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<1>
Accession Number
2010391264
Authors
Gorlitzer M. Wagner F. Pfeiffer S. Folkmann S. Meinhart J. Fischlein T.
Reichenspurner H. Grabenwoger M.
Institution
(Gorlitzer, Folkmann, Grabenwoger) Department of Cardiovascular Surgery,
Hospital Hietzing, Wolkersbergenstr. 1, A-1130 Vienna, Austria
(Wagner, Reichenspurner) Department of Cardiovascular Surgery, University
Hospital Hamburg-Eppendorf, Hamburg, Germany
(Pfeiffer, Fischlein) Department of Cardiac Surgery, Heart Center,
Nuernberg, Germany
(Meinhart) Karl Landsteiner Institute for Cardiovascular Surgery Research,
Hospital Hietzing, Vienna, Austria
Title
A prospective randomized multicenter trial shows improvement of sternum
related complications in cardiac surgery with the Posthorax support vest.
Source
Interactive Cardiovascular and Thoracic Surgery. 10 (5) (pp 714-718),
2010. Date of Publication: May 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Sternal instability, dehiscence and mediastinitis are major causes of
morbidity and mortality in cardiac surgery. The aim of this analysis is to
determine the effect of a Posthorax support vest (Epple Inc,
Vienna, Austria) after median sternotomy. One thousand five hundred and
sixty cases were included in a prospective randomized multicenter trial.
Patients were randomized as follows: 905 received a flexible dressing
postoperatively (group A) and 655 patients were given a
Posthorax support vest (group B). Patients in groups A and B
were well matched. Their mean age was 68 years (range: 34-87 years). The
patient characteristics and operative data were equally distributed in
both groups. The mean total hospital stay was significantly shorter in
group B than in group A (A: 17.33 +/- 17.5; B: 14.76 +/- 7.7; P=0.04).
Sternal wound complications necessitating reoperation during the 90 days
follow-up period were observed in 4.5%. Reoperation rates were as follows:
3.9% in group A and 0.6% in group B (P<0.05). The use of the
Posthorax sternum support vest is a valuable adjunct to prevent
sternum-related complications after cardiac surgery. In the 90 days
follow-up period, additional surgical procedures were significantly
reduced by the use of the support vest. 2010 Published by European
Association for Cardio-Thoracic Surgery.

<2>
Accession Number
2010389766
Authors
Bauer T. Mollmann H. Weidinger F. Zeymer U. Seabra-Gomes R. Eberli F.
Serruys P. Vahanian A. Silber S. Wijns W. Hochadel M. Nef H.M. Hamm C.W.
Marco J. Gitt A.K.
Institution
(Bauer, Mollmann, Nef, Hamm) Kerckhoff-Klinik, Kardiologie, Benekestr.
2-8, 61231 Bad Nauheim, Germany
(Weidinger) Krankenhaus Rudolfstiftung, Vienna, Austria
(Zeymer, Hochadel, Gitt) Herzzentrum Ludwigshafen, Institut fur
Herzinfarktforschung Ludwigshafen, Universitat Heidelberg, Ludwigshafen,
Germany
(Seabra-Gomes) Instituto do Coracao, Lisbon, Portugal
(Eberli) Stadtspital Triemli, Zurich, Switzerland
(Serruys) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Vahanian) Bichat Hospital, Paris, France
(Silber) Kardiologische Gemeinschaftspraxis und Praxisklinik, Munich,
Germany
(Wijns) Cardiovascular Center, Aalst, Belgium
(Marco) Centre Cardiothoracique de Monaco, Monaco Cedex, Monaco
Title
Use of platelet glycoprotein IIb/IIIa inhibitors in diabetics undergoing
PCI for non-ST-segment elevation acute coronary syndromes: Impact of
clinical status and procedural characteristics.
Source
Clinical Research in Cardiology. 99 (6) (pp 375-383), 2010. Date of
Publication: June 2010.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Abstract Background The most recent ESC guidelines for percutaneous
coronary intervention (PCI) recommend the use of glycoprotein IIb/IIIa
inhibitors (GPI) in high risk patients with non-ST-segment elevation acute
coronary syndromes (NSTE-ACS), particularly in diabetics. Little is known
about the adherence to these guidelines within Europe. Methods and results
Between May 2005 and April 2008 a total of 47,407 consecutive patients
undergoing PCI were prospectively enrolled into the PCI-Registry of the
Euro Heart Survey Programme. In the present analysis we examined the use
of GPI in 2,922 diabetics who underwent PCI for NSTE-ACS. In this high
risk population only 22.2% received a GPI; 8.9% upstream and 13.4% during
PCI. The strategy of the individual institution had a major impact on the
usage of GPI. In the multiple regression analysis clinical instability and
complex lesion characteristics were strong independent determinants for
the use of GPI, whereas renal insufficiency was negatively associated with
its use. After adjustment for confounding variables no significant
differences in hospital mortality could be observed between the cohorts,
but a significantly higher rate of non-fatal postprocedural myocardial
infarction was observed among patients receiving GPI upstream. Conclusions
Despite the recommendation for its use in the current ESC guidelines, only
a minority of the diabetics in Europe undergoing PCI for NSTE-ACS received
a GPI. The use of GPI was mainly triggered by high-risk interventional
scenarios. The Author(s) 2010.

