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<1>
Accession Number
2011574329
Authors
Zhang S. Ge J. Yao K. Qian J.
Institution
(Zhang, Ge, Yao, Qian) Shanghai Institute of Cardiovascular Diseases,
Zhongshan Hospital, Fudan University, Shanghai, China
(Ge) Institutes of Biomedical Sciences, Fudan University, Shanghai, China
Title
Meta-analysis of early versus deferred revascularization for NonST-segment
elevation acute coronary syndrome.
Source
American Journal of Cardiology. 108 (9) (pp 1207-1213), 2011. Date of
Publication: 01 Nov 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The impact of a coronary revascularization strategy (early or deferred) on
clinical outcomes of nonST-segment elevation acute coronary syndrome
(NSTE-ACS) has not been well established. The goal of this study was to
systematically review randomized trials comparing early to deferred
revascularization for NSTE-ACS. A systematic literature search of MEDLINE,
ISI Web of Science, and Cochrane databases was conducted. Two reviewers
independently determined the eligibility of clinical trials. Five trials
with 4,155 patients were included for analysis. Meta-analysis showed that
early revascularization produced no significant differences in the
incidence of death (risk ratio [RR] 0.88, p = 0.47), recurrent myocardial
infarction (RR 0.92, p = 0.58), and repeat revascularization compared to a
deferred intervention. However, a significant decrease in refractory
ischemia was observed in the early intervention group (RR 0.47, p <0.01),
and the procedure also showed a tendency toward decreasing major bleeding
events (RR 0.77, p = 0.08). According to stratification based on
intervention era, extent of revascularization, and time of
revascularization, subgroup analysis did not show between-group
differences in all-cause mortality, recurrent myocardial infarction, and
major bleeding events. Also, sensitivity analysis by alternatively using a
random-effects model did not find any relevant influence on overall
results in direction and magnitude. In conclusion, meta-analysis
demonstrated that early coronary revascularization is feasible and safe
for patients with NSTE-ACS, might markedly decrease the incidence of
refractory ischemia, and appears to produce less bleeding. 2011 Elsevier
Inc. All rights reserved.

<2>
Accession Number
2011568518
Authors
Lin M.-H. Pan S.-C. Wang J.-L. Hsu R.-B. Lin Wu F.-L. Chen Y.-C. Lin F.-Y.
Chang S.-C.
Institution
(Lin, Lin Wu) Departments of Pharmacy, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Pan, Chen, Chang) Departments of Internal Medicine, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
(Wang) Department of Internal Medicine, E-Da Hospital/I-Shou University,
Kaohsiung County, Taiwan (Republic of China)
(Hsu, Lin) Departments of Surgery, National Taiwan University Hospital,
Taipei, Taiwan (Republic of China)
(Chang) Graduate Institute of Clinical Pharmacy, College of Medicine,
National Taiwan University, Taipei, Taiwan (Republic of China)
Title
Prospective randomized study of efficacy of 1-day versus 3-day antibiotic
prophylaxis for preventing surgical site infection after coronary artery
bypass graft.
Source
Journal of the Formosan Medical Association. 110 (10) (pp 619-626), 2011.
Date of Publication: October 2011.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background/Purpose: Despite general recommendation of short-course
antibiotic prophylaxis, prolonged antibiotic use is still commonly
reported in clinical settings. This study compared the efficacy of 1-day
versus 3-day antibiotic prophylaxis in preventing surgical site infection
(SSI) in patients undergoing coronary artery bypass graft (CABG). Methods:
This prospective, randomized control study was performed in a
tertiary-care medical center from June 2002 to April 2004. Patients
underwent non-emergency CABG and were randomized into two groups receiving
either 1 day or 3 days cefazolin prophylaxis. The SSI rates were compared
between the two groups. Results: During the study period, 231 patients
were enrolled, 120 in the 1-day group and 111 in the 3-day group.
Twenty-two episodes of SSI were observed within 1 month after operation:
13 (10.8%) in the 1-day group and nine (8.1%) in the 3-day group (odds
ratio: 1.37; 95% confidence interval: 0.56-3.33; p = 0.48). By logistic
regression analysis, 1-day prophylaxis with cefazolin was not associated
with higher risk of SSI (adjusted odds ratio: 0.91; 95% confidence
interval: 0.32-2.56; p = 0.85). Conclusion: Antibiotic prophylaxis for 1
day in CABG surgery was associated with similar rates of postoperative
infection compared with antibiotic prophylaxis of 3 days. 2011.

