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<1>
Accession Number
2011521771
Authors
Zerafa N. Adami M.Z. Galea J.
Institution
(Zerafa, Adami) Department of Pharmacy, University of Malta, Msida, Malta
(Galea) Department of Surgery, University of Malta and Consultant
Cardiothoracic Surgeon Mater Dei Hospital, B'Kara, Malta
Title
Impact of drugs counselling by an undergraduate pharmacist on cardiac
surgical patient's compliance to medicines.
Source
Pharmacy Practice. 9 (3) (pp 156-161), 2011. Date of Publication:
July-September 2011.
Publisher
Grupo de Investigacion en Atencion Farmaceutica (Campus de la Cartuja,
Granada 18071, Spain)
Abstract
Open heart surgery is a procedure which warrants patient education about
the complexity of drug regimens and lifestyle modifications. Patient
nonadherence is likely to have a considerable negative impact on the
patients' quality of life postcardiac surgery. Objective: To evaluate the
impact of pharmacist intervention on patients' adherence to medication and
lifestyle changes. Method: This case-controlled study was conducted at the
Cardiac Surgical Ward and Outpatients Clinic of Mater Dei Hospital, Malta.
Eighty consecutive patients who underwent coronary artery bypass or heart
valve surgery were interviewed on their day of discharge using the 'Past
Medical History Questionnaire'. The patients were then randomized to
receive pharmacist intervention or usual care. Those who received
intervention (40 patients) were given a chart with pictorial explanation
of the time of day together with a colorful photograph of each tablet
prescribed. This group of patients was also counselled to comply to oral
analgesia and exercise and also on the avoidance of alcohol and smoking
during the recovery period. The control patients received usual care
without the pharmacist intervention. All patients were re-interviewed
eight weeks after discharge using the 'Assessing Patient Compliance
Questionnaire'. Any differences between the control and experimental
groups were analysed using Chi-square, Three-Way Cross tabulation One-Way
ANOVA and Two-Way ANOVA tests using the SPSS software version 17.0.
Results: A statistically significant difference between the two groups in
the mean percentage compliance was registered following pharmacist
intervention (p<0.05). Patients in the experimental group had a higher
mean percentage compliance score (88%) than patients in the control group
(66%). Conclusion: The statistically significant difference in the mean
percentage compliance between the two groups following pharmacist
intervention shows conclusive evidence of the advantage patients gain when
offered this intervention. The pharmacist intervention provides patients
with sufficient information to help them achieve optimal benefit from the
medication prescribed.

<2>
Accession Number
2011641103
Authors
Goodacre S.W. Bradburn M. Mohamed A. Gray A.
Institution
(Goodacre, Bradburn, Mohamed) School of Health and Related Research,
University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1
4DA, United Kingdom
(Gray) Emergency Department, Royal Infirmary of Edinburgh, Edinburgh
EH164SU, United Kingdom
Title
Evaluation of global registry of acute cardiac events and thrombolysis in
myocardial infarction scores in patients with suspected acute coronary
syndrome.
Source
American Journal of Emergency Medicine. 30 (1) (pp 37-44), 2012. Date of
Publication: January 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Purposes: We aimed to evaluate the Global Registry of Acute Cardiac Events
(GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores in
patients with suspected but not proven acute coronary syndrome (ACS).
Basic procedures: We conducted a secondary analysis of data from the
RATPAC trial. Standardized data were collected from 2263 patients
presenting to 6 emergency departments with suspected but not proven ACS.
Patients were followed up by record review and postal questionnaire at 30
and 90 days after recruitment to identify major adverse events, defined as
death, emergency revascularization, life-threatening arrhythmia,
hospitalization for ACS, or nonfatal acute myocardial infarction (AMI).
Main findings: Data were available for 2243 patients (mean age, 54.5
years; 58% male). The major adverse event rate was 43 (2%) of 2243 after
30 days and 62 (3%) of 2243 after 90 days. The c statistics for 30-day
events were 0.717 (95% confidence interval [CI], 0.698-0.735) for GRACE
and 0.682 (95% CI, 0.662-0.701) for TIMI. The corresponding 90-day c
statistics were 0.726 (95% CI, 0.707-0.745) for GRACE and 0.693 (95% CI,
0.674-0.712) for TIMI. The c statistic for patient age alone was 0.656 for
30-day events and 0.689 for 90-day events. Principal conclusions: The
GRACE and TIMI scores are little better than age alone as predictors of
major adverse events in patients with suspected but not proven ACS, and
thus add little to prognostic assessment of such patients. 2012 Elsevier
Inc. All rights reserved.

<3>
Accession Number
2011636688
Authors
Walker K. Badawi N. Holland A.J.A. Halliday R.
Institution
(Walker, Badawi, Halliday) Grace Centre for Newborn Care, Children's
Hospital at Westmead, Westmead, NSW 2145, Australia
(Holland) Douglas Cohen Department of Surgery, Children's Hospital at
Westmead, Australia
(Walker, Badawi, Holland) Discipline of Paediatrics and Child Health,
Sydney Medical School, University of Sydney, Sydney, NSW, Australia
Title
Developmental outcomes following major surgery: What does the literature
say?.
Source
Journal of Paediatrics and Child Health. 47 (11) (pp 766-770), 2011.
Date of Publication: November 2011.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Relative to the wealth of information in the medical literature regarding
developmental outcome for infants who have had cardiac surgery available,
few studies specifically detail how those who have undergone major surgery
grow and develop. The few published studies tend to be disease specific,
making their results difficult to translate to a more general setting. As
mortality for most infants who require surgery in infancy continues to
decrease, the focus for researchers and clinicians should be on how these
children will grow and develop. As parents realise that their infant will
survive, this becomes their next major concern. The most common conditions
requiring early major surgery have been reviewed in relation to data on
infant developmental outcomes. 2010 Paediatrics and Child Health Division
(Royal Australasian College of Physicians).