<3>
Accession Number
2011688242
Authors
Bolognese L. Falsini G. Schwenke C. Grotti S. Limbruno U. Liistro F.
Carrera A. Angioli P. Picchi A. Ducci K. Pierli C.
Institution
(Bolognese, Falsini, Grotti, Liistro, Angioli, Ducci) Department of
Cardiovascular Diseases, San Donato Hospital, Arezzo, Italy
(Schwenke) Sco:ssis Statistical Consulting, Berlin, Germany
(Limbruno, Picchi) Department of Cardiology, Misericordia Hospital,
Grosseto, Italy
(Carrera, Pierli) Cardiovascular Department, University Hospital of Siena,
Siena, Italy
Title
Impact of iso-osmolar versus low-osmolar contrast agents on
contrast-induced nephropathy and tissue reperfusion in unselected patients
with ST-segment elevation myocardial infarction undergoing primary
percutaneous coronary intervention (from the Contrast Media and
Nephrotoxicity Following primary Angioplasty for Acute Myocardial
Infarction [CONTRAST-AMI] trial).
Source
American Journal of Cardiology. 109 (1) (pp 67-74), 2012. Date of
Publication: 01 Jan 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Conflicting data have been reported on the effects of low-osmolar and
iso-osmolar contrast media on contrast-induced acute kidney injury
(CI-AKI). In particular, no clinical trial has yet focused on the effect
of contemporary contrast media on CI-AKI, epicardial flow, and
microcirculatory function in patients with ST-segment elevation acute
myocardial infarction who undergo primary percutaneous coronary
intervention. The Contrast Media and Nephrotoxicity Following Coronary
Revascularization by Angioplasty for Acute Myocardial Infarction
(CONTRAST-AMI) trial is a prospective, randomized, single-blind,
parallel-group, noninferiority study aiming to evaluate the effects of the
low-osmolar contrast medium iopromide compared to the iso-osmolar agent
iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment
elevation acute myocardial infarction. Four hundred seventy-five
consecutive, unselected patients who underwent primary percutaneous
coronary intervention were randomized to iopromide (n = 239) or iodixanol
(n = 236). All patients received high-dose N-acetylcysteine and hydration.
The primary end point was the proportion of patients with serum creatinine
(sCr) increases <25% from baseline to 72 hours. Secondary end points were
Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade,
increase in sCr <50%, increase in sCr <0.5 or <1 mg/dl, and 1-month major
adverse cardiac events. The primary end point occurred in 10% of the
iopromide group and in 13% of the iodixanol group (95% confidence interval
-9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion
grade of 0 or 1 was present in 14% of patients in the 2 groups. No
differences between the 2 groups were found in any of the secondary
analyses of sCr increase. No significant difference in 1-month major
adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a
population of unselected patients with ST-segment elevation acute
myocardial infarction who underwent primary percutaneous coronary
intervention, iopromide was not inferior to iodixanol in the occurrence of
CI-AKI; no significant differences were found in terms of tissue-level
reperfusion and major adverse cardiac events between the 2 contrast
agents. 2012 Elsevier Inc. All rights reserved.

<4>
Accession Number
2011688311
Authors
Schimmer C. Ozkur M. Sinha B. Hain J. Gorski A. Hager B. Leyh R.
Institution
(Schimmer, Ozkur, Gorski, Hager, Leyh) Department for Thoracic, Cardiac
and Thoracic Vascular Surgery, University Hospital of Wurzburg,
Oberdurrbacherstrase 6, 97080 Wurzburg, Germany
(Sinha) Institute of Hygiene and Microbiology, University of Wurzburg,
Germany
(Hain) Department of Mathematics VIII (Statistics), Institute of Medicine,
University of Wurzburg, Germany
Title
Gentamicin-collagen sponge reduces sternal wound complications after heart
surgery: A controlled, prospectively randomized, double-blind study.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (1) (pp 194-200),
2012. Date of Publication: January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Prophylactic retrosternal placement of a gentamicin-collagen
sponge has been the subject of several recent clinical studies and is a
matter of controversy. The present study is the first controlled,
prospective, randomized, double-blind, single-center study to investigate
the efficacy of a retrosternal gentamicin-collagen sponge in reducing
sternal wound complications after heart surgery. Methods: From June 2009
to June 2010, 720 consecutive patients who underwent median sternotomy
were assigned to a control placebo group (collagen sponge) or an
intervention group (gentamicin-collagen sponge). All patients received
guideline-compliant perioperative antibiotic prophylaxis. The primary end
point was the occurrence of deep sternal wound infections within 30 days
of index surgery (follow-up period). Secondary end points were the
occurrence of superficial sternal wound infections requiring treatment, as
well as further clinical parameters, including revision, bleeding volume,
and need for transfusions during the follow-up period. Results: A total of
720 of 994 patients (72.4%) were enrolled (control group: n = 367 vs
intervention group: n = 353). Risk factors for sternal wound infection and
demographic variables were comparable in the 2 groups. The incidence of
deep sternal wound infections was 13 of 367 (3.52%) in the control group
versus 2 of 353 (0.56%) in the intervention group (P = .014; adjusted odds
ratio, 0.15; 95% confidence interval, 0.02-0.69). The numbers needed to
treat relation for all sternal wound infections and deep sternal wound
infections were 26 and 33, respectively. No statistically significant
differences were demonstrated concerning secondary end points, such as
postoperative bleeding and transfusion of red cell units, thrombocytes,
and fresh-frozen plasma. Conclusions: Routine prophylactic retrosternal
use of a gentamicin-collagen sponge in patients undergoing cardiac surgery
significantly reduces deep sternal wound infections. 2012 by The American
Association for Thoracic Surgery.

