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<1>
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Accession Number
2011627825
Authors
Steil G.M. Langer M. Jaeger K. Alexander J. Gaies M. Agus M.S.D.
Institution
(Steil, Langer, Jaeger, Alexander, Agus) Department of Surgery and
Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA,
United States
(Gaies) Department of Pediatrics and Communicable Diseases, University of
Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
Title
Value of continuous glucose monitoring for minimizing severe hypoglycemia
during tight glycemic control.
Source
Pediatric Critical Care Medicine. 12 (6) (pp 643-648), 2011. Date of
Publication: November 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective: Tight glycemic control can potentially reduce morbidity and
mortality in the intensive care unit but increases the risk of
hypoglycemia. The most effective means to avoid hypoglycemia is to obtain
frequent blood glucose samples, but this increases the burden to nursing
staff. The objective of this study was to assess the ability of a
real-time continuous glucose monitor to reduce hypoglycemia (blood glucose
<60 mg/dL [3.3 mmol/L]) during standard care or tight glycemic control
effected with a proportional integral derivative insulin titration
algorithm. Design: Real-time continuous glucose monitor profiles obtained
from an ongoing prospective randomized trial of tight glycemic control
were retrospectively analyzed to determine whether the continuous glucose
measure had prevented instances of hypoglycemia. Setting: Cardiac
intensive care unit. Patients: Children 3 yrs of age or younger undergoing
cardiac surgery were studied. Interventions: Intravenous insulin infusion
and rescue glucose guided by the real-time continuous glucose monitor and
the proportional integral derivative algorithm in the tight glycemic
control arm (n = 155; target glucose 80-110 mg/dL [4.4-6.1 mmol/L]) and
the real-time continuous glucose monitor in the standard care arm (n =
156). Measurements and Main Results: No reduction in hypoglycemia was
observed with real-time continuous glucose monitor alarms set at 60 mg/dL
(3.3 mmol/L) (zero of 19 occurrences of blood glucose <60 mg/dL [3.3
mmol/L] detected); 18 of 40 subsequent incidences of hypoglycemia were
detected after the alarm threshold was increased to 70 mg/dL (3.9 mmol/L).
In the tight glycemic control arm, eight incidences were reduced in
duration and an additional eight events were prevented with intravenous
glucose. In the standard care arm, three of nine occurrences of
hypoglycemia were detected with the duration reduced in all cases. On
average, one to two false hypoglycemia alarms were observed in each
patient. Conclusions: The real-time continuous glucose monitor in
combination with proportional integral derivative control can reduce
hypoglycemia during tight glycemic control. The real-time continuous
glucose monitor can also reduce hypoglycemia during standard care.
However, false alarms increase the overall nursing workload. 2011 by the
Society of Critical Care Medicine and the World Federation of Pediatric
Intensive and Critical Care Societies.

<2>
Accession Number
2011628548
Authors
Sorice M. Tritto F.P. Sordelli C. Gregorio R. Piazza L.
Institution
(Sorice, Tritto, Gregorio, Piazza) Department of Cardiac Surgery, S. Anna
e S. Sebastiano Hospital, Caserta, Italy
(Sorice, Tritto, Gregorio, Piazza) Via F. Palasciano, 81100 (CE), Italy
(Sordelli) Department of Cardiothoracic Sciences, Monaldi Hospital, Second
University of Naples, Naples, Italy
(Sordelli) Via L. Bianchi, 80131 (NA), Italy
Title
N-3 polyunsaturated fatty acids reduces post-operative atrial fibrillation
incidence in patients undergoing "on-pump" coronary artery bypass graft
surgery.
Source
Monaldi Archives for Chest Disease - Cardiac Series. 76 (2) (pp 93-98),
2011. Date of Publication: June 2011.
Publisher
Fondazione Salvatore Maugeri (Via Ferrata 8, Pavia 27100, Italy)
Abstract
Background: The aim of this study was to evaluate the efficacy of
preoperative and postoperative therapy with n-3 polyunsaturated fatty
acids in reducing the incidence of atrial fibrillation after coronary
artery bypass graft surgery. Methods: 201 patients undergoing coronary
artery bypass graft surgery were randomized to 1) a control group (105
patients), or 2) n-3 polyunsaturated fatty acids 2 g/day group (96
patients) for at least 5 days before surgery and until hospital discharge.
Groups were further subdivided in four subgroups according to the
operative technique: "off-pump"or "on-pump". The primary end point was to
evaluate the reduced incidence of postoperative in-hospital atrial
fibrillation in the (N-3 PUFA) group. Secondary end points were the impact
of the surgical technique on the incidence of postoperative arrhythmia and
the impact of n-3 polyunsaturated fatty acids therapy on post-operative
hospital length of stay. Results: The overall incidence of post-operative
atrial fibrillation was 17.4% (35/201). The arrhythmia occurred in 11.4%
(11/96) of the patients in therapy with n-3 polyunsaturated fatty acids
and in 22.8% (24/105) in the control groups. In particular, the
statistical analysis of subgroups showed a significant reduction of
postoperative atrial fibrillation only in the group including patients
treated with n-3 polyunsaturated fatty acids undergoing "on-pump" coronary
artery bypass graft surgery. The length of hospital stay did not differ
among all groups. Conclusions: N-3 polyunsaturated fatty acids
administration significantly reduces the incidence of post-operative
atrial fibrillation in patients undergoing "on-pump" coronary artery
bypass graft surgery. N-3 polyunsaturated fatty acids therapy is not
associated with a shorter hospital stay.

<3>
Accession Number
2011604859
Authors
Morice M.-C. Feldman T.E. Mack M.J. Stahle E. Holmes D.R. Colombo A. Morel
M.-A. Van Den Brand M. Serruys P.W. Mohr F. Carrie D. Fournial G. James S.
Leadley K. Dawkins K.D. Kappetein A.P.
Institution
(Morice) Institut Hospitalier Jacques Cartier, 6, Avenue du Noyer Lambert,
F-91349 Massy, France
(Feldman) Evanston Hospital, Evanston, IL, United States
(Mack) Heart Hospital Baylor Plano, Dallas, TX, United States
(Stahle, James) University Hospital Uppsala, Uppsala, Sweden
(Holmes) Mayo Clinic, Rochester, MN, United States
(Colombo) San Raffaele Scientific Institute, Milan, Italy
(Morel, Van Den Brand) Cardialysis, Rotterdam, Netherlands
(Serruys, Kappetein) Erasmus University Medical Center, Rotterdam,
Netherlands
(Mohr) University of Leipzig Heart Center, Leipzig, Germany
(Carrie, Fournial) Centre Hopital Universitaire Rangueil, Toulouse, France
(Leadley, Dawkins) Boston Scientific Corporation, Inc., Natick, MA, United
States
Title
Angiographic outcomes following stenting or coronary artery bypass surgery
of the left main coronary artery: Fifteen-month outcomes from the synergy
between PCI with TAXUS express and cardiac surgery left main angiographic
substudy (SYNTAX-LE MANS).
Source
EuroIntervention. 7 (6) (pp 670-679), 2011. Date of Publication: October
2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The SYNTAX-LE MANS substudy prospectively evaluated 15-month
angiographic and clinical outcomes in patients with treated left main (LM)
disease. Methods and results: In the SYNTAX trial, 1,800 patients with
three-vessel and/or LM disease were randomised to either CABG or PCI; of
these, 271 LM patients were prospectively assigned to receive a 15-month
angiogram. The primary endpoint for the CABG arm was the ratio of >=50% to
<100% obstructed/occluded grafts bypassing LM lesions to the number
placed. The primary endpoint for the PCI arm was the proportion of
patients with <=50% diameter stenosis ('patent' stents) of treated LM
lesions. Per protocol, no formal comparison between CABG and PCI arms was
intended based on the differing primary endpoints. Available 15-month
angiograms were analysed for 114 CABG and 149 PCI patients. At 15 months,
9.9% (26/263) of CABG grafts were 100% occluded and an additional 5.7%
(15/263) were >=50% to <100% occluded. Overall, 27.2% (31/114) of patients
had >=1 obstructed/occluded graft. The 15-month CABG MACCE rate was 8.8%
(10/114) and MACCE at 15 months was not significantly associated with
graft obstruction/occlusion (p=0.85). In the PCI arm, 92.4% (134/145) of
patients had <=50% diameter LM stenosis at 15 months (89.7% [87/97] distal
LM lesions and 97.9% [47/48] non-distal LM lesions). The 15-month PCI
MACCE rate was 12.8% (20/156) and this was significantly associated with
lack of stent patency at 15 months (p<0.001), mainly due to repeat
revascularisation. Conclusions: At 15 months, 15.6% (41/263) of grafts
were at least 50% obstructed but this was not significantly associated
with MACCE; 92.4% (134/145) of patients had stents that remained patent at
15 months, and stent restenosis was significantly associated with MACCE,
predominantly due to revascularisation. Europa Edition 2011. All rights
reserved.

<4>
Accession Number
2011618912
Authors
Maj G. Landoni G. Biondi-Zoccai G. Bignami E. Cabrini L. Buratti L. Greco
M. Zambon M. Zangrillo A.
Institution
(Maj, Landoni, Bignami, Cabrini, Buratti, Greco, Zambon, Zangrillo)
Department of Anesthesia and Intensive Care, Universita Vita-Salute San
Raffaele, Via Olgettina 60, Milano, 20132, Italy
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy
Title
Nesiritide and clinically relevant outcomes in cardiac surgery: A
meta-analysis of randomized studies.
Source
Signa Vitae. 6 (2) (pp 17-23), 2011. Date of Publication: 2011.
Publisher
Pharmamed Mado Ltd (Zatisje 8 g, Zabreb 10000, Croatia)
Abstract
B-type natriuretic peptide is a cardiac hormone that relaxes vascular
smooth muscle and causes arterial dilatation. Nesiritide has been
associated with increased urine output; reduced diuretic requirements; and
suppression of aldosterone, endothelin, and norepinephrine. We have
independently conducted the first systematic review and meta-analysis of
randomized trials to determine the impact of nesiritide on renal
replacement therapy and death in patients undergoing cardiac surgery. We
performed a meta-analysis of 6 randomized controlled studies including 560
patients (280 receiving nesiritide and 280 assigned to the control group).
Two unblinded reviewers selected randomized trials studying nesiritide in
patients undergoing cardiac surgery. Nesiritide doses ranged from 0.005
mcg/kg/min to 0.01 mcg/kg/min. Nesiritide did not reduce postoperative
creatinine peak values: -0.16 [-0.42, 0.10], p for effect=0.23, p for
heterogeneity<0.01, I2=90.5%) or the need for renal replacement therapy
(1/177 in the nesiritide group vs 4/176 in the control group OR 0.39
[0.07, 2.06], p for effect=0.27, p for heterogeneity=0.70, I2=0%). We
observed an interesting trend toward a reduction in mortality in the
nesiritide group:13/280 (4.6%) vs 22/280 (7.8%) OR 0.57 [0.28, 1.15], p
for effect=0.12, p for heterogeneity=0.43, I2=0%. Nesiritide did not
reduce time of mechanical ventilation -8.77 hours [-21.42, 3.88], p=0.17,
length of hospital stay -2.67 days [-6.50, 1.16], p=0.17 or intensive care
unit (ICU) stay -0.94 days [-2.83, 0.95], p=0.33. In conclusion, further
randomized controlled trials are needed to support the hypothesis that
nesiritide improves clinically relevant outcomes in cardiac surgery.

<5>
Accession Number
2011625393
Authors
Johansson B. Houltz B. Edvardsson N. Schersten H. Karlsson T. Wandt B.
Berglin E.
Institution
(Johansson, Karlsson) Department of Cardiology, Sahlgrenska University
Hospital/Ostra, Department of Internal Medicine, S-416 85 Goteborg, Sweden
(Houltz) Department of Clinical Physiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Schersten, Berglin) Department of Cardiothoracic Surgery, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Edvardsson) Sahlgrenska Academy, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Wandt) Department of Research and Development, Orebro University
Hospital, Orebro, Sweden
Title
Cardiac function in relation to rhythm outcome after intraoperative
epicardial left atrial cryoablation.
Source
Scandinavian Cardiovascular Journal. 45 (6) (pp 327-335), 2011. Date of
Publication: December 2011.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objectives. To assess the effects of intraoperative left atrial epicardial
cryoablation on rhythm and atrial and ventricular function. Design. Thirty
five patients with coronary artery disease and documented atrial
fibrillation underwent coronary artery bypass surgery and concomitant
cryoablation. An age and gender matched control group of 35 patients with
atrial fibrillation underwent bypass surgery alone. Echocardiography was
performed 9 +/- 32 days before and 22 +/- 6 months after surgery. Results.
The proportion of patients in sinus rhythm at follow-up was 63% and 34% (p
= 0.04) in the cryoablation and control groups, respectively. In patients
with sinus rhythm both before surgery and at follow-up, the left atrial
area increased (p = 0.002) and the mitral annular excursion during atrial
contraction decreased (p = 0.01) after cryoablation. The mitral flow
velocity during atrial systole decreased after cryoablation (p = 0.002).
The LV diameter increased (p = 0.03) and the left ventricular ejection
fraction (LVEF) decreased (p = 0.03) in cryoablated but not in control
patients. Continued deterioration was seen in patients with atrial
fibrillation both pre- and postoperatively. Conclusions. At long-term
follow-up, a significantly higher proportion of patients was in sinus
rhythm in the cryoablation than in the control group. The atrial and
ventricular function had decreased at follow-up two years after surgery.
This decrease was small and occurred within or close to the reference
values in patients with sinus rhythm at follow-up, while patients
remaining in atrial fibrillation showed a significant continued
deterioration. Some subgroups were small, and the findings, although
statistically significant, should be interpreted with caution. 2011
Informa Healthcare.

