidence of POAF and all-cause arrhythmia. Secondary
endpoints were length of stay in the intensive care unit (ITU) and length
of hospital stay. Results: Vitamins C and E significantly reduced the
incidence of POAF (OR 0.43, 95% CI 0.21 to 0.89) and all-cause arrhythmia
(OR 0.54, 95% CI 0.29 to 0.99) compared with controls. A significant
reduction in both ITU stay (weighted mean difference (WMD) -0.44, 95% CI
-0.70 to -0.17) and hospital stay (WMD -1.11, 95% CI -1.70 to -0.52) was
also seen in the antioxidant group, without significant heterogeneity.
Conclusions: The prophylactic use of vitamins C and E may significantly
reduce the incidence of POAF and all-cause arrhythmia following cardiac
surgery. However, the overall quality of current studies is poor and
further research should focus on adequately powered randomised controlled
trials that standardise AF reporting, antioxidant protocol and the use of
concomitant agents. Cost analysis should be considered to establish the
potential economic benefit of antioxidant vitamin prophylaxis in POAF.

<12>
Accession Number
2011526676
Authors
Adel W. Nammas W.
Institution
(Adel, Nammas) Cardiology Department, Ain Shams University, Ain Shams
University Hospital, PO Box 11381, Abbassia, Cairo, Egypt
Title
Predictors of contractile recovery after revascularization in patients
with anterior myocardial infarction who received thrombolysis.
Source
International Journal of Angiology. 19 (2) (pp e78-e82), 2010. Date of
Publication: June 2010.
Publisher
Thieme Medical Publishers, Inc. (333 7th Avenue, New York NY 10001-5004,
United States)
Abstract
BACKGROUND: Identification of viable myocardium after myocardial
infarction has gained paramount importance with the current progress in
coronary revascularization. OBJECTIVE: To explore the prognostic power of
certain patient characteristics to predict myocardial contractile recovery
after revascularization in patients presenting with acute anterior ST
elevation myocardial infarction (STEMI) who received thrombolytic therapy.
METHODS: Seventy-three consecutive patients presenting with first acute
anterior STEMI who had received thrombolytic therapy and had significant
coronary stenosis or occlusion of the infarctrelated artery amenable for
revascularization were enrolled. All patients underwent echocardiographic
assessment of regional wall motion and left ventricular ejection fraction.
Patients underwent coronary revascularization by either percutaneous
angioplasty or surgical bypass. Echocardiography was repeated two to three
months following revascularization. Patients were classified into two
groups: group 1 had evidence of contractile recovery after
revascularization at follow-up echocardiography and group 2 had no such
evidence of recovery. RESULTS: Predictors of contractile recovery after
revascularization included a shorter time from symptom onset to the
institution of thrombolytic therapy, a lower baseline wall motion score
index, the presence of grade 3 collaterals to the infarct-related artery
and the use of beta-blockers. Instead, the presence of diabetes mellitus
and a totally occluded infarct-related artery predicted poor contractile
recovery. CONCLUSIONS: Myocardial contractile recovery after
revascularization in patients presenting with first acute anterior STEMI
may be predicted by the absence of diabetes, a shorter time from symptom
onset to thrombolytic therapy, the use of beta-blockers, a lower initial
wall motion index score and the presence of collaterals to the
infarctrelated artery. 2009 Pulsus Group Inc. All rights reserved.