<5>
Accession Number
2011688337
Authors
Pompeo E. Rogliani P. Tacconi F. Dauri M. Saltini C. Novelli G. Mineo T.C.
Institution
(Pompeo, Tacconi, Mineo) Department of Thoracic Surgery, Policlinico Tor
Vergata University, Rome, Italy
(Rogliani, Saltini) Department of Pneumology, Policlinico Tor Vergata
University, Rome, Italy
(Dauri) Department of Anesthesiology and Intensive Care, Policlinico Tor
Vergata University, Rome, Italy
(Novelli) Department of Biopathology and Diagnostic Imaging, Policlinico
Tor Vergata University, Rome, Italy
Title
Randomized comparison of awake nonresectional versus nonawake resectional
lung volume reduction surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (1) (pp 47-54), 2012.
Date of Publication: January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The study objective was to assess in a randomized controlled
study (NCT00566839) the comparative results of awake nonresectional or
nonawake resectional lung volume reduction surgery. Method: Sixty-three
patients were randomly assigned by computer to receive unilateral
video-assisted thoracic surgery lung volume reduction surgery by a
nonresectional technique performed through epidural anesthesia in 32 awake
patients (awake group) or the standard resectional technique performed
through general anesthesia in 31 patients (control group). Primary
outcomes were hospital stay and changes in forced expiratory volume in 1
second. During follow-up, the need of contralateral treatment because of
loss of postoperative benefit was considered a failure event as death.
Results: Intergroup comparisons (awake vs control) showed no difference in
gender, age, and body mass index. Hospital stay was shorter in the awake
group (6 vs 7.5 days, P = .04) with 21 versus 10 patients discharged
within 6 days (P = .01). At 6 months, forced expiratory volume in 1 second
improved significantly in both study groups (0.28 vs 0.29 L) with no
intergroup difference (P = .79). In both groups, forced expiratory volume
in 1 second improvements lasted more than 24 months. At 36 months, freedom
from contralateral treatment was 55% versus 50% (P = .5) and survival was
81% versus 87% (P = .5). Conclusions: In this randomized study, awake
nonresectional lung volume reduction surgery resulted in significantly
shorter hospital stay than the nonawake procedure. There were no
differences between study groups in physiologic improvements, freedom from
contralateral treatment, and survival. We speculate that compared with the
nonawake procedure, awake lung volume reduction surgery can offer similar
clinical benefit but a faster postoperative recovery. 2012 by The
American Association for Thoracic Surgery.

<6>
Accession Number
2011688312
Authors
Kim A.W. Boffa D.J. Wang Z. Detterbeck F.C.
Institution
(Kim, Boffa, Detterbeck) Section of Thoracic Surgery, Yale University,
School of Medicine, 330 Cedar St, BB 205, New Haven, CT 06520, United
States
(Wang) Department of Epidemiology and Public Health, School of Public
Health, Yale University, New Haven, CT, United States
Title
An analysis, systematic review, and meta-analysis of the perioperative
mortality after neoadjuvant therapy and pneumonectomy for non-small cell
lung cancer.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (1) (pp 55-63), 2012.
Date of Publication: January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Pneumonectomy after neoadjuvant therapy remains controversial.
Methods: A systematic PubMed search was performed for original articles
from 1990 through 2010 describing pneumonectomy after neoadjuvant therapy.
Specific data on 30-day and 90-day perioperative mortalities were
abstracted from these articles. Meta-analysis compared 30-day mortality
between right and left pneumonectomy with a fixed-effects model.
Comparison between 30-day and 90-day mortalities was also performed.
Results: The search strategy yielded 27 studies. Overall, 30-day and
90-day perioperative mortalities were 7% and 12%, respectively. Among 15
studies providing side-specific 30-day mortality, cumulative mortalities
were 11% and 5% for right and left pneumonectomies, respectively. In the
meta-analysis that included 10 studies, 30-day mortality for right
pneumonectomy remained greater than for left pneumonectomy (odds ratio,
1.97; 95% confidence interval, 1.11-3.49; P = .02). Among 6 studies
providing side-specific 90-day mortality, cumulative mortalities were 20%
and 9% for right and left pneumonectomies, respectively. In the
meta-analysis that included 4 studies, 90-day mortality for right
pneumonectomy was greater than for left pneumonectomy (odds ratio, 2.01;
95% confidence interval, 1.09-3.72; P = .03). Among 11 studies providing
both 30-day and 90-day mortalities, mortality difference was 5% (95%
confidence interval, 4%-7%, P < .0001). Pulmonary complications were the
most common cause of 30-day and 90-day deaths. Conclusions: Right
pneumonectomy is associated with significantly higher 30-day and 90-day
mortalities after neoadjuvant therapy than left pneumonectomy. Also,
90-day mortality for all pneumonectomies appears to be greater than
expected, suggesting that the 30-day mortality figure may inadequately
assess the perioperative mortality. 2012 by The American Association for
Thoracic Surgery.

<7>
Accession Number
2011687376
Authors
Kottenberg E. Thielmann M. Bergmann L. Heine T. Jakob H. Heusch G. Peters
J.
Institution
(Kottenberg, Bergmann, Heine, Peters) Klinik fur Anasthesiologie und
Intensivmedizin, Universitat Duisburg-Essen, Universitatsklinikum Essen,
Hufelandstr. 55, D-4511 Essen, Germany
(Thielmann, Jakob) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Universitat Duisburg-Essen, Universitatsklinikum Essen, Essen, Germany
(Heusch) Institut fur Pathophysiologie, Universitat Duisburg-Essen,
Universitatsklinikum Essen, Essen, Germany
Title
Protection by remote ischemic preconditioning during coronary artery
bypass graft surgery with isoflurane but not propofol - A clinical trial.
Source
Acta Anaesthesiologica Scandinavica. 56 (1) (pp 30-38), 2012. Date of
Publication: January 2012.
Publisher
Blackwell Munksgaard (1 Rosenorns Alle, P.O. Box 227, Copenhagen V
DK-1502, Denmark)
Abstract
Background Remote ischemic preconditioning (RIPC) of the myocardium by
limb ischemia/reperfusion may mitigate cardiac damage, but its interaction
with the anesthetic regimen is unknown. We tested whether RIPC is
associated with differential effects depending on background anesthesia.
Specifically, we hypothesized that RIPC during isoflurane anesthesia
attenuates myocardial injury in patients undergoing coronary artery bypass
graft (CABG) surgery, and that effects may be different during propofol
anesthesia. Methods In a randomized, single-blinded, placebo-controlled
prospective study, serum troponin I concentration (cTnI) (baseline, and 1,
6, 12, 24, 48, and 72 h postoperatively) were measured during
isoflurane/sufentanil or propofol/sufentanil anesthesia with or without
RIPC (three 5-min periods of intermittent left upper arm ischemia with 5
min reperfusion each) in non-diabetic patients (n = 72) with three-vessel
coronary artery disease (NCT01406678). Results RIPC during isoflurane
anesthesia (n = 20) decreased the area under the cTnI time curve (cTnI
AUC) (-50%, 190 +/- 105 ng/ml x 72 h vs. 383 +/- 262 ng/ml x 72 h, P =
0.004), and the peak (7.3 +/- 3.6 ng/ml vs. 11.8 +/- 5.5, P = 0.004) and
serial (P < 0.041) postoperative cTnI when compared to isoflurane alone (n
= 19). In contrast, RIPC during propofol anesthesia (n = 14) did not alter
the cTnI AUC [263 +/- 157 ng/ml x 72 h vs. 372 +/- 376 ng/ml x 72 h (n =
19), P = 0.318] or peak postoperative cTnI (10.1 +/- 4.5 ng/ml vs. 12 +/-
8.2, P = 0.444). None of the patients experienced harm or side effects
from the intermittent left arm ischemia. Conclusion Thus, RIPC during
isoflurane but not during propofol anesthesia decreased myocardial damage
in patients undergoing CABG surgery. Accordingly, effects of RIPC evoked
by upper limb ischemia/reperfusion depend on background anesthesia, with
combined RIPC/isoflurane exerting greater beneficial effects under
conditions studied. 2011 The Authors Acta Anaesthesiologica Scandinavica.