<6>
Accession Number
2011621202
Authors
Dunlop R.A.
Institution
(Dunlop) Heart Research Institute, Newtown, NSW, Australia
Title
Supplementary evidence to support tai chi as an 'alternative' exercise for
patients undergoing cardiac rehabilitation.
Source
Focus on Alternative and Complementary Therapies. 16 (4) (pp 307-308),
2011. Date of Publication: December 2011.
Publisher
Wiley-Blackwell (350 Main Street, Malden MA 02148, United States)

<7>
Accession Number
2011606541
Authors
Poerner T.C. Otto S. Gassdorf J. Janiak F. Danzer C. Ferrari M. Figulla
H.R.
Institution
(Poerner, Otto, Gassdorf, Janiak, Danzer, Ferrari, Figulla) 1st Dept. of
Medicine, Cardiology Division, University Hospital of Jena, Germany
Title
A prospective randomised study using optical coherence tomography to
assess endothelial coverage and neointimal proliferation at 6-months after
implantation of a coronary everolimus-eluting stent compared with a bare
metal stent postdilated with a paclitaxel-eluting balloon (OCTOPUS trial):
Rationale, design and methods.
Source
EuroIntervention. 7 (SUPPL. K) (pp K93-K99), 2011. Date of Publication:
May 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Background: Safety concerns regarding use of drug-eluting stent systems
(DES) are related mostly to late stent thrombosis, which is facilitated by
incomplete stent endothelial coverage. Specific information about time
course and amount of endothelial strut coverage of different DES is
required, in order to further refine the concept of antiplatelet therapy
after DES implantation. Optical coherence tomography (OCT) is emerging as
a new gold standard for endovascular imaging of stents, atherosclerosis
progression, vulnerable plaque, and neointimal proliferation. The aim of
this study is a comparative evaluation using OCT of the XIENCE V
everolimuseluting stent (Abbot Vascular, Santa Clara, CA, USA) on one
hand, and the bare metal stent Coroflex Blue postdilated with the
paclitaxel-eluting balloon Sequent Please (both from B Braun Melsungen AG,
Melsungen, Germany) on the other hand, with respect to endothelial
coverage and neointimal proliferation. Methods: Eighty patients scheduled
for elective percutaneous coronary intervention (PCI) of a native coronary
stenosis suitable for DES implantation and OCT imaging are scheduled to be
openly randomised 1:1 to either XIENCE or Coroflex Blue/Sequent Please.
The study is conducted prospectively at a university high-volume PCI
centre with OCT expertise. Angiographic follow-up and time-domain OCT
imaging with motorised pull-back at 1 mm/s are planned six months after
study stent implantation in all patients. OCT endpoints are: (1)
endothelial coverage, expressed as % of struts without coverage and % of
stent length containing non-covered struts, and respectively (2)
neointimal proliferation, given as % neointimal volumetric proliferation
within the whole stent and also as peak focal % neointimal area
proliferation. The study is not powered for clinical endpoints, which are:
subacute or late stent thrombosis and need for revascularisation of the
stent segment. Given the high number of measurements (15 cross-section
images / 1 mm stent length), OCT endpoints are likely to reach
significance at the level p <.05, if the drop-out rate in follow-up does
not exceed 20%. Current status: The study is currently on-going and its
termination is scheduled for February 2010. (ClinicalTrials. gov
identifier: NCT01056744). Europa Edition 2011. All rights reserved.

<8>
Accession Number
2011606540
Authors
Ali R.M. Degenhardt R. Zambahari R. Tresukosol D. Ahmad W.A.W. Kamar
H.B.H. Kui-Hian S. Ong T.K. Ismail O.B. Elis S.B. Udychalerm W. Ackermann
H. Boxberger M. Unverdorben M.
Institution
(Ali, Zambahari) National Heart Institute, Kuala Lumpur, Malaysia
(Degenhardt, Unverdorben) Clinical Research Institute, Center for
Cardiovascular Diseases, Heinz-Meise-Strasse 100, D-36199 Rotenburg an der
Fulda, Germany
(Tresukosol) Siriraj Hospital Mahidol University, Bangkok, Thailand
(Ahmad, Kamar) University Malaya Medical Center, Kuala Lumpur, Malaysia
(Kui-Hian, Ong) Sarawak Hospital, Kuching, Malaysia
(Ismail, Elis) Penang Hospital, Pulau Penang, Malaysia
(Udychalerm) King Chulalongkorn Hospital, Bangkok, Thailand
(Ackermann) Institute for Biomedical Statistics, Goethe-University,
Frankfurt/Main, Germany
(Boxberger) Clinical Science, Vascular System, BBraun, Berlin, Germany
(Unverdorben) Scientific Affairs, BBraun Medical Inc, Bethlehem, PA,
United States
Title
Paclitaxel-eluting balloon angioplasty and cobalt-chromium stents versus
conventional angioplasty and paclitaxel-eluting stents in the treatment of
native coronary artery stenoses in patients with diabetes mellitus.
Source
EuroIntervention. 7 (SUPPL. K) (pp K83-K92), 2011. Date of Publication:
May 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Coronary lesions in diabetics (DM) are associated with a high
recurrence following percutaneous coronary intervention (PCI), even after
drug-eluting stent (DES) deployment. Encouraging clinical data of the
drug-eluting balloon catheter (DEB) SeQuent Please warrant its
investigation in these patients. Methods and results: Eighty-four diabetic
patients (60.8+/-9.1years, 76.2% male) were randomised to either the DEB
SeQuent Please or the DES Taxus Liberte to compare the 9-month clinical
and angiographic outcome of PCI in native coronary arteries. Comparing the
DEB vs. the DES the 9-month results (follow-up DEB 39/45 [86.7%], DES
36/39 [92.3%]) are statistically not different at the 0.05 level for the
primary end- point of in-segment (0.37+/-0.59 mm vs. 0.35 +/-0.63 mm) and
in-stent (0.51+/-0.61 mm vs. 0.53+/-0.67 mm) late lumen loss, overall and
cardiac deaths (2/45 [4.4%] and 3/45 [6.7%] vs. 0), target lesion
revascularisation (3/45 [8.9%] vs. 4/39 [10.3%]), the total MACE rate
(6/45 [13.3%] vs. 6/39 [15.4%]), and the event free survival after
10.2+/-3.8 months (Kaplan-Meier analysis, p<0.80, log rank test).
Conclusions: The clinical and angiographic outcome of the combination of
the drug-eluting balloon SeQuent Please with a cobalt chromium stent
compared to the drug eluting Taxus stent are similar. Europa Edition
2011. All rights reserved.

<9>
Accession Number
70574382
Authors
Visnansky M. Mesaros S.
Institution
(Visnansky) SLOVAHTA, Bratislava, Slovakia
(Mesaros) SMs Consulting Ltd., Bratislava, Slovakia
Title
Patient self-testing of oral anticoagulation therapy by coaguchek xs
system. Rapid health technology assessment in Slovak health care
environment.
Source
Value in Health. Conference: ISPOR 14th Annual European Congress Madrid
Spain. Conference Start: 20111105 Conference End: 20111108. Conference
Publication: (var.pagings). 14 (7) (pp A257-A258), 2011. Date of
Publication: November 2011.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: to explore the effects of patient self-testing (PST) of oral
anticoagulation therapy (OAT) by CoaguChek XS System compared to standard
available care (laboratory testing) for selected group of patients.
METHODS: Health Economy Model (HECON), using Cost-Effectiveness Analysis
(CEA), complemented by Budget- Impact Analysis (BIA) on public health
insurance coverage in Slovakia. We searched MEDLINE, Cochrane and
available grey literature (Industrial Sources and Expert Opinions) for
meta analyses, systematic reviews, economic evaluation studies and health
technology reports on PST of OAT. Outcomes analyzed were feasibility and
accuracy of PST, thromboembolic events, hemorrhagic complications and
mortality. Real-world data from General Health Insurance, Inc. were used
for costs associated with corresponding diagnoses, complications and
management of patients on OAT, including full cohort of patients (n=100,
average age of 63 years) on PST. Markov Model (life time horizon) for OAT
patient management was developed, comparing PST with standard care.
Outcomes observed were major thromboembolic events, major hemorrhagic
complications and mortality. Payer perspective and direct healthcare costs
only, associated with OAT management were considered in CEA and BIA for
diagnosis subgroups. Discount rate of 5% was used for costs as well as
outcomes. Sensitivity analysis for major complications was performed.
RESULTS: CEA for PST vs. standard care associated with OAT shows that
intervention is cost-effective (dominant) for all diagnosis subgroups. Net
costs (BIA) associated with PST for expanding the existing cohort of
patients 10 times (n=1000) are 1.596 mil. in Year 1 (up to 3.579 in Year
5). CONCLUSIONS: PST of OAT is considered cost-effective in terms of
International Normalized Ratio (INR) regulation and safer in terms of
complications. Moreover, analysis of selected subpopulations (mitral
and/or aortic mechanical heart valve implantation, aortic and/or other
aneurysm and congenital cardiovascular malformations) shows that PST
brings the most significant cost-savings especially for those OAT patient
segments.

<10>
Accession Number
70574374
Authors
Campbell J. Faivre P. Kumar P. Drummond M.
Institution
(Campbell) OptumInsight, Medford, MA, United States
(Faivre, Kumar) OptumInsight, Uxbridge, United Kingdom
(Drummond) University of York, Heslington, York, United Kingdom
Title
The cost-effectiveness of transcatheter aortic valve implantation in
elderly patients with severe aortic stenosis who are contraindicated for
conventional surgical aortic valve replacement in the United Kingdom.
Source
Value in Health. Conference: ISPOR 14th Annual European Congress Madrid
Spain. Conference Start: 20111105 Conference End: 20111108. Conference
Publication: (var.pagings). 14 (7) (pp A256), 2011. Date of Publication:
November 2011.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: To assess the cost-effectiveness of transcatheter aortic valve
implantation (TAVI) versus medical management (MM) for severe aortic
stenosis (AS) in elderly patients with excessive surgical risk. METHODS: A
Markov model was developed of survival, quality-adjusted life-years
(QALYs) and medical costs, in elderly patients in the UK with severe AS
and excessive risk for conventional aortic valve replacement (cAVR).
Incremental cost-effectiveness ratios (ICERs) were estimated as cost per
QALY-gained, from the National Health Service (NHS) perspective, over 3
years. Clinical and utility outcomes over the first year were derived from
published results of a head-to-head randomized controlled trial comparing
[transfemoral] TAVI and MM. Base-case analyses assumed no additional
procedure-related adverse events after the first year-not including
re-hospitalizations due to cardiovascular events-and constant
treatment-specific mortality after the first month. Costs of procedures,
adverse events, re-hospitalizations and long-term health care utilization
were estimated using NHS tariff and reference cost schedules, National
Institute of Health and Clinical Excellence reports, peer-reviewed
literature and clinical experts. Outcomes and costs (2010) were discounted
at 3.5% per annum. RESULTS: Under conservative assumptions, treatment with
transfemoral TAVI is estimated to result in better survival (35% vs. 13%
at three years) and more QALYs (1.17 vs. 0.76) than MM. TAVI is also
associated with higher costs of initial treatment and procedure-related
adverse events, partially offset by lower costs of re-hospitalizations
(net costs of 34,500 vs. 23,700). The base-case ICER of 26,100 is
sensitive to variation in assumptions about long-term mortality for MM and
long-term cardiovascular events for TAVI but remains below 30,000; the
model is also sensitive to assumptions on long-term care use. CONCLUSIONS:
In elderly patients who are contraindicated for cAVR, TAVI is estimated to
result in better survival and fewer re-hospitalizations over a three-year
period compared with MM, and can be considered cost-effective at 3 years
with a base-case ICER of ~26,000.