<4>
Accession Number
2011644485
Authors
Claessen B.E. Smits P.C. Kereiakes D.J. Parise H. Fahy M. Kedhi E. Serruys
P.W. Lansky A.J. Cristea E. Sudhir K. Sood P. Simonton C.A. Stone G.W.
Institution
(Claessen, Parise, Fahy, Cristea, Stone) New York Presbyterian Hospital,
Columbia University, Medical Center and the Cardiovascular Research
Foundation, New York, NY, United States
(Smits, Kedhi) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Kereiakes) Christ Hospital Heart, Lindner Research Center, Cincinnati,
OH, United States
(Serruys) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Serruys, Sudhir, Sood, Simonton) Abbott Vascular, Santa Clara, CA, United
States
(Lansky) Yale University, School of Medicine, New Haven, CT, United States
Title
Impact of lesion length and vessel size on clinical outcomes after
percutaneous coronary intervention with everolimus- versus
paclitaxel-eluting stents: Pooled analysis from the SPIRIT (Clinical
evaluation of the XIENCE v everolimus eluting coronary stent system) and
COMPARE (second-generation everolimus-eluting and paclitaxel-eluting
stents in real-life practice) randomized trials.
Source
JACC: Cardiovascular Interventions. 4 (11) (pp 1209-1215), 2011. Date of
Publication: November 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: The aim of this study was to investigate the impact of
reference vessel diameter (RVD) and lesion length (LL) on the relative
safety and efficacy of everolimus-eluting stents (EES) and
paclitaxel-eluting stents (PES). Background: Lesion length and RVD are
well-known predictors of adverse events after percutaneous coronary
intervention. Methods: Patient-level data were pooled from the randomized
SPIRIT (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary
Stent System) II, III, IV and COMPARE (Second-generation
everolimus-eluting and paclitaxel-eluting stents in real-life practice)
trials. Quantitative angiographic core laboratory data were available for
6,183 patients randomized to EES (n = 3,944) or PES (n = 2,239). Long
lesions and small vessels were defined as LL >median (13.4 mm) and RVD
<=median (2.65 mm), respectively. Major adverse cardiac events (MACE)
(consisting of cardiac death, myocardial infarction, or ischemia-driven
target lesion revascularization) were assessed at 2 years, according to
stent type in 3 groups: short lesions in large vessels (group A, n =
1,297); long lesions or small vessels but not both (group B, n = 2,981);
and long lesions in small vessels (group C, n = 1,905). Results: The
pooled 2-year MACE rates were 5.6%, 8.2%, and 10.4% in Groups A, B, and C,
respectively (p < 0.0001). There was no significant interaction between
lesion group and stent type (p = 0.64), indicating lower MACE with EES
compared with PES regardless of LL and RVD. However, the absolute
difference was largest in Groups B and C. In Group A, 2-year MACE rates
were not significantly different between EES and PES (4.8% vs. 7.0%,
respectively, p = 0.11). In contrast, EES was associated with lower 2-year
rates of MACE in Group B (6.6% vs. 11.2%, p < 0.01) and in Group C (9.1%
vs. 12.7%, p = 0.008) as well as lower rates of myocardial infarction,
target lesion revascularization, and stent thrombosis. Multivariable
analysis confirmed EES versus PES as an independent predictor of freedom
from MACE in Groups B and C. Conclusions: Patients with short lesions in
large vessels have low rates of MACE at 2 years after treatment with
either EES or PES. In higher-risk patients with long lesions and/or small
vessels, EES results in significant improvements in both clinical safety
and efficacy outcomes. (A Clinical Evaluation of the XIENCE V Everolimus
Eluting Coronary Stent System in the Treatment of Patients With de Novo
Native Coronary Artery Lesions; NCT00180310; SPIRIT III: A Clinical
Evaluation of the Investigational Device XIENCE V Everolimus Eluting
Coronary Stent System [EECSS] in the Treatment of Subjects With de Novo
Native Coronary Artery Lesions; NCT00180479; SPIRIT IV Clinical Trial:
Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent
System in the Treatment of Subjects With de Novo Native Coronary Artery
Lesions; NCT00307047; A Randomized Controlled Trial of Everolimus-eluting
Stents and Paclitaxel-eluting Stents for Coronary Revascularization in
Daily Practice: The COMPARE Trial; NCT01016041) 2011 American College of
Cardiology Foundation.

<5>
Accession Number
2011644167
Authors
Wimmer-Greinecker G. Bouchot O. Verhoye J.P. Perrault L.P. Borgermann J.
Diegeler A. Van Garsse L. Rastan A.J.
Institution
(Wimmer-Greinecker) Department of Cardiothoracic Surgery, Heart and Vessel
Center Bad Bevensen, Roemstedter Str 25, Bad Bevensen D-29549, Germany
(Bouchot) Department of Cardiovascular Surgery, University Hospital,
Dijon, France
(Verhoye) Cardio-Pneumologic Center, Pontchaillou Hospital, Rennes, France
(Perrault) Montreal Heart Institute, Montreal, QC, Canada
(Borgermann) Herz- und Diabeteszentrum Nordrhein Westfalen, Bad
Oeynhausen, Germany
(Diegeler) Department of Cardiac Surgery, Heart and Vessel Center, Bad
Neustadt, Germany
(Van Garsse) Department of Cardiothoracic Surgery, Maastricht University
Medical Centre, Maastricht, Netherlands
(Rastan) Department of Cardiac Surgery, Heart Center Leipzig, Leipzig,
Germany
Title
Randomized clinical trial comparing a thermosensitive polymer (LeGoo) with
conventional vessel loops for temporary coronary artery occlusion during
off-pump coronary artery bypass surgery.
Source
Annals of Thoracic Surgery. 92 (6) (pp 2177-2183), 2011. Date of
Publication: December 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: During off-pump coronary artery bypass graft (OPCABG) surgery,
a bloodless surgical field is mandatory for visualization and construction
of optimal coronary anastomoses. Presently used temporary vascular
occluders are known to cause endothelial dysfunction and vessel injury.
The present prospective multicenter randomized clinical trial evaluates
safety and efficacy of a novel thermosensitive polymer (LeGoo) as an
atraumatic temporary vascular occluder. Methods: Between July 2008 and
February 2010, 110 patients undergoing OPCABG were randomized between
LeGoo (LG) and conventional vessel loops (VL) for coronary artery
occlusion during construction of the distal anastomosis. A
semiquantitative 4-point scale was used to evaluate the degree of
bloodless surgical field and surgical comfort. Duration of coronary artery
occlusion was also recorded. Safety during the operation and ensuing 30
days was evaluated by a composite endpoint of major adverse cardiac events
that consisted of death from all causes, graft occlusion, myocardial
infarction, and low cardiac output. Results: Fifty-six patients (117
distal anastomoses) were randomly assigned to LG and 54 patients (122
anastomoses) to VL. There were 2 anastomoses crossed over from LG to the
control arm, and 3 from control to LG. Five anastomoses in LG patients
were treated with an alternative device (shunts). Satisfactory hemostasis
was achieved in 88.0% of LG anastomoses (103 of 117) compared with 60.7%
of VL anastomoses (74 of 122; p < 0.001). Mean total anastomotic time was
12.8 minutes in the LG group and 15.1 minutes in the VL group (p < 0.001).
This difference was more pronounced for arteries on the posterior and
lateral than on the anterior walls of the heart. Composite adverse events
were similar in the two groups: 3 of 48 LG patients and 3 of 46 VL
patients. There was 1 death in the LG group. One patient in the LG group
and 1 in the VL arm had a myocardial infarction. No operation was
converted from OPCABG to CABG with cardiopulmonary bypass. Conclusions:
LeGoo is a safe and effective temporary coronary occluder during OPCABG.
It provided a dry surgical field for visualization of the anastomotic
field and surgical comfort more frequently than conventional vessel loops.
In addition, anastomotic times were shorter with LG. Major cardiac adverse
events were similar in the LG and VL arms. 2011 The Society of Thoracic
Surgeons.