<3>
Accession Number
2011568240
Authors
Guay J.
Institution
(Guay) Department of Anesthesiology, University of Montreal, 5415,
L'Assomption Boulevard, Montreal, QC, H1T 2M4, Canada
Title
General anaesthesia does not contribute to long-term post-operative
cognitive dysfunction in adults: A meta-analysis.
Source
Indian Journal of Anaesthesia. 55 (4) (pp 358-363), 2011. Date of
Publication: July - 2011.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Context: The contribution of anaesthesia itself to post-operative
cognitive dysfunction (POCD) or the potential protective effect of one
specific type of anaesthesia on the occurrence of POCD is unclear. Aims:
This is a meta-analysis evaluating the effects of the anaesthetic
technique (regional vs. general anaesthesia) on POCD of patients
undergoing non-cardiac surgery. Settings and Design: Meta-analysis
performed in a University affiliated hospital. Methods: A search for
randomized controlled trials (RCT) comparing regional anaesthesia to
general anaesthesia for surgery was done in PUBMED, MEDLINE, EMBASE, EBM
Reviews-Cochrane Central Register of Controlled Trials, PsychINFO and
Current Contents/all editions in 2009. Statistical Analysis: Data were
analyzed with comprehensive Meta-analysis Version 2.2.044. Results:
Twenty-six RCTs including 2365 patients: 1169 for regional anaesthesia and
1196 for general anaesthesia were retained. The standardized difference in
means for the tests included in the 26 RCTs was -0.08 (95% confidence
interval: -0.17-0.01; P value 0.094; I-squared = 0.00%). The assessor was
blinded to the anaesthetic technique for 12 of the RCTs including only 798
patients: 393 for regional anaesthesia and 405 for general anaesthesia.
The standardized difference in means for these 12 studies is 0.05
(-0.10-0.20; P=0.51; I-squared = 0.00%). Conclusions: The present
meta-analysis does not support the concerns that a single exposure to
general anaesthesia in an adult would significantly contribute to
permanent POCD after non-cardiac surgery.

<4>
Accession Number
2011568235
Authors
Mathai A.S.
Institution
(Mathai) Department of Anaesthesiology and Critical Care, Christian
Medical College and Hospital, Ludhiana, Punjab-141008, India
Title
Non-invasive ventilation in the postoperative period: Is there a role?.
Source
Indian Journal of Anaesthesia. 55 (4) (pp 325-333), 2011. Date of
Publication: July - 2011.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Non-invasive positive pressure ventilation or non-invasive ventilation
(NIV) has emerged as a simpler and safer alternative to invasive
mechanical ventilation in patients developing acute postoperative
respiratory failure. The benefits of NIV as compared to intubation and
mechanical ventilation include lower complications, shorter duration of
hospital stay, reduced morbidity, lesser cost of treatment and even
reduced mortality rates. However, its use may not be uniformly applicable
in all patient groups. This article reviews the indications,
contraindications and evidence supporting the use of NIV in individual
patient groups in the postoperative period. The anaesthesiologist needs to
recognise the subset of patients most likely to benefit from NIV therapy
so as to apply it most effectively. It is equally important to promptly
identify signs of failure of NIV therapy and be prepared to initiate
alternate ways of respiratory support. The author searched PubMed and Ovid
MEDLINE, without date restrictions. Search terms included Non-invasive
ventilation, postoperative and respiratory failure. Foreign literature was
included, though only articles with English translation were used.

<5>
Accession Number
21874215
Authors
Hansen D. Eijnde B.O. Roelants M. Broekmans T. Rummens J.L. Hensen K.
Daniels A. Van Erum M. Bonne K. Reyckers I. Alders T. Berger J. Dendale P.
Institution
(Hansen) Jessa Hospital/Heart Centre Hasselt, Rehabilitation and Health
Centre, Stadsomvaart 11, Hasselt, Belgium.
Title
Clinical benefits of the addition of lower extremity low-intensity
resistance muscle training to early aerobic endurance training
intervention in patients with coronary artery disease: a randomized
controlled trial.
Source
Journal of rehabilitation medicine : official journal of the UEMS European
Board of Physical and Rehabilitation Medicine. 43 (9) (pp 800-807), 2011.
Date of Publication: Sep 2011.
Abstract
Muscle resistance training is often combined with aerobic endurance
training during rehabilitation of patients with coronary artery disease.
However, the clinical effects of additional lower-extremity low-intensity
muscle resistance training during early rehabilitation (within the first
month after coronary revascularization) in patients with coronary artery
disease remain unclear. Prospective randomized controlled trial. Sixty
patients with coronary artery disease. Subjects were randomly assigned to
early aerobic endurance training (n=30) or combined aerobic endurance and
resistance muscle training (n=30). Subjects performed 18 (standard
deviation 2) exercise sessions (at 65% VO(2peak), for 40 mins/session). In
resistance muscle training, additional low-intensity (12-20 repetition
maximum) resistance muscle exercises were performed. The following
parameters were evaluated: exercise capacity, body composition, blood
lipid profile, glycaemic control, blood endothelial progenitor cell and
cytokine content, and muscle performance. A total of 47 patients with
coronary artery disease completed the intervention. Total body lean tissue
mass tended to increase with greater magnitude (p=0.07), and blood
high-density lipid cholesterol content increased with significantly
greater magnitude in resistance muscle training (p<0.05), compared with
aerobic endurance training. Maximal exercise capacity, ventilatory
threshold, and muscle performance increased, and steady-state exercise
respiratory exchange ratio, and adipose tissue mass reduced significantly
(p <0.05), without differences between groups (p <0.05). In early aerobic
endurance training intervention in patients with coronary artery disease,
additional low-intensity resistance muscle training contributes to a
greater increase in blood high-density lipid cholesterol content, and
tends to affect lean tissue mass.