<11>
Accession Number
70582119
Authors
Khawaja M.Z. Asress K. Haran H. Nadra I. Wilson K. MacGillivray K. Hancock
J. Young C. Bapat V. Redwood S. Thomas M.
Institution
(Khawaja, Asress, Wilson, MacGillivray, Hancock, Young, Bapat, Redwood,
Thomas) Department of Cardiology, Guy's and St Thomas' NHS Foundation
Trust, London, United Kingdom
(Khawaja, Asress, Haran, Redwood) King's College, London, London, United
Kingdom
(Nadra) Nottingham University Hospitals NHS Trust, Nottingham, United
Kingdom
Title
The effects of pre-existing significant coronary artery disease defined by
QCA analysis upon outcome after transcatheter aortic valve implantation
using the Edwards bioprosthesis.
Source
Journal of the American College of Cardiology. Conference: 23rd Annual
Symposium of the Transcatheter Cardiovascular Therapeutics, TCT 2011 San
Francisco, CA United States. Conference Start: 20111107 Conference End:
20111111. Conference Publication: (var.pagings). 58 (20 SUPPL. 1) (pp
B201-B202), 2011. Date of Publication: 08 Nov 2011.
Publisher
Elsevier USA
Abstract
Background: Patients undergoing surgical aortic valve replacement (sAVR)
routinely undergo simultaneous coronary artery bypass grafting (CABG) for
significant coronary artery disease (CAD) due to adverse prognostic
impact. Whilst manufacturers advise percutaneous intervention (PCI) to
significant CAD prior to transcatheter aortic valve implantation (TAVI)
there is considerable variation amongst operators. We sought to analyse
the impact of CAD in our centre's patients. Methods: We performed a
retrospective analysis of 164 patients who underwent TAVI using the
Edwards bioprosthesis from March 2008 to October 2010. 6 angiograms were
not available for analysis. Patients were classified using pre-TAVI
quantitative coronary angiographic (QCA) analysis as 'CAD' (patients with
>=1 coronary stenosis of >=70% severity or >=50% if left main stem) and
'No CAD' (Group 2). Results: 54 patients (32.9%) had significant CAD prior
to TAVI, with 10 (6.5%) undergoing PCI prior to their procedure. The CAD
group had more males (70.4% v 51.0%, p=0.02) and a greater proportion with
previous PCI (27.8% v 11.5%, p=0.01). [|#7#|][|#7#|]At a mean follow up of
337+/-275 days (mean+/-SD), the overall mortality in the CAD group was
higher (35.2% v 16.3%, p=0.007), as were 30-day (16.7% v 3.8%, p=0.005)
and 12 month mortalities (31.5% v 14.4%, p=0.01). Kaplan Meier analysis
confirmed the increase in mortality with the presence of CAD
(logrank=0.02). The incidence of MACCE was not significantly different
(35.2% v 23.1%, p=0.11). [|#7#|][|#7#|]Amongst the 10 patients who
underwent PCI in Group 1, 8 had single vessel intervention and 2 had PCI
to 2 vessels. Mortality in this sub-group was not significantly different
from the CAD patients who did not receive PCI (50% versus 31.8%, p=0.28).
Conclusion: The presence of significant CAD as defined by QCA analysis
increased overall, 30-day and 12 month mortality in patients after TAVI in
our study. As yet, the impact of PCI to significant CAD upon outcome after
TAVI is not clear and will be assessed in a prospective, randomised
controlled trial.

<12>
Accession Number
70581767
Authors
Kunadian V. Pugh A. Qiu W.
Institution
(Kunadian) Institute of Cellular Medicine, Faculty of Medical Sciences,
Newcastle University, Newcastle upon Tyne, United Kingdom
(Pugh) Faculty of Medical Sciences, Newcastle University Medical School,
Newcastle upon Tyne, United Kingdom
(Qiu) Department of Medicine, Harvard Medical School, Brigham and Women's
Hospital, Boston, MA, United States
Title
Percutaneous coronary intervention in patients with severe left
ventricular dysfunction: A meta-analysis of 19 studies.
Source
Journal of the American College of Cardiology. Conference: 23rd Annual
Symposium of the Transcatheter Cardiovascular Therapeutics, TCT 2011 San
Francisco, CA United States. Conference Start: 20111107 Conference End:
20111111. Conference Publication: (var.pagings). 58 (20 SUPPL. 1) (pp
B108), 2011. Date of Publication: 08 Nov 2011.
Publisher
Elsevier USA
Abstract
Background: Coronary artery disease (CAD) is the most common cause for
left ventricular dysfunction (LVD). Coronary artery bypass surgery (CABG)
results in equivalent benefit in reducing mortality compared with medical
therapy in patients with CAD and severe LVD. However, the benefit of
percutaneous coronary intervention (PCI) in patients with severe LVD is
not clear. A meta-analysis of studies utilising PCI in patients with
severe LVD (EF<=40%) was performed to determine inhospital (IH) and
long-term (LT) [>=1year] mortality. Methods: A systematic computerised
literature search was performed. Studies of patients undergoing PCI for
CAD in the presence of severe LVD were included. Studies that did not
report LT mortality and same centre studies were excluded. Results: In
total, 4766 patients (19 studies) were included. The mean (pooled
estimate) age was 64.7 years with a mean (estimate) EF of 29.9% and 79.7%
were men. The IH mortality rate using random effects model (13 studies,
total PCI n=2202, 39 deaths) was 1.8% (95% CI 1.0-2.9%). The LT mortality
rate (23.86 months) using random effects model (19 studies, total
follow-up n=2937, 401 deaths) was 15.6% (95% CI 11.0-20.7%). Five studies
compared PCI versus CABG (n=455 vs. n=502) and provide LT mortality data
(PCI n=102 vs. CABG n=115 deaths). The relative risk using random effects
model (PCI vs. CABG) was 0.98 (95% CI 0.78-1.22, p value 0.83). (Table
Presented) Conclusion: This meta-analysis demonstrates that based on
available clinical studies, PCI among patients with severe LVD is feasible
with acceptable in-hospital and longterm mortality and yields comparable
outcomes with CABG.

<13>
Accession Number
70581521
Authors
Eaton J.N. Mealing S. Nicolo P. Moat N. Pascale B. Busca R. Sculpher M.
Watt M.
Institution
(Eaton, Mealing, Sculpher, Watt) Health Economics, Oxford Outcomes,
Oxford, United Kingdom
(Pascale, Busca) Medtronic Ltd, Tolochenaz, Switzerland
(Nicolo) German Heart Centre, Munich, Germany
(Moat) Royal Brompton and Harefield NHS Trust, London, United Kingdom
Title
TAVI for high risk patients with Severe Aortic Stenosis who satisfy all
the criteria for conventional aortic valve replacement: A United Kingdom
based cost-utility analysis.
Source
Journal of the American College of Cardiology. Conference: 23rd Annual
Symposium of the Transcatheter Cardiovascular Therapeutics, TCT 2011 San
Francisco, CA United States. Conference Start: 20111107 Conference End:
20111111. Conference Publication: (var.pagings). 58 (20 SUPPL. 1) (pp
B37-B38), 2011. Date of Publication: 08 Nov 2011.
Publisher
Elsevier USA
Abstract
Background: SAVR is an invasive intervention, carrying a risk of
perioperative mortality and an alternative treatment option, transcatheter
aortic valve implantation (TAVI), has been developed. The clinical
efficacy of TAVI was demonstrated in a recently published randomized
controlled trial (PARTNER). To date, however, there is little information
about the cost-effectiveness of TAVI relative to SAVR. Methods: A 20 year
Markov model was developed in Microsoft Excel from the perspective of the
UK NHS. Treatment options included were TAVI and SAVR. Treatment specific
mortality and adverse event data were taken from the PARTNER study (Cohort
A) which was supplemented by UK specific life table information. Resource
use and cost data were drawn, where possible, on information from publicly
available national databases. Other parameters were taken from published
literature. Decrements were applied to age-specific EQ-5D population norms
to generate Quality Adjusted Life Years (QALYs). Alternative modelling
approaches and data sources for key parameters were included into the
model. Extensive probabilistic and deterministic sensitivity analyses were
performed. Costs and benefits were discounted at an annual rate of 3.5%
Results: The base case Incremental Cost-Effectiveness Ratio (ICER) was
30,538 per QALY gained (95% Crl 21,322 to 39,287). At willingness to pay
thresholds of 30,000 per QALY, the probability that TAVI is cost-effective
is 44%. Results were not sensitive to changes in baseline survival curve,
approach used to model the benefit of TAVI, or procedure time, but
sensitive to changes in procedure cost and resource use. Conclusion: TAVI
may be a cost-effective alternative to conventional surgery at a threshold
accepted by the United Kingdom reimbursement agency. Further examination
of the resource use and treatment pathway in this patient group will help
to reduce the uncertainty in the ICER.

<14>
Accession Number
70583750
Authors
Conceica-Souza G.E. Osawa E.A. Oliveira E.S. Ayub-Ferreira S.M. Issa V.S.
Baca F. Chizzola P.R. Bocchi E.A.
Institution
(Conceica-Souza, Osawa, Ayub-Ferreira, Issa, Baca, Chizzola, Bocchi) Heart
Institute-InCor, Sao Paulo, Brazil
(Oliveira) Clinicas' Hospital-Nephrology Division, Sao Paulo, Brazil
Title
Peritoneal dialysis as an alternative approach to end stage refractory
heart failure contraindicated for heart transplantation: A retrospective
controlled cohort study.
Source
European Journal of Heart Failure, Supplement. Conference: Heart Failure
Congress 2011 Gothenburg Sweden. Conference Start: 20110521 Conference
End: 20110524. Conference Publication: (var.pagings). 10 (pp S30),
2011. Date of Publication: May 2011.
Publisher
Oxford University Press
Abstract
Purpose: To evaluate the impact of peritoneal dialysis (PD) in end stage
systolic heart failure (SHF) who are not candidates for heart
transplantation (HT) Methods: Retrospective Cohort study. Inclusion
criteria: SHF defined by Framigham's criteria and left ventricular
ejection fraction (LVEF) < 35%; inpatient stage D SHF defined at heart
failure specialist discretion (under evaluation for HT), dependant on
intravenous inothropic therapy; presence of at least one absolute
contraindication for HT. Exclusion criteria: patients with severe
comorbidities which could affect survival in the next 6 months or with end
stage renal disease with clear indication of dialysis. Patients were
followed by clinical inpatient and outpatient visits and/or telephone
contact after one year of the index admission. Data were additionally
extracted from electronic chart review and telephonic interview with
patients and/or their families. Two goups were followed separately:
(G1)-with patients who underwent PD (under clinical discretion) and
(G2)-with patients who underwent standard therapy. P value was considered
statistically significant if < 0,05. Comparative statistical analysis used
Fischer's exact test for categoric variables; non-paired T-student test
for parametric continuous variables. Results: From january 2007 to june
2009, 12 patients were included-3 patients in G1 and 9 patients in G2.
Medical treatment, clinical, laboratorial and echocardiographic variables
were similar in both groups. Among G1 and G2 patients, respectively, the
main contraindication for HT in both groups was fixed pulmonary
hypertension (67% vs 55%-p = ns). After 12 months follow-up, mortality
incidence was 0% among G1 patients and 67% among G2 patients. In average,
G1 and G2 patients survived for 540+/-176 days vs 255+/-264 days,
respectively. All survivors in G1 group improved their functional class
and there were no complications regarding PD catheter use. Among G2
patients most of the survivors maintained a poor functional status.
Conclusions: PD appear to be safe and seems to benefit end stage
refractory SHF patients who were ineligible for HT. A large randomized
controlled trial is necessary to fully investigate its utility.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 27

Results Generated From:
Embase <1980 to 2011 Week 46>
Embase (updates since 2011-11-10)

<1>
Accession Number
2011481510
Authors
Lyons O. Clough R. Patel A. Saha P. Carrell T. Taylor P.
Institution
(Lyons, Clough, Patel, Saha, Carrell, Taylor) Vascular Surgery Unit,
King's Health Partners, London, United Kingdom
Title
Endovascular management of Stanford type A dissection or intramural
hematoma with a distal primary entry tear.
Source
Journal of Endovascular Therapy. 18 (4) (pp 591-600), 2011. Date of
Publication: August 2011.
Publisher
Allen Press Publishing Services (810 E, 10th Street, Lawrence KS 66044,
United States)
Abstract
A systematic review was conducted of all published cases of endovascular
repair of retrograde Stanford type A dissection or intramural hematoma to
determine mortality of this less invasive approach to treatment. Using the
PRISMA guidelines, databases were searched for any of the terms
'dissect$', 'IMH', ('aortic ADJ wall'), 'intramur$', 'intra-mur$' in
combination with any of 'stent$', 'perc$', 'endo$', 'TEVAR' in combination
with any of ('type ADJ A'), 'ascend$' and 'retro$.' The search retrieved
3131 titles, 280 abstracts, and 108 papers. Of 23 relevant papers
selected, mortality data could be extracted from 11 studies, representing
60 patients. Overall in-hospital mortality was 1.8% (95% CI 1.2% to 2.4%).
Additional all-cause mortality during follow-up was 5.4% (95% CI 3.5% to
7.2%). The placement of an endoluminal device in the descending thoracic
aorta to treat a DeBakey IIId/retrograde type A aortic dissection or
intramural hematoma may be a safer procedure in the short to medium term
than open surgical replacement of the ascending aorta (with or without the
arch). Open surgical repair in these patients may therefore be
unjustified. 2011 by the International Society of Endovascular
Specialists.