<6>
Accession Number
2011644151
Authors
MacK M.J. Banning A.P. Serruys P.W. Morice M.-C. Taeymans Y. Van Nooten G.
Possati G. Crea F. Hood K.L. Leadley K. Dawkins K.D. Kappetein A.P.
Institution
(MacK) Heart Hospital Baylor Plano, Baylor Healthcare System, Dallas, TX,
United States
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Serruys, Kappetein) Erasmus University Medical Center Rotterdam,
Rotterdam, Netherlands
(Morice) Institut Cardiovasculaire Paris Sud, Massy, France
(Taeymans, Van Nooten) Universitair Ziekenhuis Gent, Gent, Belgium
(Possati, Crea) Policlinico Agostino Gemelli, Roma, Italy
(Hood, Leadley, Dawkins) Boston Scientific Corporation, Natick, MA, United
States
Title
Bypass versus drug-eluting stents at three years in SYNTAX patients with
diabetes mellitus or metabolic syndrome.
Source
Annals of Thoracic Surgery. 92 (6) (pp 2140-2146), 2011. Date of
Publication: December 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Diabetes mellitus increases adverse outcomes after coronary
revascularization; however, the impact of metabolic syndrome is unclear.
We examined the impact of diabetes and metabolic syndrome on coronary
artery bypass graft surgery (CABG) and stenting outcomes to determine the
optimal revascularization option for the treatment of complex coronary
artery disease. Methods: Patients (n = 1,800) with left main or
three-vessel disease or both were randomly allocated to treatment with a
TAXUS Express² paclitaxel-eluting stent (PES) or CABG, and were
included in predefined nondiabetic (n = 1,348) or diabetic subgroups (n =
452); 258 patients with diabetes also had metabolic syndrome. Results:
Among diabetic patients, the 3-year major adverse cardiac and
cerebrovascular event (MACCE) rate (22.9% CABG, 37.0% PES; p = 0.002) and
revascularization rate (12.9% CABG, 28.0% PES; p < 0.001) were higher
after PES treatment. Diabetes increased MACCE rates among PES-treated
patients, but had little impact on results after CABG. Compared with CABG,
PES treatment yielded comparable MACCE in diabetic patients (30.5% versus
29.8%, p =0.98) and nondiabetic patients (20.2% versus 20.3%, p =0.99)
with low Synergy Between Percutaneous Coronary Intervention With Taxus and
Cardiac Surgery (SYNTAX) study scores of 22 or less. For patients with
SYNTAX Scores of 33 or greater, MACCE rates were lower with CABG (18.5%
versus 45.9%, p < 0.001 diabetic; 19.8% versus 30.0%, p = 0.01
nondiabetic). Metabolic syndrome did not significantly predict MACCE or
repeat revascularization. Conclusions: These exploratory analyses suggest
that among diabetic patients with complex left main or three-vessel
disease, or both, 3-year MACCE is higher after PES compared with CABG.
Although PES is a potential treatment option in patients with less complex
lesions, CABG should be the revascularization option of choice for
patients with more complex anatomic disease, especially with concurrent
diabetes. Metabolic syndrome had little impact on 3-year outcomes. 2011
The Society of Thoracic Surgeons.

<7>
Accession Number
2011644120
Authors
Lim C.C.S. Cuculi F. Van Gaal W.J. Testa L. Arnold J.R. Karamitsos T.
Francis J.M. Digby J.E. Antoniades C. Kharbanda R.K. Neubauer S. Westaby
S. Banning A.P.
Institution
(Lim, Cuculi, Testa, Arnold, Digby, Antoniades, Kharbanda, Westaby,
Banning) Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford
OX3 9DU, United Kingdom
(Van Gaal) Department of Cardiology, Northern Hospital, Melbourne, VIC,
Australia
(Van Gaal) Department of Medicine, University of Melbourne, Melbourne,
VIC, Australia
(Testa) Department of Interventional Cardiology, Sant'Ambrogio Clinical
Institute, Milan, Italy
(Karamitsos, Francis, Neubauer) University of Oxford Centre for Clinical
Magnetic Resonance Research, Department of Cardiovascular Medicine, John
Radcliffe Hospital, Oxford, United Kingdom
Title
Early diagnosis of perioperative myocardial infarction after coronary
bypass grafting: A study using biomarkers and cardiac magnetic resonance
imaging.
Source
Annals of Thoracic Surgery. 92 (6) (pp 2046-2053), 2011. Date of
Publication: December 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Myocardial injury related to coronary artery bypass grafting
(CABG) is poorly characterized, and understanding the characteristic
release of biomarkers associated with revascularization injury might
provide novel therapeutic opportunities. This study characterized early
changes in biomarkers after revascularization injury during on-pump CABG.
Methods: This prospective study comprised 28 patients undergoing on-pump
CABG and late gadolinium enhancement (LGE) cardiac magnetic resonance
imaging (CMRI) who underwent measurements of cardiac troponin I (cTnI),
creatine kinase-MB, and inflammatory markers (C-reactive protein, serum
amyloid A, myeloperoxidase, interleukin 6, tumor necrosis factor-alpha,
matrix metalloproteinase 9a, monocyte chemotactic protein-1, plasminogen
activator inhibitor-1a) at baseline, at 1, 6, 12, and 24 hours, and at 1
week (inflammatory markers only) post-CABG. Biomarker results at 1 hour
were studied for a relationship to new myocardial infarction as defined by
CMRI-LGE, and the diagnostic utility of combining positive biomarkers was
assessed. Results: All patients had an uneventful recovery, but 9 showed a
new myocardial infarction demonstrated by new areas of hyperenhancement on
CMR. Peak cTnI at 24 hours ( = 0.66, p < 0.001) and CK-MB ( = 0.66, p <
0.001) correlated with the amount of new LGE. At 1 hour, 3 biomarkerscTnI,
interleukin 6, and tumor necrosis factor-alphawere significantly elevated
in patients with vs those without new LGE. Receiver operating curve
analysis showed cTnI was the most accurate at detecting new LGE at 1 hour:
a cutoff of cTnI exceeding 5 mug/L at 1 hour had 67% sensitivity and 79%
specificity for detecting new LGE. Conclusions: Unexpected CABG-related
myocardial injury occurs in a significant proportion of patients. A cTnI
test at 1 hour after CABG could potentially differentiate patients with
significant revascularization injury. 2011 The Society of Thoracic
Surgeons.