<6>
Accession Number
2011566392
Authors
Harling L. Saso S. Jarral O.A. Kourliouros A. Kidher E. Athanasiou T.
Institution
(Harling, Saso, Jarral, Kourliouros, Kidher, Athanasiou) Department of
Surgery and Cancer, Imperial College London, London, United Kingdom
Title
Aortic valve replacement for aortic stenosis in patients with concomitant
mitral regurgitation: Should the mitral valve be dealt with?.
Source
European Journal of Cardio-thoracic Surgery. 40 (5) (pp 1087-1096), 2011.
Date of Publication: November 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Co-existent mitral regurgitation may adversely influence both morbidity
and mortality in patients undergoing aortic valve replacement for severe
aortic stenosis. Whilst it is accepted that concomitant mitral
intervention is required in severe, symptomatic mitral regurgitation, in
cases of mild-moderate non-structural mitral regurgitation, improvement
may be seen following aortic valve replacement alone, avoiding the
increased risk of double-valve surgery. The exact benefit of such a
conservative approach is, however, yet to be adequately quantified. We
performed a systematic literature review identifying 17 studies
incorporating 3053 patients undergoing aortic valve replacement for aortic
stenosis with co-existing mitral regurgitation. These were meta-analysed
using random effects modelling. Heterogeneity and subgroup analysis were
assessed. Primary end points were change in mitral regurgitation severity
and 30-day, 3-, 5- and 10-year mortality. Secondary end points were
end-organ dysfunction (neurovascular, renal and respiratory), and the
extent of ventricular remodelling following aortic valve replacement. Our
results revealed improvement in the severity of mitral regurgitation
following aortic valve replacement in 55.5% of patients, whereas 37.7%
remained unchanged, and 6.8% worsened. No significant difference was seen
between overall data and either the functional or moderate subgroups. The
overall 30-day mortality following aortic valve replacement was 5%. This
was significantly higher in moderate-severe mitral regurgitation than
nil-mild mitral regurgitation both overall (p= 0.002) and in the
functional subgroup (p= 0.004). Improved long-term survival was seen at 3,
5 and 10 years in nil-mild mitral regurgitation when compared with
moderate-severe mitral regurgitation in all groups (overall p<. 0.0001,
p<. 0.00001 and p= 0.02, respectively). The relative risk of respiratory,
renal and neurovascular complications were 7%, 6% and 4%, respectively.
Reverse remodelling was demonstrated by a significant reduction in
left-ventricular end-diastolic diameter and left-ventricular mass (p=
0.0007 and 0.01, respectively), without significant heterogeneity. No
significant change was seen in left-ventricular end-systolic diameter (p=
0.10), septal thickness (p= 0.17) or left atrial area (p= 0.23). We
conclude that despite reverse remodelling, concomitant moderate-severe
mitral regurgitation adversely affects both early and late mortality
following aortic valve replacement. Concomitant mitral intervention should
therefore be considered in the presence of moderate mitral regurgitation,
independent of the aetiology. 2011 European Association for
Cardio-Thoracic Surgery.

<7>
Accession Number
2011566409
Authors
Kazemi B. Ahmadzadeh A. Safaei N. Jodati A. Sohrabi B. Afrasiabi A.
Institution
(Kazemi, Ahmadzadeh, Safaei, Jodati, Sohrabi, Afrasiabi) Cardiovascular
Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
Title
Influence of anterior periaortic fat pad excision on incidence of
postoperative atrial fibrillation.
Source
European Journal of Cardio-thoracic Surgery. 40 (5) (pp 1191-1196), 2011.
Date of Publication: November 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: In humans, the existence of an anterior periaortic fat pad
(AFP) containing parasympathetic ganglia has been described in the
aortopulmonary window. Changes in the autonomic nervous system (ANS) tone
can lead to postoperative atrial fibrillation (POAF). The AFP is usually
removed during coronary bypass grafting (CABG) to fully expose the aortic
root. The purpose of this study was to evaluate the influence of AFP
removal during CABG on the ANS tone, incidence of POAF, hospital stay, and
in-hospital morbidity and mortality. Methods: A total of 215 patients were
randomized in this prospective, double-blind trial to either removal (n=
107) or maintenance (n= 108) of the AFP during their first CABG. All
patients underwent continuous telemetry monitoring after surgery. They
underwent at least 1-h Holter monitoring on the second postoperative day.
Heart rate variability measurements of both time-domain and
frequency-domain analysis were included. POAF was defined as AF for more
than 5 min or causing hemodynamic instability. Results: The mean age was
nearly 58 years, and 76% were male. There was no difference in the
incidence of POAF between the retained and removed AFP groups (19.3% vs
17%, respectively; P= 0.664, odds ratio = 1.16). Mean heart rate and heart
rate variability parameters, in-hospital stay, and postoperative morbidity
and mortality were similar in both groups. Conclusions: Removal of the AFP
during CABG has no significant effect on the incidence of POAF, ANS tone,
and postoperative morbidity or mortality. 2011 European Association for
Cardio-Thoracic Surgery.