<13>
Accession Number
21483189
Authors
Hessami M.A. Najafi F. Hatami S.
Institution
(Hessami) Department of Surgery, Kermanshah University of Medical
Sciences, Iran.
Title
Volume threshold for chest tube removal: a randomized controlled trial.
Source
Journal of injury & violence research. 1 (1) (pp 33-36), 2009. Date of
Publication: Jul 2009.
Abstract
Despite importance of chest tube insertion in chest trauma, there is no
general agreement on the level of daily volume drainage from chest tube.
This study was conducted to compare the effectiveness and safety of chest
tube removal at the levels of 150 ml/day and 200 ml/day. Eligible patients
(138) who needed replacement of chest tube (because of trauma or
malignancy) were randomized into two groups; control (removal of chest
tube when drainage reached to 150 ml/day) and trial (removal of chest tube
at the level of 200 ml/day). All patients received standard care during
hospital admission and a follow-up visit after 7 days of discharge from
hospital. Patients were then compared in terms of major clinical outcomes
using chi-squared and t-test. From the total of 138 patients, 70 and 68
patients were randomized to control (G150) and trial (G200) group,
respectively. Baseline characteristics were comparable between the two
groups. Although the trial group had a shorter mean for length of hospital
stay (LOS) (4.1 compared to 4.8, p=0.04), their differences in drainage
time did not reach to the level of statistical significance (p=0.1).
Analysis of data showed no statistically significant differences between
the rate of radiological reaccumulation, thoracentesis and decrease in
pulmonary sounds (auscultatory), one week after discharge from hospital.
Compared to a daily volume drainage of 150 ml, removal of chest tube when
there is 200 ml/day is safe and will even result in a shorter hospital
stay. This in turn leads to a lower cost.

<14>
Accession Number
70548812
Authors
Von Meyenfeldt E.M. Gooiker G.A. Van Gijn W. Post P.N. Van De Velde C.J.H.
Tollenaar R.A.E.M. Klomp H.M. Wouters M.W.J.M.
Institution
(Von Meyenfeldt, Klomp, Wouters) Netherlands Cancer Institute - Antoni van
Leeuwenhoek Hospital, Department of Surgical Oncology/Thoracic Surgery,
Amsterdam, Netherlands
(Gooiker, Van Gijn, Van De Velde, Tollenaar) Leiden University Medical
Center, Department of Surgery, Leiden, Netherlands
(Post) Dutch Institute for Healthcare Improvement, CBO, Utrecht,
Netherlands
Title
The relationship between volume or surgeon specialty and outcome in the
surgical treatment of lung cancer - A systematic review and meta-analysis.
Source
European Journal of Cancer. Conference: 2011 European Multidisciplinary
Cancer Congress Stockholm Sweden. Conference Start: 20110923 Conference
End: 20110927. Conference Publication: (var.pagings). 47 (pp
S263-S264), 2011. Date of Publication: September 2011.
Publisher
Elsevier Ltd
Abstract
Background: Whether improvement of quality and increased costeffectiveness
of surgical cancer care can be achieved by centralising care in
high-volume specialized centres is subject of an ongoing debate in many
countries.We have conducted a systematic review and the first metaanalysis
of the literature on the effect of procedural volume or surgeon specialty
on outcome of lung resections for cancer.Material and Methods: A
systematic search was done to identify articles investigating the effects
of surgeon specialty and hospital or surgeon volume of lung resections on
mortality and survival, published between January 1990 and December
2010.All articles were scrutinized on methodological quality.After strict
inclusion, meta-analysis assuming a random effects model was done to
estimate the effect of surgeon specialty and higher volume on patient
outcome.Meta-regression was used to identify volume cut-off
values.Heterogeneity in study results was evaluated with an
I²-test; the risk of publication bias with Egger's regression
intercept.Results: Nineteen studies investigating the relationship between
procedural volume or surgeon specialty and outcome of lung resections were
found.Studies were heterogeneous, especially in the definition of volume
categories.Ten studies met the inclusion criteria for meta-analysis on
hospital volume and postoperative mortality and 7 studies on hospital
volume and survival.The pooled estimated effect size was significant in
favour of high-volume providers in the analysis of postoperative mortality
(OR 0.71; CI 0.62-0.81) but not for the survival analysis (OR 0.93; CI
0.84-1.03).The meta-analysis on surgeon volume and outcome showed no
significant results.General surgeons had significantly higher mortality
rates than general thoracic (OR 0.78; 0.70-0.88) or cardio-thoracic
surgeons (OR 0.82; 0.69-0.96).A cut-off value for volume of resections for
lung cancer could not be identified.No publication bias was
detected.Conclusions: Hospital volume and surgeon specialty are important
determinants of outcome in lung cancer resections, but evidence-based
minimal volume standards are lacking.Using a minimal volume standard as a
tool, not a goal in itself, to enable more statistically accurate
evaluation of individual institutions in a national audit program can help
elucidate the influence of individual quality-of-care parameters,
including hospital volume, on outcome.