<8>
Accession Number
2011643787
Authors
Weir R.A.P. Tsorlalis I.K. Steedman T. Dargie H.J. Fraser R. McMurray
J.J.V. Connell J.M.C.
Institution
(Weir, Steedman, Dargie, McMurray) Cardiology Department, Western
Infirmary, Glasgow G11 6NT, United Kingdom
(Tsorlalis, Fraser) BHF Cardiovascular Research Centre, University of
Glasgow, United Kingdom
(Connell) Ninewells Hospital and Medical School, Dundee, United Kingdom
Title
Aldosterone and cortisol predict medium-term left ventricular remodelling
following myocardial infarction.
Source
European Journal of Heart Failure. 13 (12) (pp 1305-1313), 2011. Date of
Publication: December 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Mineralocorticoid receptor (MR) antagonists improve cardiovascular
outcomes in patients with heart failure complicating acute myocardial
infarction (AMI) and in chronic heart failure. It is unclear whether these
beneficial effects are due solely to aldosterone blockade, as MR has a
similar affinity for cortisol. We examined the relationships between
plasma and urinary steroid hormones and left ventricular (LV) remodelling
in patients with LV dysfunction following AMI. Methods and resultsPlasma
concentrations of renin, aldosterone, and N-terminal pro-brain natriuretic
peptide (NT-proBNP), and 24 h urinary excretion rates of
tetrahydroaldosterone (THAldo) and total cortisol metabolites were
measured in 93 patients at a mean of 46 h following AMI prior to
contrast-enhanced cardiac magnetic resonance (ceCMR). Patients were then
randomized to 24 weeks of placebo or eplerenone therapy in addition to
standard treatment, after which ceCMR was repeated. In placebo-treated
patients, aldosterone, NT-proBNP, and excretion rates of THAldo and total
cortisol metabolites were univariate predictors of remodelling (i.e.
change in LV end-systolic volume index); aldosterone (P 0.040) and total
cortisol metabolite excretion (P 0.038) remained independent predictors on
multivariate analysis. None of the measured biomarkers predicted
remodelling in the presence of eplerenone. Plasma and urinary aldosterone
measures, and urinary cortisol metabolites, were not only related to
larger infarct volumes and greater infarct remodelling over time, but were
also higher in patients with microvascular obstruction on baseline ceCMR.
ConclusionAldosterone and cortisol are associated with medium-term LV
remodelling when measured early after AMI. The beneficial effects of MR
antagonism may relate to blockade of both aldosterone-and cortisol-induced
MR activation.ClinicalTrials.gov: NCT00132093. 2011 The Author.

<9>
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Accession Number
2011643377
Authors
Imazio M. Brucato A. Ferrazzi P. Rovere M.E. Gandino A. Cemin R. Ferrua S.
Belli R. Maestroni S. Simon C. Zingarelli E. Barosi A. Sansone F. Patrini
D. Vitali E. Trinchero R. Spodick D.H. Adler Y.
Institution
(Imazio, Belli, Trinchero) Department of Cardiology, Maria Vittoria
Hospital, Via Cibrario 72, 10141 Torino, Italy
(Brucato, Maestroni) Department of Medicine, Ospedali Riuniti, Bergamo,
Italy
(Ferrazzi, Simon) Cardiac Surgery, Ospedali Riuniti, Bergamo, Italy
(Rovere, Zingarelli, Sansone) Cardiac Surgery, Ospedale Mauriziano,
Torino, Italy
(Gandino, Barosi) Ospedale Niguarda, Milano, Italy
(Cemin) Department of Cardiology, San Maurizio Regional Hospital, Bolzano,
Italy
(Ferrua) Ospedale Degli Infermi, Rivoli, Italy
(Patrini, Vitali) Humanitas Gavazzeni, Bergamo, Italy
(Spodick) Department of Medicine, St. Vincent Hospital, University of
Massachusetts, Worcester, MA, United States
(Adler) Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine,
University of Tel Aviv, Israel
Title
Colchicine reduces postoperative atrial fibrillation: Results of the
Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS)
atrial fibrillation substudy.
Source
Circulation. 124 (21) (pp 2290-2295), 2011. Date of Publication: 22 Nov
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-: Inflammation and pericarditis may be contributing factors for
postoperative atrial fibrillation (POAF), and both are potentially
affected by antiinflammatory drugs and colchicine, which has been shown to
be safe and efficacious for the prevention of pericarditis and the
postpericardiotomy syndrome (PPS). The aim of the Colchicine for the
Prevention of the Post-Pericardiotomy Syndrome (COPPS) POAF substudy was
to test the efficacy and safety of colchicine for the prevention of POAF
after cardiac surgery. Methods and Results-: The COPPS POAF substudy
included 336 patients (mean age, 65.7+/-12.3 years; 69% male) of the COPPS
trial, a multicenter, double-blind, randomized trial. Substudy patients
were in sinus rhythm before starting the intervention (placebo/colchicine
1.0 mg twice daily starting on postoperative day 3 followed by a
maintenance dose of 0.5 mg twice daily for 1 month in patients ge;70 kg,
halved doses for patients <70 kg or intolerant to the highest dose). The
substudy primary end point was the incidence of POAF on intervention at 1
month. Despite well-balanced baseline characteristics, patients on
colchicine had a reduced incidence of POAF (12.0% versus 22.0%,
respectively; P=0.021; relative risk reduction, 45%; number needed to
treat, 11) with a shorter in-hospital stay (9.4+/-3.7 versus 10.3+/-4.3
days; P=0.040) and rehabilitation stay (12.1+/-6.1 versus 13.9+/-6.5 days;
P=0.009). Side effects were similar in the study groups. Conclusion-:
Colchicine seems safe and efficacious in the reduction of POAF with the
potentiality of halving the complication and reducing the hospital stay.
Clinical Trial Registration-: URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00128427. 2011 American Heart Association, Inc.