<8>
Accession Number
2011566417
Authors
Biancari F. Yli-Pyky S.
Institution
(Biancari, Yli-Pyky) Division of Cardio-thoracic and Vascular Surgery,
Department of Surgery, Oulu University Hospital, Oulu, Finland
Title
Meta-analysis on the use of the Heartstring anastomotic device to prevent
stroke in patients undergoing off-pump coronary artery bypass grafting.
Source
European Journal of Cardio-thoracic Surgery. 40 (5) (pp 1236-1240), 2011.
Date of Publication: November 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Postoperative stroke is the Achilles' heel of coronary artery
bypass surgery compared with percutaneous coronary intervention. In this
meta-analysis, we sought to determine the efficacy of the Heartstring
proximal anastomotic device to reduce the risk of postoperative stroke
after off-pump coronary artery bypass grafting (OPCAB). Methods: Studies
on the Heartstring device were identified by searching PubMed, Cochrane
Library and Scopus up to November 2010. The results were expressed as
pooled proportions (%) with 95% confidence interval (95% CI).
Heterogeneity across the studies was evaluated by the I² test
and a random effects model was used. Results: Eighteen articles were
pertinent with this issue and we were able to retrieve data on the
Heartstring anastomotic device in OPCAB from eight studies. Three studies
were prospective and routine epi-aortic ultrasound was used in three
studies. A total of 819 patients were enrolled in these eight studies and
six of them suffered stroke postoperatively. Cumulative analysis showed a
pooled rate of immediate postoperative stroke after OPCAB with the use of
Heartstring of 1.9% (95% CI 0.8-4.5, I²=23%). Sensitivity
analysis including the only three studies evaluating patients with
diseased ascending aorta as detected at epi-aortic ultrasound showed that
a pooled rate of stroke was 3.2% (95% CI 0.8-11.9, I²=0%). Six
studies reported on immediate postoperative mortality and the pooled
mortality rate was 1.9% (95% CI 0.1-3.4). Conclusions: The results of this
meta-analysis suggest that the risk of stroke after OPCAB may not be
markedly reduced by the use of Heartstring device. On the other hand, a
rather low rate of stroke was observed among patients with diseased
ascending aorta indicating its potential value in these patients. Most of
studies included in this meta-analysis were of poor methodological
quality, and properly conducted prospective studies are needed to get more
conclusive results on the safety and efficacy of Heartstring anastomosis
device. 2011 European Association for Cardio-Thoracic Surgery.

<9>
Accession Number
21713745
Authors
Mirhosseini S.J. Forouzannia S.K. Sayegh A.H. Sanatkar M.
Institution
(Mirhosseini) Department of Cardiovascular Surgery, Afshar Hospital,
Shahid Sadoughi University of medical sciences, Yazd, Iran.
Title
Effect of prophylactic low dose of methylprednisolone on postoperative new
atrial fibrillation and early complications in patients with severe LV
dysfunction undergoing elective off-pump coronary artery bypass surgery.
Source
Acta medica Iranica. 49 (5) (pp 288-292), 2011. Date of Publication:
2011.
Abstract
Atrial fibrillation (AF) is the most common arrhythmia after
cardiothoracic surgery. AF following coronary artery bypass graft (CABG)
is associated with an increase in morbidity, mortality, hemodynamic
instability, thromboembolic events, severity of heart failure and ICU and
hospital stay. Corticosteroids have a variety of beneficial effects on
recovery after elective surgery. This study was designed to test the
hypothesis that low dose of Methylprednisolone (MP) can affect post-CABG
AF and early complications in patients with severe left ventricle
dysfunction who underwent elective off-pump coronary artery bypass. A
total of 120 patients with LV dysfunction undergoing elective off- pump
CABG randomly received either MP or placebo. Diabetic patients and those
who were receiving corticosteroids were excluded. The MP group received
5mg/kg of MP intravenously after induction of anesthesia and the placebo
group received an equal volume of normal saline. We evaluated Post-CABG
variables including incidence, duration and frequency of AF recurrence and
early morbidity such as bleeding, infection, vomiting, renal and
respiratory dysfunctions, ICU or hospital stay and early mortality. The
mean age of patients was 62.11 +/- 12.34 years with the 2.4 male to female
ratio. AF occurred in 23(19.2%) patients. No significant difference in the
incidence of new AF was found between the placebo (21.7%) and MP group
(16.7%) (P=0.47). MP did not affect postoperative bleeding, infection,
vomiting, renal and respiratory dysfunction and mortality; however, MP
significantly reduced ICU and hospital length of stay. MP did not affect
the incidence, duration and frequency of AF recurrence in patients with
severe LV dysfunction undergoing off-pump CABG. However, MP could reduce
ICU and hospital stay significantly in these patients.

<10>
Accession Number
2011569136
Authors
Hijazi E.
Institution
(Hijazi) Department of General Surgery, Jordan University of Science and
Technology, King Abdullah University Hospital, Irbid 22110, Jordan
Title
Aspirin does not increase bleeding and allogeneic blood transfusion in
coronary artery surgery.
Source
Thoracic and Cardiovascular Surgeon. 59 (7) (pp 421-424), 2011. Date of
Publication: 2011.
Publisher
Georg Thieme Verlag (Rudigerstrasse 14, Stuttgart D-70469, Germany)
Abstract
Background: Traditionally, the administration of aspirin is stopped seven
days before coronary artery bypass surgery to reduce the risk of
postoperative bleeding. The aim of this study was to evaluate the effect
of preoperative aspirin on bleeding in these patients. Methods: A
prospective nonrandomized unblinded study was carried out at the King
Abdullah University Hospital in Jordan/Irbid from June 2005 to December
2009 in 756 patients. Patients were divided into 2 groups: Group 1 (n=400)
consisted of patients on aspirin, 100mg/day, until the day of surgery;
Group 2 (n=356) consisted of patients who stopped taking aspirin seven
days before surgery. The groups were compared to evaluate the effect of
preoperative aspirin on bleeding in patients undergoing elective coronary
artery bypass surgery. Data were collected and compared and included total
amount of postoperative chest tube drainage, number of transfused units of
blood and blood products, and numbers of patients who required
reexploration for bleeding. Results were considered significant when
p<0.05. Results: There was no significant increase in the amount of blood
loss, units of transfused blood products, or the incidence of
reexploration between the two groups (p>0.05). Conclusion: Aspirin does
not increase bleeding or increase the need for allogeneic blood
transfusion in coronary artery surgery. 2011 Georg Thieme Verlag KG
Stuttgart New York.