<2>
Accession Number
2011604691
Authors
Jarral O.A. Saso S. Athanasiou T.
Institution
(Jarral, Saso, Athanasiou) Department of Surgery and Cancer, Imperial
College London, London, United Kingdom
Title
Off-pump coronary artery bypass in patients with left ventricular
dysfunction: A meta-analysis.
Source
Annals of Thoracic Surgery. 92 (5) (pp 1686-1694), 2011. Date of
Publication: November 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: In symptomatic multivessel disease with left ventricular
dysfunction, coronary artery bypass surgery (CAB) is the conventional
approach. This study assesses outcomes in patients with left ventricular
dysfunction undergoing coronary artery bypass with (on-pump; ONCAB) and
without cardiopulmonary bypass (off-pump; OPCAB). Methods: A systematic
literature search was performed and data were extracted for the following
outcomes of interest: 30-day, midterm, and late-term mortality, myocardial
infarction, and completeness of revascularization. Random effects
meta-analysis was used to aggregate the data. Sensitivity, heterogeneity,
and publication bias were assessed. Results: Analysis of 23 nonrandomized
studies revealed 7,759 patients, of whom 2,822 received OPCAB and 4,937
underwent ONCAB. Early mortality was significantly lower in the OPCAB
group (odds ratio 0.64, 95% confidence interval 0.51 to 0.81) with no
significant heterogeneity between the studies. This finding was supported
by subgroup analysis that included assessment of studies only including
patients with poor left ventricular function. Based on 13 studies, there
was no difference in mortality at the midterm, and based on 4 studies
there was no significant difference when comparing late-term mortality.
Analysis of four studies revealed the OPCAB group was associated with
significantly less complete revascularization. Conclusions: Off-pump CAB
may be associated with lower incidence of early mortality in patients with
impaired left ventricular function, although the method of handling the
conversion-related mortality in each study is uncertain and may challenge
these results. Incomplete revascularization provided by the OPCAB group
occurred more often, although its impact was not reflected in the clinical
outcomes but may explain why the early advantage in mortality was not
continued to the late term. 2011 The Society of Thoracic Surgeons.

<3>
Accession Number
2011595140
Authors
Rossignol P. Menard J. Fay R. Gustafsson F. Pitt B. Zannad F.
Institution
(Rossignol, Fay, Zannad) INSERM, Centre d'Investigations Cliniques 9501,
Nancy, France
(Rossignol) Nancy-Universite, Nancy, France
(Rossignol, Zannad) INSERM U961, Nancy, France
(Zannad) CHU Nancy, Ple de Cardiologie, Institut Lorrain du Coeur et des
Vaisseaux, Vandoeuvre ls Nancy, France
(Menard) INSERM, CIC 9201, Paris, France
(Menard) Universite Paris-Descartes, Paris, France
(Gustafsson) Heart Centre, Department of Cardiology, Rigshospitalet,
Copenhagen, Denmark
(Pitt) University of Michigan School of Medicine, Ann Arbor, MI, United
States
Title
Eplerenone survival benefits in heart failure patients post-myocardial
infarction are independent from its diuretic and potassium-sparing
effects: Insights from an EPHESUS (Eplerenone Post-Acute Myocardial
Infarction Heart Failure Efficacy and Survival Study) substudy.
Source
Journal of the American College of Cardiology. 58 (19) (pp 1958-1966),
2011. Date of Publication: 01 Nov 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to determine whether a diuretic
effect may be detectable in patients treated with eplerenone, a
mineralocorticoid receptor antagonist, as compared with placebo during the
first month of EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart
Failure Efficacy and Survival study) (n = 6,080) and whether this was
associated with eplerenone's beneficial effects on cardiovascular
outcomes. Background: The mechanism of the survival benefit of eplerenone
in patients with heart failure post-myocardial infarction remains
uncertain. Methods: A diuretic effect was indirectly estimated by changes
at 1 month that was superior to the median changes in the placebo group in
body weight (-0.05 kg) and in the estimated plasma volume reduction
(+1.4%). A potassium-sparing effect was defined as a serum potassium
increase greater than the median change in the placebo group: +0.11
mmol/l. Results: In the eplerenone group, body weight (p < 0.0001) and
plasma volume (p = 0.047) decreased, whereas blood protein and serum
potassium increased (both, p < 0.0001), as compared with the placebo
group, suggesting a diuretic effect induced by eplerenone, associated with
a potassium-sparing effect. A diuretic effect, as defined by an estimated
plasma volume reduction, was independently associated with 11% to 19%
better outcomes (lower all-cause death, cardiovascular death or
cardiovascular hospitalization, all-cause death or hospitalization,
hospitalization for heart failure). Potassium sparing was also
independently associated with 12% to 34% better outcomes. There was no
statistically significant interaction between the observed beneficial
effects of eplerenone (9% to 17%) on cardiovascular outcomes and
potassium-sparing or diuretic effects. Conclusions: Eplerenone's
beneficial effects on long-term survival and cardiovascular outcomes are
independent from early potassium-sparing or diuretic effects, suggesting
that mineralocorticoid receptor antagonism provides cardiovascular
protection beyond its diuretic and potassium-sparing properties. 2011
American College of Cardiology Foundation.

<4>
Accession Number
2011611068
Authors
Zhao Q. Ye X.
Institution
(Zhao, Ye) Shanghai Jiaotong University, Ruijin Hospital, Department of
Cardiac Surgery, No.197, Ruijin Er Road, Shanghai, 200025, China
Title
Additive value of adult bone-marrow-derived cell transplantation to
conventional revascularization in chronic ischemic heart disease: A
systemic review and meta-analysis.
Source
Expert Opinion on Biological Therapy. 11 (12) (pp 1569-1579), 2011. Date
of Publication: December 2011.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objective: Whether adult bone marrow (BM)-derived cells (BMCs)
transplantation benefits patients with chronic ischemic heart disease
(IHD) remains controversial. This systemic and meta-analysis study aimed
to assess the potential therapeutic effects of BMCs transplantation with
revascularization in chronic IHD. Research design and methods: Randomized
controlled trials of BMCs in combination with coronary artery bypass
grafting (CABG) or percutaneous coronary intervention (PCI) for chronic
IHD were identified by searching Medline, Embase, the Cochrane Controlled
Trials Register, the Cochrane Library, and the Web of Science. We
conducted a random-effects meta-analysis across eligible studies measuring
the same outcomes. Results: Ten randomized controlled trials including 422
participants were reviewed. In the trials with six months of follow-up,
BMCs transplantation improved left ventricular (LV) ejection fraction
(LVEF) by 4.02% and reduced LV end-systolic and end-diastolic volumes.
Subgroup analysis revealed a statistically significant difference in LVEF
associated with primary intervention, route of cell delivery, cell type,
and baseline LVEF, but not with cell dose or storage duration.
Conclusions: Selected-BMCs transplantation through myocardial injection
after surgical revascularization may benefit patients with chronic IHD and
severely impaired LV function. Due to the limitation of patient number,
RCT with larger sample size and long follow-up are required for future
research. 2011 Informa UK, Ltd.

<5>
Accession Number
2011608995
Authors
Wiedemann D. Schachner T. Kocher A. Weidinger F. Bonatti J. Bonaros N.
Institution
(Wiedemann, Schachner, Kocher, Weidinger, Bonaros) University Clinic of
Cardiac Surgery, Innsbruck Medical University, Anichstrase 35, 6020
Innsbruck, Austria
(Bonatti) Division of Cardiac Surgery, Department of Surgery, University
of Maryland, Baltimore, United States
Title
Robotic totally endoscopic surgery for congenital cardiac anomalies.
Source
European Surgery - Acta Chirurgica Austriaca. 43 (4) (pp 212-217), 2011.
Date of Publication: August 2011.
Publisher
Springer Wien (Sachsenplatz 4-6, P.O. Box 89, Vienna A-1201, Austria)
Abstract
BACKGROUND: During the last decade totally endoscopic cardiac surgery
became a reality in dedicated centers. Apart from totally endoscopic
coronary bypass surgery and endoscopic mitral valve repair, totally
endoscopic surgery for simple congenital cardiac anomalies is feasible. In
this review we summarize the possibilities and the outcome of robotic
surgery for congenital cardiac anomalies, and give an outline of future
perspectives for the treatment of more complex cardiac congenital
anomalies in a totally endoscopic fashion. METHODS: A PubMed search for
the period 1990 to 2010 was conducted with the following key words:
"robotic heart surgery", "endoscopic ASD", "robotic ASD", "congenital
robotic surgery", "robotic VSD", "robotic patent ductus arteriosus".
Additional information from our own database and experience concerning
robotic cardiac surgery was included in this review. RESULTS: Several
procedures for congenital cardiac anomalies have been performed
endoscopically. Robotic ASD closure, endoscopical removal of dislocated
Amplatzer devices, closure of patent ductus arteriosus and division of
vascular rings are reported. After initial experimental experiences with
VSD closure recently the first clinical cases have been reported. In
experimental models even coarctation of the aorta has been repaired.
CONCLUSIONS: Robotic cardiac surgery for congenital anomalies is feasible
and represents an attractive option for selected patients. In the future,
with further development and refinement of this technology, more complex
congenital lesions will most likely be addressed with this approach. 2011
Springer-Verlag.

<6>
Accession Number
2011597330
Authors
Lee M.S. Liao H. Yang T. Dhoot J. Tobis J. Fonarow G. Mahmud E.
Institution
(Lee, Yang, Dhoot, Tobis, Fonarow, Mahmud) David Geffen School of
Medicine, University of California, Los Angeles (Division of Cardiology),
Los Angeles, CA, United States
(Lee, Yang, Dhoot, Tobis, Fonarow, Mahmud) Boston Scientific Corporation,
Maple Grove, MN, United States
(Lee, Yang, Dhoot, Tobis, Fonarow, Mahmud) University of California, San
Diego (Division of Cardiology), San Diego, CA, United States
(Liao) Boston Scientific Corporation, Marlborough, MA, United States
Title
Comparison of bivalirudin versus heparin plus glycoprotein IIb/IIIa
inhibitors in patients undergoing an invasive strategy: A meta-analysis of
randomized clinical trials.
Source
International Journal of Cardiology. 152 (3) (pp 369-374), 2011. Date of
Publication: 03 Nov 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: This meta-analysis was performed to assess the efficacy and
safety of bivalirudin compared with unfractionated heparin or enoxaparin
plus glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing
percutaneous coronary intervention (PCI). Background: Pharmacotherapy for
patients undergoing PCI includes bivalirudin, heparin, and GP IIb/IIIa
inhibitors. We sought to compare ischemic and bleeding outcomes with
bivalirudin versus heparin plus GP IIb/IIIa inhibitors in patients
undergoing PCI. Methods: A literature search was conducted to identify
fully published randomized trials that compared bivalirudin with heparin
plus GP IIb/IIIa inhibitors in patients undergoing PCI. Results: A total
of 19,772 patients in 5 clinical trials were included in the analysis
(9785 patients received bivalirudin and 9987 patients received heparin
plus GP IIb/IIIa inhibitors during PCI). Anticoagulation with bivalirudin,
as compared with heparin plus glycoprotein IIb/IIIa inhibitors, results in
no difference in major adverse cardiovascular events (odds ratio [OR]
1.07, 95% confidence interval [CI] 0.96 to 1.19), death (OR 0.93, 95% CI
0.72 to 1.21), or urgent revascularization (OR 1.06, 95% CI 0.86 to 1.30).
There is a trend towards a higher risk of myocardial infarction (OR 1.12,
95% CI 0.99 to 1.28) but a significantly lower risk of TIMI major bleeding
with bivalirudin (OR 0.55, 95% CI 0.44 to 0.69). Conclusion: In patients
who undergo PCI, anticoagulation with bivalirudin as compared with
unfractionated heparin or enoxaparin plus GP IIb/IIIa inhibitors results
in similar ischemic adverse events but a reduction in major bleeding.
2011 Elsevier Ireland Ltd. All rights reserved.

<7>
Accession Number
2011616801
Authors
Knight S.R. Morris P.J.
Institution
(Knight, Morris) Centre for Evidence in Transplantation, Royal College of
Surgeons of England, University of London, London, United Kingdom
Title
Steroid sparing protocols following nonrenal transplants; The evidence is
not there. A systematic review and meta-analysis.
Source
Transplant International. 24 (12) (pp 1198-1207), 2011. Date of
Publication: December 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Summary We have recently reported that steroid avoidance or withdrawal
(SAW) following renal transplantation results in an increase in acute
rejection (AR) rates but does not affect graft or patient survival.
Cardiovascular risk factors were significantly reduced. It cannot be
assumed that the same risks and benefits apply to nonrenal transplants and
we have therefore extended this work to evaluate SAW protocols in nonrenal
organ transplantation. A detailed literature search identified nine
relevant studies; seven in liver, one in cardiac and one in pancreatic
transplant recipients. In liver recipients no difference in AR, graft or
patient survival was identified. A significant reduction in the risk of
new-onset diabetes was observed with SAW, with trends towards benefits in
other cardiovascular risk factors, but meta-analysis was hampered by the
small number of studies and significant heterogeneity. Some benefits in
cardiovascular risk factors were also identified in the cardiac and
pancreatic transplant recipients, but again this evidence is of limited
quality. Whilst the trend in effect of SAW in nonrenal recipients appears
to be similar to that in renal recipients, the lack of robust evidence
requires further randomized controlled trials before the true risk/benefit
ratio of SAW in nonrenal transplant recipients can be ascertained. 2011
The Authors.