<8>
Accession Number
2011687478
Authors
Diercks D.B. Peacock IV W.F. Hollander J.E. Singer A.J. Birkhahn R.
Shapiro N. Glynn T. Nowack R. Safdar B. Miller C.D. Lewandrowski E.
Nagurney J.T.
Institution
(Diercks) University of California, Davis, Sacramento, CA, United States
(Peacock IV) Cleveland Clinic, Cleveland, OH, United States
(Hollander) University of Pennsylvania, Philadelphia, PA, United States
(Singer) Stony Brook University and Medical Center, Stony Brook, NY,
United States
(Birkhahn) New York Methodist Hospital, Brooklyn, NY, United States
(Shapiro) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Glynn) Ingham Regional Medical Center, Lansing, MT, United States
(Diercks, Peacock IV, Hollander, Singer, Birkhahn, Shapiro, Glynn, Nowack,
Safdar, Miller, Lewandrowski, Nagurney) Henry Ford Medical Center,
Detroit, MI, United States
(Nowack, Safdar) Yale University, New Haven, CT, United States
(Miller) Wake Forest University Health Sciences, Winston-Salem, NC, United
States
(Lewandrowski, Nagurney) Massachusetts General Hospital, Boston, MA,
United States
Title
Diagnostic accuracy of a point-of-care troponin i assay for acute
myocardial infarction within 3 hours after presentation in early
presenters to the emergency department with chest pain.
Source
American Heart Journal. 163 (1) (pp 74-80.e4), 2012. Date of
Publication: January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Guidelines recommend that serial cardiac marker testing to
rule out acute myocardial infarction (AMI) be performed for 8 to 12 hours
after symptom onset. We aim to determine the diagnostic accuracy of a
contemporary point-of-care (POC) troponin I (TnI) assay within 3 hours for
patients presenting within 8 hours of symptom onset. Methods: The MIDAS
study collected blood from patients presenting with suspected acute
coronary syndrome at presentation and at 90 minutes, 3 hours, and 6 hours
in whom the emergency physician planned an objective cardiac ischemia
evaluation. Criterion standard diagnoses were adjudicated by experienced
clinicians using all available medical records per American Heart
Association/American College of Cardiology criteria. Reviewers were
blinded to the investigational marker, Cardio3 TnI POC. The Cardio3 TnI
reference value was defined as >0.05 ng/mL. Measures of diagnostic
accuracy are presented with 95% CI. Results: A total of 858 of 1107
patients met the inclusion criteria. The study cohort had 476 men (55.5%)
with median age of 57.0 years (interquartile range 48.0-67.0 years).
Median time from symptom onset to initial blood draw was 3.9 hours
(interquartile range 2.7-5.2 hours). Acute myocardial infarction was
diagnosed in 82 patients (9.6%). The sensitivity, specificity, positive
likelihood ratio, and negative likelihood ratio over 3 hours were 84.1,
93.4, 12.8, and 0.17, respectively. There was no significant improvement
in diagnostic accuracy associated with adding 6-hour serial testing to the
3-hour sample. Conclusion: In suspected patients with acute coronary
syndrome presenting to the emergency department within 8 hours of symptom
onset, 3 hours of serial testing with the Cardio3 TnI POC platform
provides similar diagnostic accuracy for AMI as longer periods. 2012
Mosby, Inc. All rights reserved.