<10>
Accession Number
2011632331
Authors
Yasufuku K. Pierre A. Darling G. De Perrot M. Waddell T. Johnston M. Da
Cunha Santos G. Geddie W. Boerner S. Le L.W. Keshavjee S.
Institution
(Yasufuku, Pierre, Darling, De Perrot, Waddell, Johnston, Keshavjee)
Division of Thoracic Surgery, University of Toronto, Toronto General
Hospital, 200 Elizabeth St, Toronto, ON M5G2C4, Canada
(Da Cunha Santos, Geddie, Boerner) Department of Pathology, Toronto
General Hospital, University Health Network, Toronto, ON, Canada
(Le) Department of Biostatistics, Princess Margaret Hospital, University
Health Network, Toronto, ON, Canada
Title
A prospective controlled trial of endobronchial ultrasound-guided
transbronchial needle aspiration compared with mediastinoscopy for
mediastinal lymph node staging of lung cancer.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (6) (pp
1393-1400.e1), 2011. Date of Publication: December 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The study objective was to compare endobronchial
ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with
mediastinoscopy for mediastinal lymph node staging of potentially
resectable non-small cell lung cancer. Methods: Patients with confirmed or
suspected non-small cell lung cancer who required mediastinoscopy to
determine suitability for lung cancer resection were entered into the
trial. All patients underwent EBUS-TBNA followed by mediastinoscopy under
general anesthesia. If both were negative for N2 or N3 disease, the
patient underwent pulmonary resection and mediastinal lymphadenectomy.
Results: Between July 2006 and August 2010, 190 patients were registered
in the study, 159 enrolled, and 153 were eligible for analysis. EBUS-TBNA
and mediastinoscopy sampled an average of 3 and 4 lymph node stations per
patient, respectively. The mean short axis of the lymph node biopsied by
EBUS-TBNA was 6.9 +/- 2.9 mm. The prevalence of N2/N3 disease was 35%
(53/153). There was excellent agreement between EBUS-TBNA and
mediastinoscopy for mediastinal staging in 136 patients (91%; Kappa, 0.8;
95% confidence interval, 0.7-0.9). Specificity and positive predictive
value for both techniques were 100%. The sensitivity, negative predictive
value, and diagnostic accuracy for mediastinal lymph node staging for
EBUS-TBNA and mediastinoscopy were 81%, 91%, 93%, and 79%, 90%, 93%,
respectively. No significant differences were found between EBUS-TBNA and
mediastinoscopy in determining the true pathologic N stage (McNemars test,
P = .78). There were no complications from EBUS-TBNA. Minor complications
from mediastinoscopy were observed in 4 patients (2.6%). Conclusions:
EBUS-TBNA and mediastinoscopy achieve similar results for the mediastinal
staging of lung cancer. As performed in this study, EBUS-TBNA can replace
mediastinoscopy in patients with potentially resectable non-small cell
lung cancer. Copyright 2011 by The American Association for Thoracic
Surgery.

<11>
Accession Number
2011632299
Authors
Graham E.M. Atz A.M. Butts R.J. Baker N.L. Zyblewski S.C. Deardorff R.L.
Desantis S.M. Reeves S.T. Bradley S.M. Spinale F.G.
Institution
(Graham, Atz, Butts, Zyblewski) Division of Cardiology, Department of
Pediatrics, Medical University of South Carolina, Charleston, SC, United
States
(Baker, Desantis) Biostatistics and Epidemiology, Medical University of
South Carolina, Charleston, SC, United States
(Reeves) Anesthesia and Perioperative Medicine, Medical University of
South Carolina, Charleston, SC, United States
(Deardorff, Bradley, Spinale) Division of Cardiothoracic Surgery,
Department of Surgery, Medical University of South Carolina, Charleston,
SC, United States
Title
Standardized preoperative corticosteroid treatment in neonates undergoing
cardiac surgery: Results from a randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (6) (pp 1523-1529),
2011. Date of Publication: December 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: A heightened inflammatory response occurs after cardiac
surgery. The perioperative use of glucocorticoids has been advocated as a
method to improve postoperative outcomes. Randomized prospective studies
to quantify the effect of methylprednisolone on perioperative outcomes in
neonatal cardiac surgery have not been performed. We sought to determine
whether preoperative methylprednisolone would improve postoperative
recovery in neonates requiring cardiac surgery. Methods: Neonates
scheduled for cardiac surgery were randomly assigned to receive either
2-dose (8 hours preoperatively and operatively, n = 39) or single-dose
(operatively, n = 37) methylprednisolone (30 mg/kg per dose) in a
prospective double-blind trial. The primary outcome was the incidence of
low cardiac output syndrome (standardized score) or death 36 hours
postoperatively. Secondary outcomes were death at 30 days, interleukin-6
levels, inotropic score, fluid balance, serum creatinine, and intensive
care unit and hospital stay. Results: Preoperative plasma levels of the
inflammatory cytokine interleukin-6 were reduced by 2-fold (P < .001) in
the 2-dose methylprednisolone group, consistent with the anti-inflammatory
effects of methylprednisolone. However, the incidence of low cardiac
output syndrome was 46% (17/37) in the single-dose and 38% (15/39) in the
2-dose methylprednisolone groups (P = .51). Two-dose methylprednisolone
was associated with a higher serum creatinine (0.61 +/- 0.18 mg/dL vs 0.53
+/- 0.12 mg/dL, P = .03) and poorer postoperative diuresis (-96 +/- 49 mL,
P = .05). Inotropic requirement, duration of mechanical ventilation,
intensive care unit, and hospital stay did not differ between the 2
groups. Conclusions: Combined preoperative and intraoperative use of
glucocorticoids in neonatal cardiac surgery does not favorably affect
early clinical outcomes and may exacerbate perioperative renal
dysfunction. Copyright 2011 by The American Association for Thoracic
Surgery.