<11>
Accession Number
2011569134
Authors
Baslaim G. Jamjoom A. Al-Githmi I. Al-Malki F.
Institution
(Baslaim, Jamjoom, Al-Githmi) Division of Cardiothoracic Surgery, King
Faisal Specialist Hospital and Research Center, MBC-J 16, P.O. Box 40047,
21499 Jeddah, Saudi Arabia
(Al-Malki) Perfusion Service, King Faisal Specialist Hospital and Research
Center, Jeddah, Saudi Arabia
Title
Nitroglycerin cardioplegia effect on coronary artery targets in bypass
grafting.
Source
Thoracic and Cardiovascular Surgeon. 59 (7) (pp 411-415), 2011. Date of
Publication: 2011.
Publisher
Georg Thieme Verlag (Rudigerstrasse 14, Stuttgart D-70469, Germany)
Abstract
Background: Coronary artery targets are essential for referral acceptance
to achieve complete coronary revascularization. Patients and Methods: A
prospective double-blind study was carried out to determine whether the
addition of nitroglycerin to cold blood hyperkalemic cardioplegia would
optimize the size and number of coronary artery targets during
conventional coronary bypass grafting. Results: A total of 60 adult
elective coronary artery bypass grafting cases were enrolled; 30 in group
N (nitroglycerin added to cardioplegia) and 30 in group C (controls). The
number of bypassed vessels ranged from 2 to 5 with a mean of 3.63. In a
comparison between groups N and C, the average number of grafts per
patient (3.67+/-0.77 vs. 3.67+/-0.92); the average performed/predicted
ratio for coronary artery bypass grafting targets (0.96+/-0.18 vs.
1.02+/-0.31); and the average intraoperatively measured luminal diameter
of the bypassed coronary artery targets (1.55+/-0.23 vs. 1.51+/-0.23)
showed no significant difference between the two groups, except that the
luminal diameter of the obtuse marginal II artery was larger in group C
compared to group N (p=0.037). Conclusions: The addition of nitroglycerin
to cardioplegia did not show any benefit, either quantitatively or
qualitatively, for optimizing coronary artery bypass grafting targets.
2011 Georg Thieme Verlag KG Stuttgart New York.

<12>
Accession Number
2011567494
Authors
Wikkelsoe A.J. Afshari A. Wetterslev J. Brok J. Moeller A.M.
Institution
(Wikkelsoe, Moeller) Department of Anesthesiology and Intensive Care,
Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730
Herlev, Denmark
(Afshari) Department of Anesthesiology, Juliane Marie Centre, Cochrane
Anaesthesia Review Group, Copenhagen, Denmark
(Wetterslev) Copenhagen Trial Unit, Center for Clinical Intervention
Research, Copenhagen, Denmark
(Brok) Department of Paediatrics, Hvidovre Hospital, Hvidovre, Denmark
(Brok) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Copenhagen University Hospital, Copenhagen, Denmark
(Moeller) Cochrane Anaesthesia Review Group, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
Title
Monitoring patients at risk of massive transfusion with Thrombelastography
or Thromboelastometry: A systematic review.
Source
Acta Anaesthesiologica Scandinavica. 55 (10) (pp 1174-1189), 2011. Date
of Publication: November 2011.
Publisher
Blackwell Munksgaard (1 Rosenorns Alle, P.O. Box 227, Copenhagen V
DK-1502, Denmark)
Abstract
Background Thrombelastography (TEG) and Thrombelastometry (ROTEM) are
viscoelastic whole-blood assays evaluating the haemostatic capacity of
blood. These devices are used in algorithms to guide transfusion of
haemostatic blood components. Methods The methods used for this study were
systematic reviews with meta-analyses and trial sequential analyses of
randomised clinical trials (RCTs) of TEG/ROTEM-based algorithm compared
with standard treatment in patients with bleeding. Primary outcome was
all-cause mortality. We searched the literature in seven databases (up to
31 October 2010), reference lists, registers of ongoing trials, and
contacted authors and experts. We extracted data from included studies
related to study methods, interventions, outcomes, bias risk and adverse
events using Cochrane methodology. All trials irrespective of blinding or
language status were included. Results Nine trials involving 776
participants were included. Eight trials involved cardiac surgery with an
average blood loss of 390-960ml, and one trial investigated liver
transplantations. One trial was classified as low-risk-of-bias trial. We
found two ongoing trials. No impact was identified on mortality, amount of
blood transfused, incidence of surgical reinterventions, time to
extubation, or length of stay in hospital and intensive care unit. We
identified a significant reduction in blood loss favouring the use of
TEG/ROTEM {85ml [95% confidence interval (CI) 29.4-140.7]} and in the
proportion of patients receiving freshly frozen plasma and platelets
[relative risk 0.39 (95%CI 0.27-0.57)]. Conclusion There is currently weak
evidence to support the use of TEG/ROTEM as a tool to guide transfusion in
patients with severe bleeding. Further studies need to address other
clinical settings and with larger blood losses. 2011 The Acta
Anaesthesiologica Scandinavica Foundation.