<9>
Accession Number
2011687477
Authors
Lamy A. Devereaux P.J. Prabhakaran D. Hu S. Piegas L.S. Straka Z. Paolasso
E. Taggart D. Lanas F. Akar A.R. Jain A. Noiseux N. Ou Y. Chrolavicius S.
Ng J. Yusuf S.
Institution
(Lamy, Devereaux, Yusuf) Population Health Research Institute, Hamilton
Health Sciences, McMaster University, Hamilton, Canada
(Prabhakaran) National Coordination Office, Center for Chronic Disease
Control and COE CARRS, Public Health Foundation of India, New Delhi, India
(Hu) Fuwai Hospital, Beijing, China
(Piegas) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Straka) Third Faculty of Medicine, Charles University, Prague, Czech
Republic
(Paolasso) Instituto de Investigaciones Clinicas de Rosario (IICR),
Rosario, Argentina
(Taggart) University of Oxford, Oxford, United Kingdom
(Lanas) Universidad de la Frontera, Temuco, Chile
(Akar) Ankara University School of Medicine, Ankara University Stem Cell
Institute, Ankara, Turkey
(Jain) SAL Hospital and Medical Institute, Ahmedabad, India
(Noiseux) Centre Hospitalier Universitaire de Montreal (CHUM), Montreal,
Canada
(Ou, Chrolavicius, Ng) Population Health Research Institute, Hamilton,
Canada
Title
Rationale and design of the coronary artery bypass grafting surgery off or
on pump revascularization study: A large international randomized trial in
cardiac surgery.
Source
American Heart Journal. 163 (1) (pp 1-6), 2012. Date of Publication:
January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Uncertainty remains regarding the benefits and risks of the
technique of operating on a beating heart (off pump) for coronary artery
bypass grafting (CABG) surgery versus on-pump CABG. Prior trials had few
events and relatively short follow-up. There is a need for a large
randomized, controlled trial with long-term follow-up to inform both the
short- and long-term impact of the 2 approaches to CABG. Methods: We plan
to randomize 4,700 patients in whom CABG is planned to undergo the
procedure on pump or off pump. The coprimary outcomes are a composite of
total mortality, myocardial infarction (MI), stroke, and renal failure at
30 days and a composite of total mortality, MI, stroke, renal failure, and
repeat revascularization at 5 years. We will also undertake a
cost-effectiveness analysis at 30 days and 5 years after CABG surgery.
Other outcomes include neurocognitive dysfunction, recurrence of angina,
cardiovascular mortality, blood transfusions, and quality of life.
Results: As of May 3, 2011, CORONARY has recruited >3,884 patients from 79
centers in 19 countries. Currently, patient's mean age is 67.6 years,
80.7% are men, 47.0% have a history of diabetes, 51.4% have a history of
smoking, and 34.4% had a previous MI. In addition, 20.9% of patients have
a left main disease, and 96.6% have double or triple vessel disease.
Conclusions: CORONARY is the largest trial yet conducted comparing
off-pump CABG to on-pump CABG. Its results will lead to a better
understanding of the safety and efficacy of off-pump CABG. 2012 Mosby,
Inc. All rights reserved.

<10>
Accession Number
2011687473
Authors
Lamas G.A. Goertz C. Boineau R. Mark D.B. Rozema T. Nahin R.L. Drisko J.A.
Lee K.L.
Institution
(Lamas) Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL
33140, United States
(Goertz) Palmer Center for Chiropractic Research, Davenport, IA, United
States
(Boineau) National Heart, Lung, and Blood Institute, Bethesda, MD, United
States
(Mark, Lee) Duke Clinical Research Institute, Durham, NC, United States
(Rozema) Biogenesis Medical Center, Landrum, SC, United States
(Nahin) National Center for Complementary and Alternative Medicine,
Bethesda, MD, United States
(Drisko) Integrative Medicine, University of Kansas Medical Center, Kansas
City, KS, United States
Title
Design of the Trial to Assess Chelation Therapy (TACT).
Source
American Heart Journal. 163 (1) (pp 7-12), 2012. Date of Publication:
January 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
TACT is an National Institutes of Health-sponsored, randomized,
double-blind, placebo-controlled, 2 x 2 factorial clinical trial testing
the benefits and risks of 40 infusions of a multicomponent disodium EDTA
chelation solution compared with placebo and of an oral, high-dose
multivitamin and mineral supplement. TACT has randomized and will follow
up 1,708 patients for an average of approximately 4 years. The primary end
point is a composite of all-cause mortality, myocardial infarction,
stroke, coronary revascularization, and hospitalization for angina. A
900-patient substudy will examine quality-of-life outcomes. The trial is
designed to have >85% power to detect a 25% relative reduction in the
primary end point for each treatment factor. Enrollment began in September
2003 and was completed in October 2010. 2012 Mosby, Inc. All rights
reserved.

<11>
Accession Number
2011687355
Authors
Carvalho A.R. Ichinose F. Schettino I.A. Hess D. Rojas J. Giannella-Neto
A. Agnihotri A. Walker J. MacGillivray T.E. Vidal Melo M.F.
Institution
(Carvalho) Laboratory of Respiration Physiology, Carlos Chagas Filho
Institute of Biophysics, Rio de Janeiro, Brazil
(Ichinose, Schettino, Hess, Rojas, Vidal Melo) Department of Anesthesia,
Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard
Medical School, 55 Fruit St, Boston, MA 02114, United States
(Agnihotri, Walker, MacGillivray) Department of Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Giannella-Neto) Biomedical Engineering Program, Federal University of Rio
de Janeiro, Rio de Janeiro, Brazil
Title
Tidal lung recruitment and exhaled nitric oxide during coronary artery
bypass grafting in patients with and without chronic obstructive pulmonary
disease.
Source
Lung. 189 (6) (pp 499-509), 2011. Date of Publication: December 2011.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Background: We studied the occurrence of intraoperative tidal alveolar
recruitment/derecruitment, exhaled nitric oxide (eNO), and lung
dysfunction in patients with and without chronic obstructive pulmonary
disease (COPD) undergoing coronary artery bypass grafting (CABG). Methods:
We performed a prospective observational physiological study at a
university hospital. Respiratory mechanics, shunt, and eNO were assessed
in moderate COPD patients undergoing on-pump (n = 12) and off-pump (n = 8)
CABG and on-pump controls (n = 8) before sternotomy (baseline), after
sternotomy and before cardiopulmonary bypass (CPB), and following CPB
before and after chest closure. Respiratory system resistance (R
_rs), elastance (E _rs), and stress index (to quantify
tidal recruitment) were estimated using regression analysis. eNO was
measured with chemiluminescence. Results: Mechanical evidence of tidal
recruitment/derecruitment (stress index <1.0) was observed in all
patients, with stress index <0.8 in 29% of measurements. Rrs in on-pump
COPD was larger than in controls (p < 0.05). Ers increased in controls
from baseline to end of surgery (19.4 +/- 5.5 to 27.0 +/- 8.5 ml cm
H₂O ^-1, p < 0.01), associated with increased shunt
(p < 0.05). Neither Ers nor shunt increased significantly in the COPD
on-pump group. eNO was comparable in the control (11.7 +/- 7.0 ppb) and
COPD on-pump (9.9 +/- 6.8 ppb) groups at baseline, and decreased similarly
by 29% at end of surgery(p < 0.05). Changes in eNO were not correlated to
changes in lung function. Conclusions: Tidal recruitment/derecruitment
occurs frequently during CABG and represents a risk for
ventilator-associated lung injury. eNO changes are consistent with small
airway injury, including that from tidal recruitment injury. However,
those changes are not correlated with respiratory dysfunction. Controls
have higher susceptibility to develop complete lung derecruitment. 2011
Springer Science+Business Media, LLC.