<12>
Accession Number
2011635229
Authors
Moon K.T.
Title
Outcomes of First-Generation drug-eluting stents in large Coronary Artery
repair.
Source
American Family Physician. 84 (10) (pp 1175), 2011. Date of Publication:
20111115.
Publisher
American Academy of Family Physicians (11400 Tomahawk Creek Parkway, Suite
440, Leawood KS 66211, United States)
Abstract
Background: Drug-eluting stents are thought to be more effective than
bare-metal stents for small coronary arteries (less than 3.0 mm in
diameter). However, it is unclear which type of stent is more effective
for large-vessel stenting. Compared with bare-metal stents,
first-generation drug-eluting stents (e.g., stents that release paclitaxel
or sirolimus) have lower restenosis rates, but an increased risk of late
stent thrombosis, which in turn may be associated with death from cardiac
causes or nonfatal myocardial infarction. Kaiser and colleagues conducted
a large, prospective, randomized, multicenter trial to evaluate the
effectiveness of first-generation drug-eluting stents and bare-metal
stents placed in large coronary arteries.The Study: The authors randomly
assigned 2,314 patients with acute or chronic coronary disease requiring
stenting to receive bare-metal stents (n = 765), first-generation
drug-eluting stents containing sirolimus (n = 775), or second-generation
drug-eluting stents containing everolimus (n = 774). Patients were
eligible if they required stents 3.0 mm or larger in diameter. All
patients received aspirin in a daily dosage of 75 to 100 mg indefinitely
and clopidogrel (Plavix) in a daily dosage of 75 mg for one year. The
primary end point was death from cardiac causes or nonfatal myocardial
infarction at two years.Results: Two-thirds of patients presented with
acute coronary syndromes, and one-half of those had myocardial infarction
with ST-segment elevation. At two years, no significant differences were
seen between groups with regard to the composite primary outcome of
nonfatal myocardial infarction or death from cardiac causes, or when these
factors were studied separately. The need for revascularization unrelated
to myocardial infarction was significantly greater with bare-metal stents
than with either drug-eluting stent group (8.9 percent for bare-metal, 3.7
percent for sirolimus, and 3.1 percent for everolimus), although rates
with both drug-eluting stent groups were similar. No differences in
thrombosis rates were noted between groups.Conclusion: In patients who
required large-vessel coronary artery stenting, no increased mortality
risk was noted among those who received first- or second- generation
drug-eluting stents compared with bare-metal stents. Both drug-eluting
stent groups showed a reduced rate of target vessel revascularization
compared with bare-metal stents; however, the risk of clinically relevant
restenosis is lower among patients requiring only large-vessel stents than
in those requiring small-vessel stents. Also, a nonsignificant reduction
in death from cardiac causes or nonfatal myocardial infarction was noted
in the drug-eluting stent groups. 2011 by the American Academy of Family
Physicians.

<13>
Accession Number
2011633192
Authors
Haase-Fielitz A. Mertens P.R. Plass M. Kuppe H. Hetzer R. Westerman M.
Ostland V. Prowle J.R. Bellomo R. Haase M.
Institution
(Haase-Fielitz, Mertens, Haase) Department of Nephrology and Hypertension
and Endocrinology and Metabolic Diseases, Otto-von-Guericke-University,
Leipziger Strasse 44, D-39120 Magdeburg, Germany
(Plas, Kuppe) Institute of Anesthesiology, German Heart Center,
Augustenburger Platz 1, D-13353 Berlin, Germany
(Hetzer) Department of Cardiothoracic Surgery, German Heart Center,
Augustenburger Platz 1, D-13353 Berlin, Germany
(Westerman, Ostland) Intrinsic LifeSciences LLC, 505 Coast Boulevard
South, Suite 102, La Jolla, CA 92037, United States
(Prowle, Bellomo) Department of Intensive Care, Austin Hospital, Studley
Road, Heidelberg 3084, Melbourne, Australia
Title
Urine hepcidin has additive value in ruling out cardiopulmonary
bypass-associated acute kidney injury: An observational cohort study.
Source
Critical Care. 15 (4) , 2011. Article Number: R186. Date of
Publication: 04 Aug 2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: Conventional markers of acute kidney injury (AKI) lack
diagnostic accuracy and are expressed only late after cardiac surgery with
cardiopulmonary bypass (CPB). Recently, interest has focused on hepcidin,
a regulator of iron homeostasis, as a unique renal biomarker.Methods: We
studied 100 adult patients in the control arm of a randomized, controlled
trial http://www.clinicaltrials.gov/NCT00672334 who were identified as
being at increased risk of AKI after cardiac surgery with CPB. AKI was
defined according to the Risk, Injury, Failure, Loss, End-stage renal
disease classification of AKI classification stage. Samples of plasma and
urine were obtained simultaneously (1) before CPB (2) six hours after the
start of CPB and (3) twenty-four hours after CPB. Plasma and urine
hepcidin 25-isoforms were quantified by competitive enzyme-linked
immunoassay.Results: In AKI-free patients (N = 91), urine hepcidin
concentrations had largely increased at six and twenty-four hours after
CPB, and they were three to seven times higher compared to patients with
subsequent AKI (N = 9) in whom postoperative urine hepcidin remained at
preoperative levels (P = 0.004, P = 0.002). Furthermore, higher urine
hepcidin and, even more so, urine hepcidin adjusted to urine creatinine at
six hours after CPB discriminated patients who did not develop AKI (area
under the curve (AUC) receiver operating characteristic curve 0.80 [95%
confidence interval (95% CI) 0.71 to 0.87] and 0.88 [95% CI 0.78 to 0.97])
or did not need renal replacement therapy initiation (AUC 0.81 [95% CI
0.72 to 0.88] 0.88 [95% CI 0.70 to 0.99]) from those who did. At six
hours, urine hepcidin adjusted to urine creatinine was an independent
predictor of ruling out AKI (P = 0.011). Plasma hepcidin did not predict
no development of AKI. The study findings remained essentially unchanged
after excluding patients with preoperative chronic kidney
disease.Conclusions: Our findings suggest that urine hepcidin is an early
predictive biomarker of ruling out AKI after CPB, thereby contributing to
early patient risk stratification. 2011 Haase-Fielitz et al.; licensee
BioMed Central Ltd.