<13>
Accession Number
2011567437
Authors
Wolff G.A. Weitzel N.S.
Institution
(Wolff, Weitzel) University of Colorado Denver, 12631 E 17th Avenue, AO1
8203, Aurora, CO 80045, United States
Title
Management of acquired cardiac disease in the obstetric patient.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 15 (3) (pp 85-97),
2011. Date of Publication: September 2011.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Physiologic changes incurred by pregnancy can cause severe decompensation
in the parturient with underlying cardiac disease. The result is increased
morbidity and mortality for both mother and child. Appropriate anesthetic
management can significantly impact these outcomes. This review
systematically presents the pathophysiology, peripartum risk, and
anesthetic management in the puerperium of specific acquired cardiac
abnormalities including: valvular disease, pulmonary hypertension,
cardiomyopathy, cardiac transplantation, ischemia, arrhythmias, and
cardiac arrest. 2011 SAGE Publications.

<14>
Accession Number
2011564172
Authors
Liang Y. Pan W. Su Y. Ge J.
Institution
(Liang, Pan, Su, Ge) Department of Cardiology, Zhongshan Hospital, Fudan
University, Shanghai, China
Title
Meta-analysis of randomized controlled trials comparing isolated left
ventricular and biventricular pacing in patients with chronic heart
failure.
Source
American Journal of Cardiology. 108 (8) (pp 1160-1165), 2011. Date of
Publication: 15 Oct 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Cardiac resynchronization therapy (CRT) has been mostly achieved by
biventricular pacing (BVP) in patients with chronic heart failure (CHF),
although it can also be provided by left ventricular pacing (LVP). The
superiority of BVP over LVP remains uncertain. The present meta-analysis
of randomized controlled trials was performed to compare the effects of
LVP to BVP in patients with CHF. Outcomes analyzed included clinical
status (6-minute walk distance, peak oxygen consumption, quality of life,
New York Heart Association class), LV function (LV ejection fraction), and
LV remodeling (LV end-systolic volume). Five trials fulfilled criteria for
inclusion in analysis, which included 574 patients with CHF indicated for
CRT. After a midterm follow-up, pooled analysis demonstrated that LVP
resulted in similar improvements in 6-minute walk distance (weighted mean
difference [WMD] 11.25, 95% confidence interval [CI] -12.39 to 34.90, p =
0.35), quality of life (WMD 0.34, 95% CI -3.72 to 4.39, p = 0.87), peak
oxygen consumption (WMD 1.00, 95% CI -0.84 to 2.85, p = 0.29), and New
York Heart Association class (WMD -0.19, 95% CI -0.79 to 0.42, p = 0.54).
There was a trend toward a superiority of BVP over LVP for LV ejection
fraction (WMD 1.28, 95% CI -0.11 to 2.68, p = 0.07) and LV end-systolic
volume (WMD -5.73, 95% CI -11.86 to 0.39, p = 0.07). In conclusion, LVP
achieves similar improvement in clinical status as BVP in patients with
CHF, whereas there was a trend toward superiority of BVP over LVP for LV
reverse modeling and systolic function. 2011 Elsevier Inc.

<15>
Accession Number
2011552812
Authors
Huang T.-T. Hudson M.M. Stokes D.C. Krasin M.J. Spunt S.L. Ness K.K.
Institution
(Huang, Ness) Department of Epidemiology and Cancer Control, St. Jude
Children's Research Hospital, Mail Stop 735, 262 Danny Thomas Place,
Memphis, TN 38105, United States
(Hudson, Spunt) Department of Oncology, St. Jude Children's Research
Hospital, Memphis, TN, United States
(Stokes) Department of Pediatric Pulmonary Medicine, St. Jude Children's
Research Hospital, Memphis, TN, United States
(Krasin) Department of Radiological Sciences, St. Jude Children's Research
Hospital, Memphis, TN, United States
Title
Pulmonary outcomes in survivors of childhood cancer: A systematic review.
Source
Chest. 140 (4) (pp 881-901), 2011. Date of Publication: October 2011.
Publisher
American College of Chest Physicians (3300 Dundee Road, Northbrook IL
60062-2348, United States)
Abstract
Background: The purpose of this article is to summarize the literature
that documents the long-term impact of cancer treatment modalities on
pulmonary function among survivors of cancer and to identify potential
areas for further research. Methods: Systematic reviews of clinical
trials, observational studies, case series, and review articles were
conducted. Articles were limited to the studies that discussed pulmonary
toxicity or late effects among pediatric cancer survivors and to follow-up
investigations that were conducted a minimum of 2 years after completion
of cancer-related treatment or 1 year after hematopoietic stem cell
transplant. Results: Sixty publications (51 clinical studies/reports and
nine reviews) published from January 1970 to June 2010 in PubMed met the
inclusion criteria. Data showed an association between radiotherapy,
alkylating agents, bleomycin, hematopoietic stem cell transplant, and
thoracic surgery and pulmonary toxicity, as well as possible interactions
among these modalities. Conclusions: Pulmonary toxicity is a common
long-term complication of exposure to certain anticancer therapies in
childhood and can vary from subclinical to life threatening. Pulmonary
function and associated loss of optimal exercise capacity may have adverse
effects on long-term quality of life in survivors. Lung function
diminishes as a function of normal aging, and the effects of early lung
injury from cancer therapy may compound these changes. The information
presented in this review is designed to provide a stimulus to promote both
observational and interventional research that expands our knowledge and
aids in the design of interventions to prevent or ameliorate pulmonary
late effects among survivors of childhood cancer. 2011 American College
of Chest Physicians.