<8>
Accession Number
2011601274
Authors
Meredith I.T. Whitbourn R. Scott D. El-Jack S. Zambahari R. Stone G.W.
Teirstein P.S. Starzyk R.M. Allocco D.J. Dawkins K.D.
Institution
(Meredith) MonashHEART, Southern Health, Monash Medical Centre, 246
Clayton Road, Clayton, VIC 3168, Australia
(Whitbourn) St. Vincent's Hospital, Fitzroy, VIC, Australia
(Scott) Middlemore Hospital, Centre for Clinical Research and Effective
Practice, Otahuhu, Auckland, New Zealand
(El-Jack) North Shore Hospital, Takapuna, Auckland, New Zealand
(Zambahari) Institut Jantung Negara, Kuala Lumpur, Malaysia
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
(Teirstein) Scripps Clinic, Division of Cardiovascular Diseases, San
Diego, CA, United States
(Starzyk, Allocco, Dawkins) Boston Scientific Corporation, Natick, MA,
United States
Title
PLATINUM QCA: A prospective, multicentre study assessing clinical,
angiographic, and intravascular ultrasound outcomes with the novel
platinum chromium thin-strut PROMUS Element everolimus-eluting stent in de
novo coronary stenoses.
Source
EuroIntervention. 7 (1) (pp 84-90), 2011. Date of Publication: May 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Assess clinical, angiographic, and intravascular ultrasound results
in lesions treated with the PROMUS Element platinum chromium
everolimus-eluting stent (EES). Methods and results: Patients (N=100) with
one de novo target lesion <=34 mm long and reference vessel diameter (RVD)
>=2.25-<=4.25 mm were enrolled at 14 sites. The primary endpoint was the
30-day composite of cardiac death, myocardial infarction, target lesion
revascularisation (TLR), or definite/probable stent thrombosis (ST). The
efficacy endpoint of 9-month in-stent late loss in workhorse lesions
(defined as RVD >=2.5-<=4.25 mm, lesion <=24 mm) was compared to a
performance goal based on historical results with TAXUS Express
paclitaxel-eluting stents. Post-procedure incomplete stent apposition
(ISA) was compared to a performance goal based on results with the
PROMUS/XIENCE V EES in SPIRIT III. Mean age was 61.8+/-9.9 years; 77.0%
were male; 19% had medically treated diabetes. Baseline RVD was
2.72+/-0.53 mm; lesion length was 15.4+/-7.0 mm. The primary endpoint
occurred in one patient (periprocedural ST with TLR) with no additional
major clinical events through one year. Nine-month in-stent l ate loss in
workhorse lesions (0.17+/-0.25 mm, N=73) and post-procedure ISA (5 .7%,
5/88) were below performance goals (p<0.001). Conclusions: Through one
year, PROMUS Element EES had an acceptable safety and efficacy profile
with low in-stent late loss and post-procedure ISA. Europa Edition 2011.
All rights reserved.

<9>
Accession Number
2011601272
Authors
Silber S. Gutierrez-Chico J.L. Behrens S. Witzenbichler B. Wiemer M.
Hoffmann S. Slagboom T. Harald D. Suryapranata H. Nienaber C. Chevalier B.
Serruys P.W.
Institution
(Silber) Heart Centre at the Isar, Academic Practice, University of
Munich, Munich, Germany
(Gutierrez-Chico, Serruys) Erasmus Medical Centre, Thoraxcentre,
Rotterdam, Netherlands
(Behrens) Vivantes Humboldt-Klinikum, Berlin, Germany
(Witzenbichler) Charite - Campus Benjamin Franklin, Berlin, Germany
(Wiemer) Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
(Hoffmann) Vivantes Klinikum Am Urban, Berlin, Germany
(Slagboom) OLVG, Amsterdam, Netherlands
(Harald) Vivantes Klinikum Neukolln, Berlin, Germany
(Suryapranata) Radboud University Medical Centre, Nijmegen, Netherlands
(Nienaber) Universitatsklinikum, Rostock, Germany
Title
Effect of paclitaxel elution from reservoirs with bioabsorbable polymer
compared to a bare metal stent for the elective percutaneous treatment of
de novo coronary stenosis: The EUROSTAR-II randomised clinical trial.
Source
EuroIntervention. 7 (1) (pp 64-73), 2011. Date of Publication: May 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To compare the angiographic and clinical performance of a
paclitaxel-eluting stent using reservoirs technology and a bioabsorbable
polymer, without surface coating (CoStar), vs. an equivalent bare metal
stent (BMS) using an identical metallic platform. Methods and results:
Three hundred and three (303) patients (335 lesions) with de novo coronary
artery stenosis suitable for elective percutaneous treatment were
randomised in an international multicentre single-blind trial to receive
the CoStar stent (n=152) or the equivalent BMS (n=151). At eight months,
the primary endpoint of in-segment binary restenosis was significantly
lower in the CoStar than in the BMS group (17.6 vs. 30.3%, p=0.029).
In-stent late loss (0.41 vs. 0.81 mm; p<0.0001) and all the other
angiographic secondary endpoints also favoured CoStar. The composite of
cardiac death, myocardial infarction related to the target vessel and
target lesion revascularisation was significantly lower at eight months in
the CoStar arm (19.7 vs. 29.1%; hazard ratio 0.54, 95% CI: 0.34-0.87;
p=0.010), mainly due to lower incidence of target lesion revascularisation
(15.1 vs. 26.5%; 95% CI: hazard ratio 0.45, 95% CI: 0.27-0.76; p=0.002).
Conclusions: As compared with a bare metal stent of identical design, the
paclitaxel elution from reservoirs results in significantly less binary
restenosis, less late loss and lower revascularisation rates at eight
months. Therefore, based on these data, the CoStar paclitaxel-eluting
stent was found to be effective and safe. Europa Edition 2011. All rights
reserved.

<10>
Accession Number
2011616806
Authors
Pengel L.H.M. Liu L.Q. Morris P.J.
Institution
(Pengel, Liu, Morris) Centre for Evidence in Transplantation, Royal
College of Surgeons of England, University of London, 35-43 Lincoln's Inn
Fields, London WC2A 3PE, United Kingdom
Title
Do wound complications or lymphoceles occur more often in solid organ
transplant recipients on mTOR inhibitors? A systematic review of
randomized controlled trials.
Source
Transplant International. 24 (12) (pp 1216-1230), 2011. Date of
Publication: December 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Summary mTOR inhibitors have been associated with wound complications and
lymphoceles. We systematically reviewed randomized controlled trials
(RCTs) to compare these outcomes for solid organ transplant recipients.
Relevant medical databases were searched to identify RCTs in solid organ
transplantation comparing mTOR inhibitors with an alternative therapy
reporting on wound complications and/or lymphoceles. Methodological
quality of RCTs was assessed. Pooled analyses were performed to calculate
odds ratios (OR) and 95% confidence intervals (CI). Thirty-seven RCTs in
kidney, heart, simultaneous pancreas-kidney and liver transplantation were
included. Pooled analyses showed a higher incidence of wound complications
(OR 1.77, CI 1.31-2.37) and lymphoceles (OR 2.07, CI 1.62-2.65) for kidney
transplant recipients on mTOR inhibitors together with calcineurin
inhibitors (CNIs). There was also a higher incidence of wound
complications (OR 3.00, CI 1.61-5.59) and lymphoceles (OR 2.13, CI
1.57-2.90) for kidney transplant recipients on mTOR inhibitors together
with antimetabolites. Heart transplant patients receiving mTOR inhibitors
together with CNIs also reported more wound complications (OR 1.82, CI
1.15-2.87). We found a higher incidence of wound complications and
lymphoceles after kidney transplantation and a higher incidence of wound
complications after heart transplantation for immunosuppressive regimens
that included mTOR inhibitors from the time of transplantation. 2011 The
Authors.

<11>
Accession Number
2011613306
Authors
Davidavicius G. Chieffo A. Shannon J. Arioli F. Ielasi A. Mussardo M.
Takagi K. Maisano F. Montorfano M. Godino C. Latib A. Colombo A.
Institution
(Davidavicius, Chieffo, Shannon, Arioli, Ielasi, Mussardo, Takagi,
Maisano, Montorfano, Godino, Latib, Colombo) Interventional Cardiology
Unit, San Raffaele Scientific Institute, Milan, Italy
(Davidavicius) Vilnius University, Hospital Santariskiu Klinikos, Vilnius,
Lithuania
(Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus,
via Buonarotti 48, 20145 Milan, Italy
Title
A high dose of adenosine to induce transient asystole for valvuloplasty in
patients undergoing transcatheter aortic valve implantation (TAVI): Is it
a valid alternative to rapid pacing a prospective pilot study.
Source
Journal of Invasive Cardiology. 23 (11) (pp 467-471), 2011. Date of
Publication: November 2011.
Publisher
HMP Communications (83 General Warren Blvd. Suite 100, Malven PA 19355,
United States)
Abstract
BACKGROUND: Rapid right ventricular pacing (RRVP) at rates above 200
beats/minute is used to suppress cardiac output during balloon aortic
valvuloplasty (BAV) in transcatheter aortic valve replacement (TAVI)
patients. A risk of inducing myocardial ischemia with RRVP remains,
especially in patients with left ventricular dysfunction. Alternatively, a
transient cardiac arrest can be achieved with administration of adenosine.
METHODS: The primary endpoint was successful valvuloplasty defined by
complete balloon inflation and deflation across aortic valve during the
transient asystole induced by adenosine. Secondary endpoints were defined
as the failure of adenosine to induce asystole, the incidence of
ventricular ectopic beats (VEB) during balloon inflation or deflation, and
balloon displacement. RESULTS: From November 2010 to January 2011, twenty
consecutive patients who underwent TAVI were included. A balloon for
valvuloplasty was positioned across the aortic valve. A low-dose (24 mg, n
<= 10) or high-dose (36 mg, n <= 10) bolus of adenosine was administrated.
A single bolus of adenosine-induced atrioventricular (AV) block (mean
duration, 18.6 +/- 6.6 seconds) followed by cardiac asystole in 16
patients (80%) (low-dose, n <= 9). A successful BAV was achieved in 12
patients (60%) (low-dose, n <= 8). Adenosine induced only bradycardia in 4
patients (20%) (low-dose, n <= 1). A burst of VEB during BAV occurred in
all patients. Balloon displacement occurred in 6 patients (37.5%).
CONCLUSION: BAV after administration of adenosine is feasible, safe, and
may represent an option for high-risk TAVI patients in whom RRVP might not
be well tolerated. The occurrence of ventricular ectopic contractions
triggered by balloon inflation and deflations accounts for balloon
displacement and crossover to RRVP.

<12>
Accession Number
2011605671
Authors
van Lier F. Schouten O. Poldermans D.
Institution
(van Lier, Poldermans) Department of Anaesthesiology, Erasmus Medical
Center, Rotterdam, Netherlands
(Schouten) Department of Vascular Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
Title
Statins in Intensive Care Medicine: Still too early to tell.
Source
Netherlands Journal of Critical Care. 15 (3) (pp 137-142), 2011. Date of
Publication: June 2011.
Publisher
NVIC - Netherlands Society of Intensive Care (Horapark 9, Ede LZ 6717,
Netherlands)
Abstract
Patients admitted to an intensive care unit after vascular and
cardiothoracic surgery are at very high risk of postoperative cardiac
morbidity and mortality. Increasing evidence shows that statins should be
prescribed to high risk surgical patients in the perioperative period, and
that statin therapy should not be withheld in the postoperative period.
Because of their pleiotropic effects, the indication for statin therapy
has expanded to other patient categories often admitted to an intensive
care unit. There is increasing discussion of a potential role for statins
in the management of severe infections, sepsis and renal failure.
Therefore statin therapy may be the next logical step in the search for
adjuvant therapy in diseases commonly seen on the intensive care unit.
Copyright 2011, Nederlandse Vereniging voor Intensive Care.

<13>
Accession Number
2011604867
Authors
Ferrante G. Presbitero P. Valgimigli M. Morice M.-C. Pagnotta P. Belli G.
Corrada E. Onuma Y. Barlis P. Locca D. Eeckhout E. Mario C.D. Serruys P.W.
Institution
(Ferrante, Presbitero, Pagnotta, Belli, Corrada) Department of
Interventional Cardiology, Istituto Clinico Humanitas IRCCS, Via Manzoni,
56, 20089, Rozzano, Milan, Italy
(Valgimigli) Cardiovascular Institute, Arcispedale S. Anna, University of
Ferrara, Ferrara, Italy
(Morice) Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques
Cartier, Massy, France
(Onuma, Serruys) Department of Cardiology, Erasmus Medical Center,
Thoraxcentrum, Rotterdam, Netherlands
(Barlis) Department of Cardiology, Northern Hospital, VIC, Australia
(Locca, Eeckhout) Department of Cardiology, University Hospital, Lausanne,
Switzerland
(Mario) Cardiovascular Department, Royal Brompton Hospital, Imperial
College, London, United Kingdom
Title
Percutaneous coronary intervention versus bypass surgery for left main
coronary artery disease: A meta-analysis of randomised trials.
Source
EuroIntervention. 7 (6) (pp 738-746), 2011. Date of Publication: October
2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: We performed a meta-analysis of randomised trials comparing
percutaneous coronary intervention (PCI) with stent implantation to
coronary artery bypass grafting (CABG) for the treatment of unprotected
left main coronary artery stenosis (ULMCA). Methods and results: Pubmed
and other databases were searched. Data were expressed as odds ratios (OR)
with 95% confidence interval (CI). Four randomised trials enrolling 1,611
patients were selected. At 12-month follow-up PCI, as compared to CABG,
was associated with a significant risk reduction of stroke (0.12% vs.
1.90%, OR 0.14, 95% CI [0.04 to 0.55], p=0.004), with an increased risk of
repeat revascularisation (11.03% vs. 5.45%, OR 2.17, 95% CI [1.48 to
3.17], p <0.001), a similar risk of mortality (OR 0.72, 95% CI [0.42 to
1.24], p=0.23) or myocardial infarction (OR 0.97, 95% CI [0.54 to 1.74],
p=0.91), leading to an increased risk of major adverse cardiovascular
events (14.37% vs. 10.14%, OR 1.50, 95% CI [1.10 to 2.04], p=0.01) and
similar hazard of major adverse cardiac or cerebrovascular events (14.49%
vs. 12.04%, OR 1.24, 95% CI [0.93 to 1.67], p=0.15). Conclusions: PCI is
comparable to CABG for the treatment of ULMCA with respect to the
composite of major adverse cardiovascular or cerebrovascular events at
12-month follow-up. Europa Edition 2011. All rights reserved.