<14>
Accession Number
2011621841
Authors
Wenaweser P. Pilgrim T. Kadner A. Huber C. Stortecky S. Buellesfeld L.
Khattab A.A. Meuli F. Roth N. Eberle B. Erdos G. Brinks H. Kalesan B.
Meier B. Jni P. Carrel T. Windecker S.
Institution
(Wenaweser, Pilgrim, Stortecky, Buellesfeld, Khattab, Meuli, Roth, Meier,
Windecker) Department of Cardiology, Swiss Cardiovascular Center, Bern
University Hospital, Freiburgstrasse 10, 3010 Bern, Switzerland
(Kadner, Huber, Brinks, Carrel) Department of Cardiovascular Surgery,
Swiss Cardiovascular Center, Bern, Switzerland
(Eberle, Erdos) Department of Anesthesiology, Bern University Hospital,
Bern, Switzerland
(Kalesan, Jni) Institute of Social and Preventive Medicine, Clinical
Trials Unit, Bern University Hospital, Bern, Switzerland
Title
Clinical outcomes of patients with severe aortic stenosis at increased
surgical risk according to treatment modality.
Source
Journal of the American College of Cardiology. 58 (21) (pp 2151-2162),
2011. Date of Publication: 15 Nov 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The aim of this study was to assess the role of transcatheter
aortic valve implantation (TAVI) compared with medical treatment (MT) and
surgical aortic valve replacement (SAVR) in patients with severe aortic
stenosis (AS) at increased surgical risk. Background: Elderly patients
with comorbidities are at considerable risk for SAVR. Methods: Since July
2007, 442 patients with severe AS (age: 81.7 +/- 6.0 years, mean logistic
European System for Cardiac Operative Risk Evaluation: 22.3 +/- 14.6%)
underwent treatment allocation to MT (n = 78), SAVR (n = 107), or TAVI (n
= 257) on the basis of a comprehensive evaluation protocol as part of a
prospective registry. Results: Baseline clinical characteristics were
similar among patients allocated to MT and TAVI, whereas patients
allocated to SAVR were younger (p < 0.001) and had a lower predicted
peri-operative risk (p < 0.001). Unadjusted rates of all-cause mortality
at 30 months were lower for SAVR (22.4%) and TAVI (22.6%) compared with MT
(61.5%, p < 0.001). Adjusted hazard ratios for death were 0.51 (95%
confidence interval: 0.30 to 0.87) for SAVR compared with MT and 0.38 (95%
confidence interval: 0.25 to 0.58) for TAVI compared with MT. Medical
treatment (<0.001), older age (>80 years, p = 0.01), peripheral vascular
disease (<0.001), and atrial fibrillation (p = 0.04) were significantly
associated with all-cause mortality at 30 months in the multivariate
analysis. At 1 year, more patients undergoing SAVR (92.3%) or TAVI (93.2%)
had New York Heart Association functional class I/II as compared with
patients with MT (70.8%, p = 0.003). Conclusions: Among patients with
severe AS with increased surgical risk, SAVR and TAVI improve survival and
symptoms compared with MT. Clinical outcomes of TAVI and SAVR seem similar
among carefully selected patients with severe symptomatic AS at increased
risk. 2011 American College of Cardiology Foundation.

<15>
Accession Number
2011632867
Authors
Zia M.I. Wijeysundera H.C. Tu J.V. Lee D.S. Ko D.T.
Institution
(Zia, Wijeysundera, Tu, Ko) Division of Cardiology, Schulich Heart Center,
Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON,
Canada
(Tu, Lee, Ko) Institute for Clinical Evaluative Sciences, Toronto, ON,
Canada
Title
Percutaneous Coronary Intervention With vs Without On-Site Cardiac Surgery
Backup: A Systematic Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 27 (5) (pp 664.e9-664.e16), 2011. Date
of Publication: September 2011.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
Although the popularity of performing percutaneous coronary intervention
(PCI) in centres without on-site cardiac surgery backup is increasing, the
safety of this practice is unknown. Our goal was to perform a systematic
review and meta-analysis of PCI with and without on-site cardiac surgery
backup. We identified studies using computerized literature searches
through July 2009. Main outcomes of interest included in-hospital
mortality and early coronary artery bypass grafting (CABG). Analyses were
stratified by procedure indication (primary PCI and nonprimary PCI).
Pooled estimates were obtained using random-effects models. We identified
9 primary PCI studies (106,089 patients) and 7 nonprimary studies (910,422
patients) comparing centres with and without on-site cardiac surgery. For
primary PCI, centres without on-site surgery had no significantly
increased risk of in-hospital mortality (odds ratio [OR] 0.93; 95%
confidence interval [CI], 0.83-1.05) or early CABG (OR 0.87; 95% CI,
0.68-1.11) compared with centres with on-site surgery. For nonprimary PCI,
no increased risk of in-hospital mortality (OR 1.03; 95% CI, 0.64-1.66)
and early CABG (OR 1.38; 95% CI, 0.65-2.95) was observed in centres
without backup. However, significant heterogeneity existed in estimates of
nonprimary PCI studies, suggesting substantial variation in outcomes of
nonprimary PCI across centres without on-site cardiac surgery. We
demonstrated that rates of in-hospital mortality and early CABG were
similar at PCI centres with and without on-site cardiac surgery backup.
However, variations in outcomes suggest that assurance of optimal outcomes
at each PCI centre without on-site surgery is needed. 2011 Canadian
Cardiovascular Society.

<16>
Accession Number
70586396
Authors
Faraoni D. Van Der Linden P.
Institution
(Faraoni, Van Der Linden) Department of Anesthesiology, CHU-Brugmann -
HUDERF, Brussels, Belgium
Title
What do we know about the use of tranexamic acid in pediatric cardiac
surgery?.
Source
Transfusion Alternatives in Transfusion Medicine. Conference: 12th Annual
NATA Symposium Dublin Ireland. Conference Start: 20110407 Conference End:
20110408. Conference Publication: (var.pagings). 12 (1) (pp 39), 2011.
Date of Publication: April 2011.
Publisher
Blackwell Publishing
Abstract
Introduction: Tranexamic acid (TXA) is the only available antifibrinolytic
agent in Europe. The efficacy of this agent to reduce blood loss and
transfusion requirement is well established in adults. However, risks,
benefits and doses schemes are not clearly defined in the pediatric
population. Until now, different meta-analysis exist but they include
different antifibrinolytic agents; so far the large variability in
patients studied, procedures, methods, and dosing schemes makes an
analysis of the literature impractical. The goal of our analysis was to
review the actual literature and define our actual knowledge about the use
of TXA in pediatric population. Methods: A systematic search of all
randomized controlled trials using TXA during pediatric cardiac surgery
was conducted. Number of patient, mean age, mean weight, TXA dose and
regimen of administration, cardiopulmonary bypass time, sternal closure
time, volume of blood loss, red blood cell (RBC), fresh frozen plasma
(FFP) and platelet transfusion (PLT) at 24 hour, platelet count and
fibrinogen at 24 hour, type of surgery were extracted from the different
studies and then analyzed. Results: Seven studies were included in our
analysis, and 689 patients were studied (379 in the TXA group, 310 in the
Placebo group). Blood loss (mL/kg) at 24 hour postoperative is too
heterogeneously distributed to be evaluated. TXA reduced significantly the
need for RBC, FFP and PLT transfusion. Placebo was associated with an
increase in the ECC time by about only 2.15 minute (95% CI [-4.17,
-0.12]). Other outcomes were too heterogeneously distributed to be
interpreted. A subgroup analysis evaluates specifically cyanotic and
non-cyanotic patients. In non-cyanotic patients, TXA did not significantly
decrease the perioperative blood loss. In cyanotic patients, the results
were too heterogeneously distributed to be interpreted. Conclusion: The
results of this meta-analysis show that the real benefit of TXA in
reducing blood loss during pediatric cardiac surgery is not clearly
demonstrated. Possible side effects of the use of TXA are poorly reported.
Randomized controlled trials are too heterogeneous to give recommendations
on the systematic use of tranexamic acid. Also, the best dose cannot be
evaluate with this analyze and further studies are needed to explore other
outcomes such as re-exploration, extubation time, side effects, length of
stay in hospital and intensive care unit, and mortality.