<16>
Accession Number
2011577967
Authors
Chan J.Y.-S. Fang F. Zhang Q. Fung J.W.-H. Razali O. Azlan H. Lam K.-H.
Chan H.C.-K. Yu C.-M.
Institution
(Chan, Fang, Zhang, Fung, Yu) Department of Medicine and Therapeutics,
Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong
Kong
(Zhang) Department of Cardiology, West China Hospital, Sichuan University,
China
(Fung) Department of Medicine, North District Hospital, Hong Kong, Hong
Kong
(Razali, Azlan, Lam) Department of Cardiology, National Heart Institute,
Kuala Lumpur, Malaysia
(Chan) Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai
Po, Hong Kong
Title
Biventricular pacing is superior to right ventricular pacing in
bradycardia patients with preserved systolic function: 2-year results of
the PACE trial.
Source
European Heart Journal. 32 (20) (pp 2533-2540), 2011. Date of
Publication: October 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims: The Pacing to Avoid Cardiac Enlargement (PACE) trial is a
prospective, double-blinded, randomized, multicentre study that reported
the superiority of biventricular (BiV) pacing to right ventricular apical
(RVA) pacing in the prevention of left ventricular (LV) adverse
remodelling and deterioration of systolic function at 1 year. In the
current analysis, we report the results at extended 2-year follow-up for
changes in LV function and remodelling. Methods and results: Patients
(n=177) with bradycardia and preserved LV ejection fraction (EF <45) were
randomized to receive RVA or BiV pacing. The co-primary endpoints were
LVEF and LV end-systolic volume (LVESV).Eighty-one (92) of 88 in the RVA
pacing group and 82 (92) of 89 patients in the BiV pacing group completed
2-year follow-up with a valid echocardiography. In the RVA pacing group,
LVEF further decreased from the first to the second year, but it remained
unchanged in the BiV pacing group, leading to a significant difference of
9.9 percentage points between groups at 2-year follow-up (P < 0.001).
Similarly, LVESV continues to enlarge from the first to the second year in
the RVA pacing group, leading to a difference of 13.0 mL (P < 0.001)
between groups. Predefined subgroup analysis showed consistent results
with the whole study population for both co-primary endpoints, which
included patients with pre-existing LV diastolic dysfunction. Eighteen
patients in the BiV pacing group (20.2) and 55 in the RVA pacing group
(62.5) had a significant reduction of LVEF (of <5, P < 0.001). Conclusion:
Left ventricular adverse remodelling and deterioration of systolic
function continues at the second year after RVA pacing. This deterioration
is prevented by BiV pacing. 2011 The Author.

<17>
Accession Number
2011577956
Authors
Tardif J.-C. Omeara E. Komajda M. Bohm M. Borer J.S. Ford I. Tavazzi L.
Swedberg K.
Institution
(Tardif, Omeara) Montreal Heart Institute, Universite de Montreal, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Komajda) Department of Cardiology, University Pierre et Marie Curie Paris
VI, La Pitie-Salpetriere Hospital, Paris, France
(Bohm) Universitatskliniken des Saarlandes, Klinik fur Innere Medizin III,
Homburg/Saar, Germany
(Borer) Division of Cardiovascular Medicine, Howard Gilman Institute for
Heart Valve Disease, State University of New York, Brooklyn, New York, NY,
United States
(Ford) Robertson Centre for Biostatistics, University of Glasgow, Glasgow,
United Kingdom
(Tavazzi) Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini
Health Science Foundation, Cotignola, Italy
(Swedberg) Department of Emergency and Cardiovascular Medicine,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Title
Effects of selective heart rate reduction with ivabradine on left
ventricular remodelling and function: Results from the SHIFT
echocardiography substudy.
Source
European Heart Journal. 32 (20) (pp 2507-2515), 2011. Date of
Publication: October 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims: The SHIFT echocardiographic substudy evaluated the effects of
ivabradine on left ventricular (LV) remodelling in heart failure (HF).
Methods and results: Eligible patients had chronic HF and systolic
dysfunction [LV ejection fraction (LVEF) <=35], were in sinus rhythm, and
had resting heart rate <70 bpm. Patients were randomly allocated to
ivabradine or placebo, superimposed on background therapy for HF. Complete
echocardiographic data at baseline and 8 months were available for 411
patients (ivabradine 208, placebo 203). Treatment with ivabradine reduced
LVESVI (primary substudy endpoint) vs. placebo [-7.0 +/- 16.3 vs. -0.9 +/-
17.1 mL/m²; difference (SE), -5.8 (1.6), 95 CI -8.8 to -2.7, P<
0.001]. The reduction in LVESVI was independent of beta-blocker use, HF
aetiology, and baseline LVEF. Ivabradine also improved LV end-diastolic
volume index (-7.9 +/- 18.9 vs. -1.8 +/- 19.0 mL/m², P 0.002)
and LVEF (2.4 +/- 7.7 vs. -0.1 +/- 8.0, P< 0.001). The incidence of the
SHIFT primary composite outcome (cardiovascular mortality or
hospitalization for worsening HF) was higher in patients with LVESVI above
the median (59 mL/m²) at baseline (HR 1.62, 95 CI 1.032.56, P
0.04). Patients with the largest relative reductions in LVESVI had the
lowest event rates. Conclusion: Ivabradine reverses cardiac remodelling in
patients with HF and LV systolic dysfunction. 2011 The Author.