<12>
Accession Number
2011692441
Authors
Cho Y.-R. Kim Y.-D. Park T.-H. Park K. Baek H. Choi S.-Y. Kim K.-S. Hong
T.-J. Yang T.-H. Hwang J.-Y. Park J.-S. Hur S.-H. Lee S.-G.
Institution
(Cho, Kim, Park, Park, Park, Baek) Department of Internal Medicine, Dong-A
University College of Medicine, Busan, South Korea
(Cho, Kim, Park, Park, Park, Baek, Choi) Department of Cardiovascular
Center, Dong-A University Hospital, Busan, South Korea
(Kim) Department of Internal Medicine, Daegu Catholic University College
of Medicine, Daegu, South Korea
(Hong) Department of Internal Medicine, Pusan National University College
of Medicine, Busan, South Korea
(Yang) Department of Internal Medicine, Inje University College of
Medicine, Pusan Paik Hospital, Busan, South Korea
(Hwang) Department of Internal Medicine, Gyeongsang National University
College of Medicine, Jinju, South Korea
(Park) Department of Internal Medicine, Yeungnam University College of
Medicine, Daegu, South Korea
(Hur) Department of Internal Medicine, Keimyung University College of
Medicine, Deagu, South Korea
(Lee) Department of Internal Medicine, Ulsan University College of
Medicine, Ulsan, South Korea
Title
The impact of dose of the angiotensin-receptor blocker valsartan on the
post-myocardial infarction ventricular remodeling: Study protocol for a
randomized controlled trial.
Source
Trials. 12 , 2011. Article Number: 247. Date of Publication: 22 Nov
2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Angiotensin-converting enzyme inhibitors and the
angiotensin-receptor blocker valsartan ameliorate ventricular remodeling
after myocardial infarction (MI). Based on previous clinical trials, a
maximum clinical dose is recommended in practical guidelines. Yet, has not
been clearly demonstrated whether the recommended dose is more efficacious
compared to the lower dose that is commonly used in clinical
practice.Method/Design: Valsartan in post-MI remodeling (VALID) is a
randomized, open-label, single-blinded multicenter study designed to
compare the efficacy of different clinical dose of valsartan on the
post-MI ventricular remodeling. This study also aims to assess
neurohormone change and clinical parameters of patients during the
post-infarct period. A total of 1116 patients with left ventricular
dysfunction following the first episode of acute ST-elevation MI are to be
enrolled and randomized to a maximal tolerable dose (up to 320 mg/day) or
usual dose (80 mg/day) of valsartan for 12 months in 2:1 ratio.
Echocardiographic analysis for quantifying post-MI ventricular remodeling
is to be conducted in central core laboratory. Clinical assessment and
laboratory test are performed at fixed times.Discussion: VALID is a
multicenter collaborative study to evaluate the impact of dose of
valsartan on the post-MI ventricular remodeling. The results of the study
provide information about optimal dosing of the drug in the management of
patients after MI. The results will be available by 2012.Trial
registration: NCT01340326. 2011 Cho et al; licensee BioMed Central Ltd.

<13>
Accession Number
2011697676
Authors
Girasis C. Garg S. Rber L. Sarno G. Morel M.-A. Garcia-Garcia H.M. Lscher
T.F. Serruys P.W. Windecker S.
Institution
(Girasis, Garg, Rber, Sarno, Serruys) Department of Interventional
Cardiology Thoraxcenter, Erasmus Medical Center, Ba-583, 's Gravendijkwal
230, 3015, Rotterdam, Netherlands
(Rber, Windecker) Department of Cardiology, Bern University Hospital,
Bern, Switzerland
(Morel, Garcia-Garcia) Cardialysis B.V., Rotterdam, Netherlands
(Lscher) Department of Cardiology, Zurich University Hospital, Zurich,
Switzerland
Title
SYNTAX score and Clinical SYNTAX score as predictors of very long-term
clinical outcomes in patients undergoing percutaneous coronary
interventions: A substudy of SIRolimus-eluting stent compared with
pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial.
Source
European Heart Journal. 32 (24) (pp 3115-3127), 2011. Date of
Publication: December 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims To investigate the ability of SYNTAX score and Clinical SYNTAX score
(CSS) to predict very long-term outcomes in an all-comers population
receiving drug-eluting stents. Methods and resultsThe SYNTAX score was
retrospectively calculated in 848 patients enrolled in the
SIRolimus-eluting stent compared with pacliTAXel-Eluting Stent for
coronary revascularization (SIRTAX) trial. The CSS was calculated using
age, and baseline left ventricular ejection fraction and creatinine
clearance. A stratified post hoc comparison was performed for all-cause
mortality, cardiac death, myocardial infarction (MI), ischaemia-driven
target lesion revascularization (TLR), definite stent thrombosis, and
major adverse cardiac events (MACE) at 1- and 5-year follow-up. Tertiles
for SYNTAX score and CSS were defined as SSLOW <=7, 7< SSMID <=14, SSHIGH
>14 and CSSLOW <=8.0, 8.0 <CSSMID <=17.0 and CSSHIGH >17.0, respectively.
Major adverse cardiac events rates were significantly higher in SSHIGH
compared with SSLOW at 1- and 5-year follow-up, which was also seen at 5
years for all-cause mortality, cardiac death, MI, and TLR. Stratifying
outcomes across CSS tertiles confirmed and augmented these results. Within
CSSHIGH, 5-year MACE increased with use of paclitaxel- compared with
sirolimus-eluting stents (34.7 vs. 21.3, P 0.008). SYNTAX score and CSS
were independent predictors of 5-year MACE; CSS was an independent
predictor for 5-year mortality. Areas-under-the-curve for SYNTAX score and
CSS for 5-year MACE were 0.61 (0.560.65) and 0.62 (0.570.67), for 5-year
all-cause mortality 0.58 (0.510.65) and 0.66 (0.590.73) and for 5-year
cardiac death 0.63 (0.540.72) and 0.72 (0.630.81),
respectively.ConclusionSYNTAX score and to a greater extent CSS were able
to stratify risk for very long-term adverse clinical outcomes in an
all-comers population receiving drug-eluting stents. Predictive accuracy
for 5-year all-cause mortality was improved using CSS.Trial Registration
Number: NCT00297661. Published on behalf of the European Society of
Cardiology. The Author 2011.