<17>
Accession Number
70587273
Authors
Scheeren T.W. Wiesenack C. Gerlach H. Marx G.
Institution
(Scheeren) University Medical Center, Groningen, Netherlands
(Wiesenack) Marienhospital, Gelsenkirchen, Germany
(Gerlach) Vivantes - Klinikum Neukoelln, Berlin, Germany
(Marx) University Hospital RWTH, Aachen, Germany
Title
Goal-directed fluid management based on stroke volume variation and stroke
volume optimization during high-risk surgery: A pilot multicentre
randomized controlled trial.
Source
Critical Care. Conference: 31st International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20110322
Conference End: 20110325. Conference Publication: (var.pagings). 15 (pp
S13), 2011. Date of Publication: 11 Apr 2011.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Perioperative hemodynamic optimization has been shown to be
useful to improve the postoperative outcome of patients undergoing major
surgery. We designed a pilot study in patients undergoing major abdominal,
urologic or vascular surgery to investigate the eff ects of a
goal-directed (GD) fluid management based on continuous stroke volume
variation (SVV) and stroke volume (SV) monitoring on postoperative
outcomes. Methods: Fifty-two high-risk-surgical patients (ASA 3 or 4,
arterial and central venous catheter in place, postoperative admission in
ICU) were randomized either to a control group (Group C, n = 26) or to a
goaldirected group (Group G, n = 26). Patients with cardiac arrhythmia or
ventilated with a tidal volume <7 ml/kg were excluded. In Group G, SVV and
SV were continuously monitored with the FloTrac/Vigileo system (Edwards
Lifesciences, USA) and patients were brought to and maintained on the
plateau of the Frank-Starling curve (SVV <10% and SV increase <10% in
response to fluid loading). During the ICU stay, organ dysfunction was
assessed using the SOFA score and resource utilization using the TISS
score. Patients were followed up to 28 days after surgery for infectious,
cardiac, respiratory, renal, hematologic and abdominal complications.
Results: Group G and Group C were comparable for ASA score, comorbidities,
type and duration of surgery (275 vs. 280 minutes), heart rate, MAP and
CVP at the start of surgery. However, Group G was younger than Group C (68
vs. 73 years, P <0.05). During surgery, Group G received more colloids
than Group C (1,589 vs. 927 ml, P <0.05) and SVV decreased in Group G
(from 9.0 to 8.0%, P <0.05) but not in Group C. The number of
postoperative wound infections was lower in Group G (0 vs. 7, P <0.01).
Although not statistically significant, the proportion of patients with at
least one complication (46 vs. 62%), the number of postoperative
complications per patient (0.65 vs. 1.40), the maximum ICU SOFA score (5.9
vs. 7.2), and the cumulative ICU TISS score (69 vs. 83) were also lower in
Group G. ICU and hospital length of stay were similar in both groups.
Conclusions: Although the two groups were not perfectly matched, this
pilot shows that fluid management based on SVV and SV optimization
decreases wound infections. It also suggests that such a GD strategy may
decrease postoperative organ dysfunction and resource utilization.

<18>
Accession Number
70587245
Authors
Paulus F. Veelo D.P. De Nijs S.B. Bresser P. De Mol B.A. Beenen L.F.
Binnekade J.M. Schultz M.J.
Institution
(Paulus, Veelo, De Nijs, Bresser, De Mol, Beenen, Binnekade, Schultz)
Academic Medical Center, Amsterdam, Netherlands
Title
Manual hyperinflation attenuates reduction of functional residual capacity
in cardiac surgical patients: A randomized controlled trial.
Source
Critical Care. Conference: 31st International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20110322
Conference End: 20110325. Conference Publication: (var.pagings). 15 (pp
S3), 2011. Date of Publication: 11 Apr 2011.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Cardiac surgical patients show deterioration of functional
residual capacity (FRC) after surgery. Manual hyperinflation (MH) aims at
preventing airway plugging, and as such could prevent the reduction of FRC
after surgery. The purpose of this study was to determine the eff ect of
MH on FRC in cardiac surgical patients. Methods: This was a randomized
controlled trial of patients after elective coronary artery bypass graft
and/or valve surgery admitted to the ICU of a university hospital.
Patients were randomly allocated to routine MH strategy (MH within 30
minutes after arrival in the ICU and every 6 hours until tracheal
extubation) or on-demand MH (MH only in cases of perceptible (audible)
sputum in the larger airways or in case of a drop in SpO₂)
during mechanical ventilation. The primary endpoint was the change of FRC
from the day before cardiac surgery to 1, 3, and 5 days after tracheal
extubation. Secondary endpoints were SpO₂, on the same time
points, and chest radiograph abnormalities at day 3. Results: One hundred
patients were enrolled. In the routine MH group FRC decreased to 72% of
the preoperative measurement, versus 59% (Figure Presented) in the
on-demand MH group (P = 0.002). Diff erences in FRC were not longer
statistically significant at day 5 (Figure 1). There were no differences
in SpO₂ between the two groups. Chest radiographs showed more
abnormalities in the on-demand MH group compared with patients in the
routine MH group (P = 0.002). Conclusions: MH attenuates the reduction of
FRC in the first three postoperative days after cardiac surgery.