<18>
Accession Number
2011574333
Authors
Friedland S. Eisenberg M.J. Shimony A.
Institution
(Friedland, Eisenberg, Shimony) Divisions of Cardiology and Clinical
Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
(Shimony) Cardiology Department, Soroka University Medical Center,
Ben-Gurion University, Be'er-Sheva, Israel
Title
Meta-analysis of randomized controlled trials of intracoronary versus
intravenous administration of glycoprotein IIb/IIIa inhibitors during
percutaneous coronary intervention for acute coronary syndrome.
Source
American Journal of Cardiology. 108 (9) (pp 1244-1251), 2011. Date of
Publication: 01 Nov 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
It is unclear whether intracoronary (IC) bolus administration of
glycoprotein IIb/IIIa inhibitors (GPIs) during percutaneous coronary
intervention (PCI) in patients with acute coronary syndromes is superior
to intravenous (IV) administration. We conducted a meta-analysis of
randomized controlled trials (RCTs) to compare the effects of IC and IV
administrations of GPIs in patients with acute coronary syndromes. We
systematically searched the Cochrane Library, EMBASE, and MEDLINE
databases for RCTs comparing IC to IV administration of GPIs (abciximab,
eptifibatide, tirofiban) during PCI. Data were pooled and stratified into
short (1 month to 3 months) and mid-/long-term (<6 months) follow-up
durations. Ten RCTs involving 1,590 patients met our inclusion criteria.
Compared to the IV group the IC group was more likely to have complete
perfusion (Thrombolysis In Myocardial Infarction grade 3 flow) after PCI
(risk ratio [RR] 1.08, 95% confidence interval [CI] 1.02 to 1.15). IC
administration was associated with similar bleeding rates as IV (RR 0.92,
95% CI 0.68 to 1.24) but with a significant decrease in short-term target
vessel revascularization (RR 0.54, 95% CI 0.30 to 0.96). IC administration
was also associated with a significant decrease in short-term mortality
(RR 0.45, 95% CI 0.23 to 0.90) but this decrease was no longer significant
in mid-/long-term RCTs. In conclusion, compared to IV administration IC
administration of GPIs has favorable effects on Thrombolysis In Myocardial
Infarction flow, target vessel revascularization, and short-term mortality
after PCI, with no difference in rates of bleeding. Data regarding
mid-/long-term outcomes were limited and inconclusive. Large RCTs with
longer follow-up are required to determine long-term safety and efficacy.
2011 Elsevier Inc. All rights reserved.

<19>
Accession Number
2011572462
Authors
Seehusen D.A.
Institution
(Seehusen) DeWitt Army Community Hospital, Fort Belvoir, Virgin Islands
(U.S.)
Title
Statins for primary cardiovascular prevention.
Source
American Family Physician. 84 (7) (pp 767-769), 2011. Date of
Publication: October 1, 2011.
Publisher
American Academy of Family Physicians (11400 Tomahawk Creek Parkway, Suite
440, Leawood KS 66211, United States)
Abstract
Background: Reducing high blood cholesterol, a risk factor for
cardiovascular disease (CVD) events in persons with and without a history
of coronary heart disease (CHD), is an important goal of pharmacotherapy.
Statins are the first-choice agents. Previous reviews of the effects of
statins have highlighted their benefits in persons with coronary artery
disease. The case for primary prevention, however, is less clear. SA
Objectives: To assess the effects, both harms and benefits, of statins in
persons with no history of CVD. Search Strategy: To avoid duplication of
effort, we checked reference lists of previous systematic reviews. We
searched the Cochrane Central Register of Controlled Trials (Issue 1,
2007), Medline (2001 to March 2007), and EMBASE (2003 to March 2007).
There were no language restrictions. Selection Criteria: Randomized
controlled trials of statins with minimum duration of one year and
follow-up of six months, in adults with no restrictions on their total
low-density lipoprotein or high-density lipoprotein cholesterol levels,
and where 10 percent or less had a history of CVD, were included. Data
Collection and Analysis: Two authors independently selected studies for
inclusion and extracted data. Outcomes included all-cause mortality, fatal
and nonfatal CHD, CVD and stroke events, combined end points (fatal and
nonfatal CHD, CVD, and stroke events), change in blood total cholesterol
concentration, revascularization, adverse events, quality of life, and
costs. Relative risk (RR) was calculated for dichotomous data, and for
continuous data pooled weighted mean differences (with 95% confidence
intervals [CIs]) were calculated. Main Results: Fourteen randomized
controlled trials (16 trial arms; 34,272 participants) were included.
Eleven trials recruited patients with specific conditions (raised lipids,
diabetes mellitus, hypertension, microalbuminuria). All-cause mortality
was reduced by statins (RR = 0.83; 95% CI, 0.73 to 0.95), as were combined
fatal and nonfatal CVD end points (RR = 0.70; 95% CI, 0.61 to 0.79).
Benefits were also seen in the reduction of revascularization rates (RR =
0.66; 95% CI, 0.53 to 0.83). Total cholesterol and low-density lipoprotein
cholesterol levels were reduced in all trials but there was evidence of
heterogeneity of effects. There was no clear evidence of any significant
harm caused by statin prescription or of effects on patient quality of
life. Authors' Conclusions: Although reductions in all-cause mortality,
composite end points, and revascularizations were found with no excess of
adverse events, there was evidence of selective reporting of outcomes,
failure to report adverse events, and inclusion of persons with CVD. Only
limited evidence showed that primary prevention with statins may be
cost-effective and improve patient quality of life. Caution should be
taken in prescribing statins for primary prevention in persons at low
cardiovascular risk.