<14>
[Use Link to view the full text]
Accession Number
2011688137
Authors
Gersh B.J. Maron B.J. Bonow R.O. Dearani J.A. Fifer M.A. Link M.S. Naidu
S.S. Nishimura R.A. Ommen S.R. Rakowski H. Seidman C.E. Towbin J.A.
Udelson J.E. Yancy C.W.
Title
2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic
cardiomyopathy: Executive summary: A report of the American College of
cardiology foundation/American heart association task force on practice
guidelines.
Source
Circulation. 124 (24) (pp 2761-2796), 2011. Date of Publication: 13 Dec
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<15>
Accession Number
2011691094
Authors
Singh M. Holmes Jr. D.R. Dehmer G.J. Lennon R.J. Wharton T.P. Kutcher M.A.
Aversano T. Rihal C.S.
Institution
(Singh, Holmes Jr., Rihal) Division of Cardiovascular Diseases, Mayo
Clinic, 200 First St SW, Rochester, MN 55905, United States
(Lennon) Division of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Dehmer) Division of Cardiology, Scott and White Healthcare, Temple, TX,
United States
(Wharton) Cardiovascular Medicine, Exeter Hospital, Exeter, NH, United
States
(Kutcher) Department of Cardiology, Wake Forest University Baptist Medical
Center, Winston-Salem, NC, United States
(Aversano) Department of Cardiology, Johns Hopkins Hospital, Baltimore,
MD, United States
Title
Percutaneous coronary intervention at centers with and without on-site
surgery: A meta-analysis.
Source
JAMA - Journal of the American Medical Association. 306 (22) (pp
2487-2494), 2011. Date of Publication: 14 Dec 2011.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Percutaneous coronary interventions are performed at centers
without onsite surgery, despite current guidelines discouraging this.
Objective: To assess literature comparing rates of in-hospital mortality
and emergency coronary artery bypass grafting surgery at centers with and
without on-site surgery. Data Sources: A systematic search of studies
published between January 1990 and May 2010 was conducted using MEDLINE,
EMBASE, and Cochrane Review databases. Study Selection: English-language
studies of percutaneous coronary intervention performed at centers with
and without on-site surgery providing data on in-hospital mortality and
emergency bypass were identified. Two study authors independently reviewed
the 1029 articles originally identified and selected 40 for analysis. Data
Extraction: Study title, time period, indication for angioplasty, and
outcomes were extracted manually from all selected studies, and quality of
each study was assessed using the strengthening the reporting of
observational studies in epidemiology (STROBE) checklist. Data Synthesis:
High-quality studies of percutaneous coronary interventions performed at
centers with and without on-site surgery were included. Pooled-effect
estimates were calculated with random-effects models. Analyses of primary
percutaneous coronary intervention for ST-segment elevation myocardial
infarction of 124 074 patients demonstrated no increase in in-hospital
mortality (no on-site surgery vs on-site surgery: observed risk, 4.6% vs
7.2%; odds ratio [OR], 0.96; 95% CI, 0.88-1.05; I² = 0%) or
emergency bypass (observed risk, 0.22% vs 1.03%; OR, 0.53; 95% CI,
0.35-0.79; I² = 20%) at centers without on-site surgery. For
nonprimary percutaneous coronary interventions (elective and urgent, n =
914 288), the rates of in-hospital mortality (observed risk, 1.4% vs 2.1%;
OR, 1.15; 95% CI, 0.93-1.41; I² = 46%) and emergency bypass
(observed risk, 0.17% vs 0.29%; OR, 1.21; 95% CI, 0.52-2.85; I
² = 5%) were not significantly different at centers without or
with on-site surgery. Conclusion: Percutaneous coronary interventions
performed at centers without onsite surgery, compared with centers with
on-site surgery, were not associated with a higher incidence of
in-hospital mortality or emergency bypass surgery. 2011 American Medical
Association. All rights reserved.