<14>
Accession Number
2011612986
Authors
Potena L. Grigioni F. Ortolani P. Magnani G. Fabbri F. Masetti M. Coccolo
F. Fallani F. Russo A. Ionico T. Saia F. Rapezzi C. Branzi A.
Institution
(Potena, Grigioni, Ortolani, Magnani, Fabbri, Masetti, Coccolo, Fallani,
Russo, Ionico, Saia, Rapezzi, Branzi) Dipartimento Cardiovascolare,
Padiglione 21, Policlinico S. Orsola-Malpighi, Via Massarenti, 9, 40138
Bologna, Italy
Title
Safety and efficacy of early aggressive versus cholesterol-driven
lipid-lowering strategies in heart transplantation: A pilot, randomized,
intravascular ultrasound study.
Source
Journal of Heart and Lung Transplantation. 30 (12) (pp 1305-1311), 2011.
Date of Publication: December 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Statins are recommended in heart transplantation regardless of
lipid levels. However, it remains unknown whether dosing should be
maximized or adjusted toward a pre-defined cholesterol threshold. Methods:
This pilot, randomized, open-label study compares an early maximal dose of
fluvastatin (80 mg/day) with a strategy based on 20 mg/day subsequently
titrated to target low-density lipoproteins (LDL) <100 mg/dl. Efficacy
outcomes consisted of achieving an LDL level of <100 mg/dl at 12 months
after transplant, and change in intracoronary ultrasound parameters.
Results: Fifty-two patients were randomized. Overall safety, and efficacy
in achieving LDL targets (13 [50%] vs 14 [54%]; p = 0.8) were comparable
between study arms, but 17 (65%) patients needed a dose increase in the
titrated-dosing arm. Early LDL levels and average LDL burden were lower in
the maximal-dosing arm (p < 0.05). Few patients developed an increase in
maximal intimal thickness of >0.5 mm, with numerical prevalence in the
titrated-dosing arm (3 [12.5%] vs 1 [5%]; p = 0.3). Intimal volume
increased in the titrated-dosing (p < 0.01) but not in the maximal-dosing
arm (p = 0.1), which accordingly showed a higher prevalence of negative
remodeling (p = 0.02). Conclusions: Despite being as effective as the
titrated-dosing approach in achieving LDL <100 mg/dl at 12 months after
transplant, the maximal-dose approach was associated with a more rapid
effect and with potential advantages in preventing pathologic changes in
graft coronary arteries. 2011 International Society for Heart and Lung
Transplantation.

<15>
Accession Number
2011609531
Authors
Kojuri J. Moaref A. Dehghani P.
Institution
(Kojuri, Moaref, Dehghani) Cardiovascular Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
The improvement of myocardial function by granulocyte colony stimulating
factor following acute anterior myocardial infarction: A double blind
placebo controlled study.
Source
Iranian Cardiovascular Research Journal. 5 (2) (pp 42-49), 2011. Date of
Publication: 20110615.
Publisher
Iranian Cardiovascular Research Journal (Zand Ave., Shiraz, Iran, Islamic
Republic of)
Abstract
Background: In patients with acute myocardial infarction (AMI),
reperfusion of the occluded infarct-related artery significantly improves
acute and late clinical outcome. There is increasing evidence that
transplantation of autologous stem cells improves cardiac function after
AMI. For propagation of peripheral blood stem cells, application of
granulocyte-colony stimulating factor (G-CSF) has been shown to be
feasible, effective, and safe. Methods: Ten patients in the treatment
group and 10 patients in the control group were enrolled in this
prospective, randomized controlled and double blind study. Two weeks after
myocardial infarction that was followed by successful recanalization and
stent implantation, the patients of the treatment group received 10 mug/kg
body weight per day (divided BID) G-CSF subcutaneously for a maximum
duration of 5.0 days. In both groups, ejection fraction was evaluated with
echocardiography and cardiac perfusion scans 10 days and 6 months after
myocardial infarction. The Tei index was measured by echocardiography.
Results: No severe side effects of G-CSF treatment were observed. There
was no significant improvement of left ventricular ejection fraction when
the G-CSF treated group was compared to the control group (P=0.821 for
cardiac scan and P=0.705 for echocardiography). Changes in Tei index was
not significant in the treatment group (P=0.815); however, it was
significantly deteriorated in the control group (P=0.005). Conclusion: In
patients with acute anterior myocardial infarction, treatment with G-CSF,
is feasible and safe and seems to be effective in improving global cardiac
function without affecting the ejection fraction under clinical
conditions.

<16>
[Use Link to view the full text]
Accession Number
2011608353
Authors
Kang W.-S. Yoon T.-G. Kim T.-Y. Kim S.-H.
Institution
(Kang, Yoon, Kim, Kim) Department of Anaesthesiology and Pain Medicine,
Konkuk University Hospital and Research Institute of Medical Science,
Konkuk University School of Medicine, Hwayang-dong, Gwangjin-gu, Seoul
143-729, South Korea
Title
Comparison of the PaO2/FiO2 ratio in sternotomy vs. thoracotomy in mitral
valve repair: A randomised controlled trial.
Source
European Journal of Anaesthesiology. 28 (11) (pp 807-812), 2011. Date of
Publication: November 2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Objective Cardiac surgery through a thoracotomy using one-lung ventilation
(OLV) is thought to be associated with worse postoperative pulmonary gas
exchange than sternotomy using two-lung ventilation (TLV), but this has
not been confirmed yet. We, therefore, compared postoperative pulmonary
gas exchange after mitral valve repair between sternotomy (group TLV) and
thoracotomy (group OLV). Design Randomised controlled study. Setting
University teaching hospital. Participants Cardiac surgery patients.
Intervention Sternotomy or thoracotomy was used for mitral valve repair.
Measurements The ratio of arterial partial pressure of oxygen (PaO2) to
fraction of inspired oxygen (FiO2) was compared in both groups before
induction of anaesthesia (T0) and just before departure from the operating
room to the ICU (T1). Fluid administration, transfusion requirements and
urine output were checked intraoperatively. Postoperative haemoglobin
(Hb), haematocrit (Hct) and creatinine were evaluated. Cardiopulmonary
bypass (CPB) time, intubation time and ICU stay were also recorded.
Results The PaO2/FiO2 ratio (mean+/-SD) at T1 was significantly lower than
at T0 in both groups (326.9+/-120.1 vs. 431.9+/-73.7mmHg in group TLV,
P<0.001; 374.9+/-130.9 vs. 445.4+/-73.7mmHg in group OLV, P=0.001), but
did not differ significantly between the two groups. The doses of
inotropes and vaopressors used were not significantly different between
the groups. Intraoperative fluid administration, transfusion requirements,
urine output and postoperative Hb/ Hct and creatinine did not differ
significantly between the groups. CPB time, intubation time and ICU stay
also did not differ significantly between the groups. Conclusion
Perioperative pulmonary function following OLV via a thoracotomy was not
significantly worse than that following TLV via a sternotomy in mitral
valve repair. 2011 Copyright European Society of Anaesthesiology.

<17>
Accession Number
2011601477
Authors
Takaki A. Umemoto S. Ono K. Seki K. Ryoke T. Fujii A. Itagaki T. Harada M.
Tanaka M. Yonezawa T. Ogawa H. Matsuzaki M.
Institution
(Takaki, Ogawa) Department of Cardiology, Tokuyama Central Hospital,
Shunan, Japan
(Takaki) Takaki Medical Clinic, Shunan, Japan
(Umemoto) Pharmaceutical Clinical Research Center, Yamaguchi University
Hospital, Ube, Japan
(Ono) Department of Cardiology, Shunan City Shinnanyou Hospital, Shunan,
Japan
(Ono) Ono Clinic, Shunan, Japan
(Seki, Fujii) Department of Cardiology, Yamaguchi Rosai Hospital, Onoda,
Japan
(Ryoke) Department of Cardiology, Shimonoseki Kosei Hospital, Shimonoseki,
Japan
(Ryoke) Ryoke Cardiology Clinic, Shimonoseki, Japan
(Fujii) Mitsuyama Clinic, Hofu, Japan
(Itagaki) Department of Cardiology, Hikari Municipal Yamato General
Hospital, Hikari, Japan
(Harada) Department of Cardiology, Ube Industries Central Hospital, Ube,
Japan
(Tanaka) Department of Cardiology, Shuto General Hospital, Yanai, Japan
(Tanaka) Ishihara Internal Medicine and Cardiology Hospital, Fukuoka,
Japan
(Yonezawa) Department of Cardiology, Souyou Hospital, Hofu, Japan
(Matsuzaki) Department of Medicine and Clinical Science, Yamaguchi
University Graduate School of Medicine, Ube, Japan
Title
Add-on therapy of EPA reduces oxidative stress and inhibits the
progression of Aortic stiffness in patients with coronary artery disease
and statin therapy: A randomized controlled study.
Source
Journal of Atherosclerosis and Thrombosis. 18 (10) (pp 857-866), 2011.
Date of Publication: 2011.
Publisher
Japan Atherosclerosis Society (2-20-15 Shinbashi, Minato-ku, Tokyo
105-0004, Japan)
Abstract
Aim: We examined the anti-oxidant mechanisms of combined therapy of
eicosapentaenoic acid (EPA) plus statin on the progression of
atherosclerosis. Methods: Patients receiving statin therapy for
dyslipidemia and with coronary artery disease (CAD) were assigned randomly
in an open-label manner to the EPA (1,800 mg/day) -plus-statin group (n=
25; combined-therapy group) or to the statin-only group (n= 25), and
followed for 48 weeks. At baseline and 48 weeks after enrollment,
oxidative stress, brachial-ankle pulse wave velocity (baPWV) and stiffness
parameter beta-index of the carotid were measured. Results: The lipid
profile remained unchanged throughout the study. Although the median value
of baPWV increased more in the statin-only group than in the
combined-therapy group, this difference was not significant (p= 0.29);
however, a decrease in baPWV was associated with combined-therapy
treatment by multiple regression analysis adjusted for age and mean blood
pressure (p= 0.04). In addition, the beta-index of the carotid was lower
in the combined-therapy group than in the statin-only group (p= 0.02).
Furthermore, although the difference in the reduction of the urinary
concentration of 8-isoprostane between the two groups did not reach
statistical significance, this concentration was significantly lower in
the combined-therapy group with higher baseline levels (>= 183 pg/mL Cr)
of urinary 8-isoprostane (p= 0.004).Conclusions: EPA may reduce oxidative
stress and inhibit the progression of arterial stiffness more efficiently
than statin-only therapy in patients with dyslipidemia and CAD.

<18>
Accession Number
2011599137
Authors
Dong M.-F. Ma Z.-S. Ma S.-J. Chai S.-D. Tang P.-Z. Yao D.-K. Wang L.-X.
Institution
(Dong, Ma, Ma, Chai, Tang, Wang) Department of Cardiac Surgery, Liaocheng
People's Hospital, Liaocheng, Shandong, 252000, China
(Dong, Ma, Ma, Chai, Tang, Wang) Liaocheng Clinical School, Taishan
Medical University, Liaocheng, Shandong, 252000, China
(Yao) Department of Cardiology, Beijing Friendship Hospital, Capital
Medical University, Beijing, China
(Ma, Wang) School of Biomedical Sciences, Charles Sturt University, Wagga
Wagga, NSW 2650, Australia
Title
Anticoagulation therapy with combined low dose aspirin and warfarin
following mechanical heart valve replacement.
Source
Thrombosis Research. 128 (5) (pp e91-e94), 2011. Date of Publication:
November 2011.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Introduction: This study was designed to evaluate safety and efficacy of
combined low dose aspirin and warfarin therapy following mechanical heart
valve replacement. Methods: A total of 1 496 patients (686 males, mean age
35 +/- 8.5 years) undergoing mechanical heart valvular replacement were
randomly divided into study (warfarin plus 75-100 mg aspirin) or control
(warfarin only) group. International normalized ratio (INR) and
prothrombin time was maintained at 1.8-2.5 and 1.5-2.0 times of the normal
value, respectively. Thromboembolic events and major bleedings were
registered during follow up. Results: Patients were followed up for 24 +/-
9 months. The average dose of warfarin in the study and control group was
2.92 +/- 0.87 mg and 2.89 +/- 0.79 mg, respectively (p > 0.05). The
overall thromboembolic events in study group were lower than in control
group (2.1% vs. 3.6%, p = 0.044). No statistically significant differences
were found in hemorrhage events (3.5% vs. 3.7%, p > 0.05) or mortality
(0.3% vs 0.4%, p > 0.05) between the two groups. Conclusions: Following
mechanical valve replacement, combined low dose aspirin and warfarin
therapy was associated with a greater reduction in thromboembolism events
than warfarin therapy alone. This combined treatment was not associated
with an increase in the rate of major bleeding or mortality. 2011
Elsevier Ltd. All rights reserved.

<19>
Accession Number
2011602844
Authors
El-Essawi A. Hajek T. Skorpil J. Boning A. Sabol F. Ostrovsky Y. Hausmann
H. Harringer W.
Institution
(El-Essawi, Harringer) Department of Thoracic and Cardiovascular Surgery,
Klinikum Braunschweig, Salzdahlumer Str. 90, 38126 Braunschweig, Germany
(Hajek, Skorpil) Department of Cardiac Surgery, University Hospital
Pilsen, Pilsen, Czech Republic
(Boning) Department of Cardiovascular Surgery, University Hospital Giessen
and Marburg, Giessen, Germany
(Sabol) Heart Surgery Department, Pavol Jozef Safarik University Kosice,
Kosice, Slovakia
(Ostrovsky) Cardiovascular Surgery, Byelorussian Center of Cardiovascular
Surgery, Minsk, Belarus
(Hausmann) Cardiovascular, Thoracic and Intensive Care, Mediclin
Herzzentrum Coswig, Coswig, Germany
Title
Are minimized perfusion circuits the better heart lung machines? Final
results of a prospective randomized multicentre study.
Source
Perfusion. 26 (6) (pp 470-478), 2011. Date of Publication: November
2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Introduction: Minimized perfusion circuits (MPCs), although aiming at
minimizing the adverse effects of cardiopulmonary bypass, have not yet
gained popularity. This can be attributed to concerns regarding their
safety, as well as lack of sufficient evidence of their benefit. Methods:
Described is a randomized, multicentre study comparing the MPC - ROCsafeRX
to standard cardiopulmonary bypass in patients undergoing elective
coronary artery bypass grafting and/ or aortic valve replacement. Results:
Five hundred patients were included in the study (252 randomized to the
ROCsafeRX group and 248 to standard cardiopulmonary bypass). Both groups
were well matched for demographic characteristics and type of surgery. No
operative mortality and no device-related complications were encountered.
Transfusion requirement (333 +/- 603 vs. 587 +/- 1010 ml; p=0.001),
incidence of atrial fibrillation (16.3% vs. 24.2%; p=0.03) and the
incidence of major adverse events (9.1% vs. 16.5%; p=0.02) were all in
favour of the MPC group. Conclusion: These results confirm both the safety
and efficacy of the ROCsafeRX MPC for a large variety of cardiac patients.
Minimized perfusion circuits should, therefore, play a greater role in
daily practice so that as many patients as possible can benefit from their
advantages. 2011 SAGE Publications.

<20>
Accession Number
2011602837
Authors
Jacobs S. De Somer F. Vandenplas G. Van Belleghem Y. Taeymans Y. Van
Nooten G.
Institution
(Jacobs) Department of Anaesthesia, University Hospital Gent, Gent,
Belgium
(De Somer, Vandenplas, Van Belleghem, Taeymans, Van Nooten) University
Hospital Gent, Heart Centre 5IE-K12, De Pintelaan 185, B-9000 Gent,
Belgium
Title
Active or passive bio-coating: Does it matters in extracorporeal
circulation?.
Source
Perfusion. 26 (6) (pp 496-502), 2011. Date of Publication: November
2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background: Two types of surface coating for cardiopulmonary bypass (CPB)
are used: bioactive (heparin, nitric oxide) and biopassive (albumin,
polyethyleneoxide (PEO), phosphorylcholine). When haemocompatible coatings
are combined with the separation of pleuro-pericardial aspiration,
attenuation of both the coagulation and complement cascades, as well as
better platelet preservation, has been demonstrated. This study wants to
investigate if the combination of a bioactive with a biopassive coating
(unfractionated heparin embedded in a phosphorylcholine matrix) combines
the beneficial effects of both approaches. Materials and methods: Thirty
patients undergoing elective CABG were prospectively randomized into two
groups of 15 patients. The sole exclusion criterion was an ejection
fraction of less than 40%. In the control group (PC), the whole CPB
circuit was coated with phosphorylcholine (PC). In the study group (XPC),
unfractionated heparin was embedded in the PC matrix of the oxygenator and
arterial line filter. Results: No differences were found for haemolytic
index, thrombin-anti-thrombin complex (TAT), IL-6, IL-10 and blood loss.
PF4 plasma concentration increased from 27.6+/-22.0 IU/mL to 165.7+/-43.9
IU/mL (p<0.001) at 15 minutes of CPB in the PC and from 16.0+/-9.7 IU/mL
to 150.9 +/- 61.3 IU/mL (p<0.001) in the XPC group. Terminal complement
complex (TCC) increased over time in both groups until the end of CPB
(Figure 2A). Within each group, TCC generation was statistically
significantly higher after the release of the aortic cross-clamp (p<0.001)
and at the end of CPB (p<0.001). Total TCC generation was statistically
significantly higher in the XPC group compared to the PC group (p=0.026).
The difference was statistically significant after the release of the
aortic cross-clamp (p=0.005) and at the end of CPB (p=0.001).Conclusions:
Based on our results, there is no additional benefit in combining
phosphorylcholine with unfractionated heparin in elective patients
undergoing coronary artery bypass grafting (CABG). Massive haemodilution
leads to enhanced complement activation. 2011 SAGE Publications.

<21>
Accession Number
2011601389
Authors
Tamura T. Kimura T. Morimoto T. Nakagawa Y. Furukawa Y. Kadota K. Tatami
R. Kawai K. Sone T. Miyazaki S. Mitsudo K.
Institution
(Tamura, Kimura) Department of Cardiovascular Medicine, Graduate School of
Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto
606-8397, Japan
(Morimoto) Center for Medical Education and Clinical, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Nara, Japan
(Furukawa) Department of Cardiovascular Medicine, Kobe City Medical Center
General Hospital, Kobe, Japan
(Kadota, Mitsudo) Division of Cardiology, Kurashiki Central Hospital,
Okayama, Japan
(Tatami) Department of Cardiovascular System, Maizuru Kyosai Hospital,
Kyoto, Japan
(Kawai) Section of Cardiovascular Medicine, Chikamori Hospital, Kochi,
Japan
(Sone) Division of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
(Miyazaki) Division of Cardiology, Department of Internal Medicine, Kinki
University School of Medicine, Osaka, Japan
Title
Three-year outcome of sirolimus-eluting stent implantation in coronary
bifurcation lesions: The provisional side branch stenting approach versus
the elective two-stent approach.
Source
EuroIntervention. 7 (5) (pp 588-596), 2011. Date of Publication:
September 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To explore optimal management strategies for bifurcation lesions
with sirolimus-eluting stents (SES). Methods and results: Among 12,824
patients enrolled in the j-Cypher Registry, we identified 2,122 patients
with 2,250 non-left main bifurcation lesions (average age: 69 years;
diabetes: 39%; acute coronary syndrome: 24%; lesion length >=30 mm: 17%;
true bifurcation: 53%) treated exclusively with SES. The majority of
lesions (1,978 lesions, 88%) were treated by provisional side branch
stenting approach with a 4.5% crossover rate, while the elective two-stent
approach (stenting both main and side branches) was adopted in 272
lesions. The 3-year incidence of target-lesion revascularisation (TLR) was
significantly higher in the elective two-stent group than in the
provisional group (18.5% vs. 9.8%, p<0.0001). The incidence of definite
stent thrombosis was not different between the two groups (1.3% vs. 0.61%,
p=0.21). Among 1,871 lesions with main branch stenting alone, final
kissing balloon dilatation (FKB) was performed in 938 lesions (50%). The
incidence of TLR was not different between the two groups with or without
FKB (9.9% vs. 9.2%, p=0.98). Conclusions: The provisional approach
provided a good long-term outcome in the majority of lesions with low
crossover rate to the two-stent approach. Lesions treated with FKB had
similar TLR outcome to those without FKB after main branch stenting alone.
Europa Edition 2011. All rights reserved.

<22>
Accession Number
2011601388
Authors
Verheye S. Ramcharitar S. Grube E. Schofer J.J. Witzenbichler B. Kovac J.
Hauptmann K.E. Agostoni P. Wiemer M. Lefevre T. Spaargaren R. Serruys P.W.
Garcia-Garcia H.M. Van Geuns R.J.
Institution
(Verheye, Agostoni) Antwerp Cardiovascular Institute Middelheim,
Ziekenhuis Netwerk Antwerpen, Lindendreef 1, 2020 Antwerp, Belgium
(Ramcharitar) Wiltshire Cardiac Centre, Swindon, United Kingdom
(Grube) Helios Klinikum, Siegburg, Germany
(Schofer) Universitares Herz-und Gefasszentrum, Hamburg, Germany
(Witzenbichler) Charite Krankenhaus, Berlin, Germany
(Kovac) Glenfield Hospital, Leicester, United Kingdom
(Hauptmann) Krankenhaus der Barmherzigen Bruder, Trier, Germany
(Wiemer) Herz- and Diabeteszentrum NRW, Bad Oeynhausen, Germany
(Lefevre) Institut Hospitalier Jacques Cartier, Massy, France
(Spaargaren) STENTYS, Paris, France
(Serruys, Garcia-Garcia, Van Geuns) Thoraxcenter, Erasmus MC, Rotterdam,
Netherlands
Title
Six-month clinical and angiographic results of the STENTYS self-apposing
stent in bifurcation lesions.
Source
EuroIntervention. 7 (5) (pp 580-587), 2011. Date of Publication:
September 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: We report the clinical and angiographic results of the OPEN I study,
a multicentre prospective single-arm study evaluating both the
drug-eluting and bare metal STENTYS stents in the treatment of coronary
bifurcation lesions. Methods and results: The STENTYS stent is a
provisional, self-expanding, nitinol stent with small interconnections
that can be disconnected by balloon angioplasty in between the stent
struts to provide access to the side branch (SB) and full ostium coverage.
In nine European centres, 60 stents (33 BMS, 27 DES) were implanted in 63
patients (procedural success of 95.2%). Angiographic QCA and IVUS were
used to measure acute gain and late loss. The Medina classification showed
35 patients (58%) had disease affecting the SB (true bifurcations) and 19
patients (32%) had disease in all three arms. The average bifurcation
angulation pre-stenting was 60degree +/-21degree . Post-stenting,
disconnection was performed on 90% of the stents implanted. In 18 cases,
disconnection was followed by SB stenting with all SB stents successfully
implanted. Post-stenting, the bifurcation angle was 51degree . The primary
clinical endpoint, cumulative MACE at six months, was low for DES (3.7%)
but higher for BMS (27.3%) with the latter driven exclusively by
clinically-driven TLR rates (3.7% vs. 24.2%). No cardiac deaths were
recorded at six months and one patient had a non-Q wave infarct. The
secondary angiographic endpoint of late luminal loss (LLL) was measured
for both DES (paclitaxel) and BMS stents in the proximal main branch (MB),
MB, distal MB as well as the SB. The values for DES were 0.39 mm, 0.42 mm,
0.40 mm and 0.16 mm, respectively. The values for BMS were 0.86 mm, 0.87
mm, 0.85 mm and 0.54 mm, respectively. Observed results using matched IVUS
analysis at six months revealed an increase in mean stent area (mm2) for
DES from 7.52+/-1.86 at baseline to 12.32+/-2.90 at six month follow-up (p
<0.001); and for BMS from 7.95+/-1.40 to 11.56+/-2.22 (p <0.001), with no
decrease in minimum lumen area (MLA) for DES (5.10 to 4.91) and a minimal
decrease for BMS (5.74 to 5.15). Conclusions: This first-in-man (FIM)
study on the STENTYS stent showed excellent procedural success and a
relatively low MACE with competitively low LLL in both MB and SB at six
months for the DES version and LLL comparable to other BMS for the BMS
version. The disconnectable struts offered excellent "cross over" to T-
stenting when necessary and the increased gains in stent area over time.
Europa Edition 2011. All rights reserved.

<23>
Accession Number
2011593932
Authors
Park K.W. Chae I.-H. Lim D.-S. Han K.-R. Yang H.-M. Lee H.-Y. Kang H.-J.
Koo B.-K. Ahn T. Yoon J.-H. Jeong M.-H. Hong T.-J. Chung W.-Y. Jo S.-H.
Choi Y.-J. Hur S.-H. Kwon H.-M. Jeon D.-W. Kim B.-O. Park S.-H. Lee N.-H.
Jeon H.-K. Gwon H.-C. Jang Y.-S. Kim H.-S.
Institution
(Park, Yang, Lee, Kang, Koo, Kim) Department of Internal Medicine,
Cardiovascular Center, Seoul National University Hospital, 28 Yongon-dong,
Chongno-gu, Seoul 110-744, South Korea
(Chae) Seoul National University Bundang Hospital, Sungnam, South Korea
(Lim) Korea University Anam Hospital, Seoul, South Korea
(Han) Kangdong Sacred Heart Hospital, Seoul, South Korea
(Ahn) Gachon University Gil Medical Center, Incheon, South Korea
(Yoon) Yonsei University Wonju Severance Hospital, Wonju, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Hong) Busan National University Hospital, Busan, South Korea
(Chung) Seoul National University Boramae Hospital, Seoul, South Korea
(Jo, Choi) Hallym University Sacred Heart Hospital, Pyungchon, South Korea
(Hur) Keimyung University Dongsan Hospital, Daegu, South Korea
(Kwon) Gangnam Severance Hospital, Seoul, South Korea
(Jeon) NHIC Ilsan Hospital, Ilsan, South Korea
(Kim) Inje University Sanggye Paik Hospital, Seoul, South Korea
(Park) Ewha Woman's University Mokdong Hospital, Seoul, South Korea
(Lee) Kangnam Sacred Heart Hospital, Seoul, South Korea
(Jeon) Catholic University Uijeongbu, St. Mary's Hospital, Uijeongbu,
South Korea
(Gwon) Sung-Kyun-Kwan University, Samsung Medical Center, Seoul, South
Korea
(Jang) Yonsei University Severance Hospital, Seoul, South Korea
Title
Everolimus-eluting versus sirolimus-eluting stents in patients undergoing
percutaneous coronary intervention: The excellent (efficacy of
Xience/Promus versus cypher to reduce late loss after stenting) randomized
trial.
Source
Journal of the American College of Cardiology. 58 (18) (pp 1844-1854),
2011. Date of Publication: 25 Oct 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The goal of this study was to compare the angiographic
outcomes of everolimus-eluting stents (EES) and sirolimus-eluting stents
(SES) in a head-to-head manner. Background: EES have been shown to be
superior to paclitaxel-eluting stents in inhibiting late loss (LL) and
clinical outcome. Whether EES may provide similar angiographic and
clinical outcomes compared with SES is undetermined. Methods: This was a
prospective, randomized, open-label, multicenter trial to demonstrate the
noninferiority of EES compared with SES in preventing LL at 9 months. A
total of 1,443 patients undergoing percutaneous coronary intervention were
randomized 3:1 to receive EES or SES. Routine follow-up angiography was
recommended at 9 months. The primary endpoint was in-segment LL at 9
months, and major secondary endpoints included in-stent LL at 9 months,
target lesion failure, cardiac death, nonfatal myocardial infarction,
target lesion revascularization, and stent thrombosis at 12 months. Data
were managed by an independent management center, and clinical events were
adjudicated by an independent adjudication committee. Results: Clinical
follow-up was available in 1,428 patients and angiographic follow-up in
924 patients (1,215 lesions). The primary endpoint of the study
(in-segment LL at 9 months) was 0.11 +/- 0.38 mm and 0.06 +/- 0.36 mm for
EES and SES, respectively (p for noninferiority = 0.0382). The in-stent LL
was also noninferior (EES 0.19 +/- 0.35 mm; SES 0.15 +/- 0.34 mm; p for
noninferiority = 0.0121). The incidence of clinical endpoints was not
statistically different between the 2 groups, including target lesion
failure (3.75% vs. 3.05%; p = 0.53) and stent thrombosis (0.37% vs. 0.83%;
p = 0.38). Conclusions: EES were noninferior to SES in inhibition of LL
after stenting, which was corroborated by similar rates of clinical
outcomes. (Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss
After Stenting [EXCELLENT]; NCT00698607) 2011 American College of
Cardiology Foundation.

<24>
Accession Number
2011591324
Authors
Alayouty H.D. Hasan T.M. Alhadad Z.A. Barabba R.O.
Institution
(Alayouty) Department of Cardiothoracic Surgery, Faculty of Medicine, Suez
Canal University, Ismailia, Egypt
(Hasan) Department of Radiology, Faculty of Medicine, Suez Canal
University, Ismailia, Egypt
(Alhadad) Department of Radiology, Hadhramout University, Hadhramout,
Yemen
(Barabba) Department of General Surgery, Hadhramout University,
Hadhramout, Yemen
Title
Mechanical versus chemical pleurodesis for management of primary
spontaneous pneumothorax evaluated with thoracic echography.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (5) (pp 475-479),
2011. Date of Publication: November 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
The current study is designed to compare the effectiveness of brushing the
pleura vs. instillation of minocycline for the management of primary
spontaneous pneumothorax, and to assess the sensitivity of echography in
defining areas of defects. Blebectomy and pleurodesis were carried out
thoracoscopically on 84 patients. In group A (42 patients), abrasions were
induced using a sponge on a long ring forceps. Group B (42 patients)
received intrapleural instillation of minocycline. Echography was carried
out two weeks after discharge and then repeated two weeks later. Follow-up
ranged between 28 and 39months. Two patients were excluded from group A
for incomplete follow-up. In group A, five patients (12%) showed areas of
free mobility of the lung on first echography. At the second examination,
three (7% of the total) showed the same areas of mobility; one patient
developed an attack of localized pneumothorax after 32 and another after
45weeks. Each had three adjacent areas of free mobility. In group B, two
patients each showed one area of free mobility on the first and second
examinations but no recurrence during follow-up. The two groups had
comparable chest drainage, postoperative hospital stay and complication
rates. The patients in group B demonstrated a trend towards a decreased
rate of prolonged air leaks (2% vs. 5%; P=0.100). Thus, pleurodesis by
instillation of minocycline as a part of thoracoscopy is more effective
than brushing the pleura. Thoracic echography is a highly sensitive method
for assessing the effectiveness of pleurodesis. 2011 Published by
European Association for Cardio-Thoracic Surgery. All rights reserved.

<25>
Accession Number
2011584754
Authors
Dorresteijn J.A.N. Visseren F.L.J. Ridker P.M. Wassink A.M.J. Paynter N.P.
Steyerberg E.W. Van Der Graaf Y. Cook N.R.
Institution
(Dorresteijn, Visseren, Wassink) Department of Vascular Medicine,
University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht,
Netherlands
(Ridker, Paynter, Cook) Division of Preventive Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Steyerberg) Department of Public Health, Erasmus Medical Center,
Rotterdam, Netherlands
(Van Der Graaf) Julius Center for Health Sciences and Primary Care,
Utrecht, Netherlands
Title
Estimating treatment effects for individual patients based on the results
of randomised clinical trials.
Source
BMJ. 343 (7828) , 2011. Date of Publication: 22 Oct 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objectives: To predict treatment effects for individual patients based on
data from randomised trials, taking rosuvastatin treatment in the primary
prevention of cardiovascular disease as an example, and to evaluate the
net benefit of making treatment decisions for individual patients based on
a predicted absolute treatment effect. Setting: As an example, data were
used from the Justification for the Use of Statins in Prevention (JUPITER)
trial, a randomised controlled trial evaluating the effect of rosuvastatin
20 mg daily versus placebo on the occurrence of cardiovascular events
(myocardial infarction, stroke, arterial revascularisation, admission to
hospital for unstable angina, or death from cardiovascular causes).
Population: 17 802 healthy men and women who had low density lipoprotein
cholesterol levels of less than 3.4 mmol/L and high sensitivity C reactive
protein levels of 2.0 mg/L or more. Methods: Data from the Justification
for the Use of Statins in Prevention trial were used to predict
rosuvastatin treatment effect for individual patients based on existing
risk scores (Framingham and Reynolds) and on a newly developed prediction
model. We compared the net benefit of prediction based rosuvastatin
treatment (selective treatment of patients whose predicted treatment
effect exceeds a decision threshold) with the net benefit of treating
either everyone or no one. Results: The median predicted 10 year absolute
risk reduction for cardiovascular events was 4.4% (interquartile range
2.6-7.0%) based on the Framingham risk score, 4.2% (2.5-7.1%) based on the
Reynolds score, and 3.9% (2.5-6.1%) based on the newly developed model
(optimal fit model). Prediction based treatment was associated with more
net benefit than treating everyone or no one, provided that the decision
threshold was between 2% and 7%, and thus that the number willing to treat
(NWT) to prevent one cardiovascular event over 10 years was between 15 and
50. Conclusions: Data from randomised trials can be used to predict
treatment effect in terms of absolute risk reduction for individual
patients, based on a newly developed model or, if available, existing risk
scores. The value of such prediction of treatment effect for medical
decision making is conditional on the NWT to prevent one outcome event.
Trial registration number: Clinicaltrials.gov NCT00239681.

<26>
Accession Number
2011603330
Authors
Heneghan H.M. Meron-Eldar S. Brethauer S.A. Schauer P.R. Young J.B.
Institution
(Heneghan, Meron-Eldar, Brethauer, Schauer) Bariatric and Metabolic
Institute, Cleveland Clinic, Cleveland, OH, United States
(Brethauer, Schauer, Young) Endocrine and Metabolic Institute, Cleveland
Clinic, Cleveland, OH, United States
Title
Effect of bariatric surgery on cardiovascular risk profile.
Source
American Journal of Cardiology. 108 (10) (pp 1499-1507), 2011. Date of
Publication: 15 Nov 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Obesity is associated with increased risk for cardiovascular (CV) disease
(CVD) and CV mortality. Bariatric surgery has been shown to resolve or
improve CVD risk factors, to varying degrees. The objective of this
systematic review was to determine the impact of bariatric surgery on CV
risk factors and mortality. A systematic review of the published research
was performed to evaluate evidence regarding CV outcomes in morbidly obese
bariatric patients. Two major databases (PubMed and the Cochrane Library)
were searched. The review included all original reports reporting outcomes
after bariatric surgery, published in English, from January 1950 to July
2010. In total, 637 studies were identified from the initial screen. After
applying inclusion and exclusion criteria, 52 studies involving 16,867
patients were included (mean age 42 years, 78% women). The baseline
prevalence of hypertension, diabetes, and dyslipidemia was 49%, 28%, and
46%, respectively. Mean follow-up was 34 months (range 3 to 155), and the
average excess weight loss was 52% (range 16% to 87%). Most studies
reported significant decreases postoperatively in the prevalence of CV
risk factors, including hypertension, diabetes, and dyslipidemia. Mean
systolic pressure reduced from to 139 to 124 mm Hg and diastolic pressure
from 87 to 77 mm Hg. C-reactive protein decreased, endothelial function
improved, and a 40% relative risk reduction for 10-year coronary heart
disease risk was observed, as determined by the Framingham risk score. In
conclusion, this review highlights the benefits of bariatric surgery in
reducing or eliminating risk factors for CVD. It provides further evidence
to support surgical treatment of obesity to achieve CVD risk reduction.
2011 Elsevier Inc.

<27>
Accession Number
70577337
Authors
Lalumiere G. Cogan J. Vargas-Schafer G. Yegin Z. Rochon A. Deschamps A.
Lebon J.-S. Ayoub C. Couture P. Denault A. Belisle S.
Institution
(Lalumiere, Cogan, Rochon, Deschamps, Lebon, Ayoub, Couture, Denault,
Belisle) Anesthesia, Institut de Cardiologie de Montreal, Universite de
Montreal, Montreal, QC, Canada
(Vargas-Schafer) Anesthesiology, Pain Clinic, Universite de Montreal,
Montreal, QC, Canada
(Yegin) Nursing, Institut de Cardiologie de Montreal, Universite de
Montreal, Montreal, QC, Canada
Title
Low dose intravenous ketamine for post cardiac surgery pain: Does it help
decrease the incidence of chronic pain?.
Source
European Journal of Pain Supplements. Conference: 7 Congress of the
European Federation of Pain Chapters: Pain in Europe VII, EFIC Hamburg
Germany. Conference Start: 20110921 Conference End: 20110924. Conference
Publication: (var.pagings). 5 (1) (pp 165), 2011. Date of Publication:
September 2011.
Publisher
W.B. Saunders Ltd
Abstract
Background: Three recent meta-analyses have concluded that low dose
intravenous ketamine infusions (LDKI) during the postoperative period may
help to decrease acute and chronic postoperative pain after major surgery.
Aims: To evaluate the incidence and level of pain at least three months
after surgery for patients treated with low dose ketamine infusion (LDKI)
vs patients without low dose ketamine infusion. Methods: Administrative
and ethics board approval were obtained for this study. We performed a
retrospective chart review for all patients receiving LDKI and an equal
number of age, sex and surgery matched patients who did not receive LDKI.
Low dose ketamine was prepared using 100mg of ketamine in 100 ml of normal
saline and run between 50 and 200 mcg/kg/hr. Results: We reviewed 115
patients with LDKI and 115 without LDKI. The average age 63.1 years, 73%
of the patients were men and sex was evenly distributed between LDKI and
non-LDKI. Average duration of the ketamine perfusions was 26.8 hours with
an average dose of 169.9 mg. An average of 9 months after surgery 42% of
the ketamine group and 38% of the non-ketamine group stated that they had
had pain upon discharge of these patients 30% of the ketamine group and
26% of the non-ketamine group still had pain at the time of the phone
call. Conclusion: These results show that LDKI does not promote a decrease
in long term postoperative pain. This may be related to varying
intraoperative practices.