<16>
Accession Number
2011679035
Authors
Drover D.R. Schmiesing C. Buchin A.F. Ortega H.R. Tanner J.W. Atkins J.H.
MacArio A.
Institution
(Drover, Schmiesing, Buchin, MacArio) Department of Anesthesia, Stanford
University, 300 Pasteur Drive, Stanford, CA 94305-5640, United States
(Ortega) ICAD Inc., Nashua, NH, United States
(Tanner, Atkins) University of Pennsylvania School of Medicine,
Philadelphia, PA, United States
Title
Titration of sevoflurane in elderly patients: Blinded, randomized clinical
trial, in non-cardiac surgery after beta-adrenergic blockade.
Source
Journal of Clinical Monitoring and Computing. 25 (3) (pp 175-181), 2011.
Date of Publication: June 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Background. Monitoring depth of anesthesia via the processed
electroencephalogram (EEG) has been found useful in reducing the amount of
anesthetic drugs, optimizing wake-up times, and, in some studies, reducing
awareness. Our goal was to determine if titrating sevoflurane as the
maintenance anesthetic to a depth of anesthesia monitor (SEDLine, Masimo,
CA) would shorten time to extubation in elderly patients undergoing
noncardiac surgery while on beta-adrenergic blockade. This patient
population was selected because the usual cardiovascular signs of
inadequate general anesthesia may be masked by beta-blocker therapy.
Methods. Surgical patients older than 65 years of age receiving
beta-adrenergic blockers for a minimum of 24 h preoperatively were
randomized to two groups: a group whose titration of sevoflurane was based
on SEDLine data (SEDLine group) and a group whose titration was based on
usual clinical criteria (control group) where SEDLine data were concealed.
The primary endpoint was time from skin closure to time to extubation.
Aldrete score, White Fast Track score and QoR-40 were also assessed.
Results. There was no significant difference in time to extubation [12.5
(SD 7.4) min in the control group versus 13.0 (SD 5.9) min for the
treatment group]. The control group used more fentanyl [339 mcg (SD 205)]
than did the treatment group [238 mcg (SD 123)] (P<0.02). There was no
difference in sevoflurane utilization, Aldrete, White Fast Track scores,
time toPACUdischarge, or QoR-40 assessments between the groups.
Conclusion. Use of the SEDLine monitor's data to titrate sevoflurane did
not improve the time to extubation or change short-term outcome of
geriatric surgical patients receiving beta-adrenergic blockers.
(ClinicalTrials.gov number, NCT00938782). Springer 2011.

<17>
Accession Number
2011693890
Authors
Matsuo S. Yamane T. Date T. Hioki M. Narui R. Ito K. Tanigawa S.-I. Nakane
T. Yamashita S. Tokuda M. Inada K. Nojiri A. Kawai M. Sugimoto K.-I.
Yoshimura M.
Institution
(Matsuo, Yamane, Date, Hioki, Narui, Ito, Tanigawa, Nakane, Yamashita,
Tokuda, Inada, Nojiri, Kawai, Sugimoto, Yoshimura) Department of
Cardiology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi,
Minato-ku, Tokyo 105-8461, Japan
Title
Completion of mitral isthmus ablation using a steerable sheath:
Prospective randomized comparison with a nonsteerable sheath.
Source
Journal of Cardiovascular Electrophysiology. 22 (12) (pp 1331-1338),
2011. Date of Publication: December 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Although mitral isthmus (MI) ablation in atrial fibrillation
(AF) patients has been shown to be an effective ablative strategy, the
establishment of the bidirectional conduction block of the MI is
technically challenging. We investigated the usefulness of a steerable
sheath for MI ablation in patients with persistent AF and its impact on
the clinical outcome of persistent AF ablation. Methods: A total of 80
consecutive patients undergoing MI ablation were randomized to 1 of the
following 2 groups: group S (using a steerable long sheath) or group NS
(using a nonsteerable long sheath). MI ablation was performed by using an
open-irrigated ablation catheter with the guidance of a 3-dimensional
mapping system. The endpoint of the MI ablation was the achievement of a
bidirectional block. Results: Bidirectional block through the MI was
achieved in 87.5% (70/80) of patients with 14.0 +/- 6.7 minutes of
radiofrequency application. The bidirectional block was more frequently
achieved in patients in group S compared to group NS (97.5% (39/40) vs
77.5% (31/40), P = 0.02). Additionally, epicardial ablation within the
coronary sinus was less frequently required in group S compared to group
NS (12.5% (5/40) vs 72.5% (29/40), P < 0.0001). Atrial tachycardia after
the procedure more frequently occurred in the patients in whom MI block
had not been achieved during the initial procedure (40.0% (4/10) vs 10.0%
(7/70), P = 0.04). Conclusions: The MI block could be achieved in the
majority of patients by using a steerable sheath. An incomplete MI block
increased the risk of AT following persistent AF ablation. 2011 Wiley
Periodicals, Inc.

<18>
Accession Number
2011682118
Authors
Gray R.M. Nagendran M. Maruthappu M.
Institution
(Gray) St. John's College, University of Oxford, St. Giles, Oxford, United
Kingdom
(Nagendran, Maruthappu) Green Templeton College, University of Oxford,
Oxford, United Kingdom
Title
Is it safe to stop anticoagulants after successful surgery for atrial
fibrillation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 642-649),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was: is it safe to stop
anticoagulants after successful surgery for atrial fibrillation?
Altogether, 177 papers were found using the reported search, of which 14
were selected that represented the best evidence to answer the clinical
question. Selection criteria included study relevance, primary outcome,
size of study population and length of follow-up. The authors, journal,
date and country of publication, patient group studied, study type,
relevant outcomes and results of these papers are tabulated. The weight of
evidence, including over 10,000 patient-years of follow-up, supports the
discontinuation of warfarin following atrial fibrillation correction
procedures as being safe, with an associated annual thromboembolic stroke
rate of 0-3.8% off warfarin, in studies where warfarin was stopped at a
mean of 3.6 months (range 0-8 months) after the procedure. However, the
confidence of this conclusion suffers from a paucity of high-quality
randomized controlled trials in the field, with the main body of evidence
coming instead from observational non-randomized studies. The stroke rate
also varies with the exact procedure performed; pulmonary vein isolation
procedures are the most extensively evaluated and carry the lowest stroke
rate following warfarin discontinuation (0-0.4% per annum when performed
as an isolated procedure). By contrast, left atrial appendage occlusion by
insertion of a transcatheter device has an associated annual stroke rate
of 0-3.8% off warfarin. Thus, discontinuation of warfarin following such
transcatheter procedures cannot be recommended at this time. Concomitant
heart surgeries, such as mitral valve repair have been shown to increase
the thromboembolic rate both unpredictably and dramatically, and this
review thus identifies concomitant mitral valve surgery as a potentially
substantial risk factor for late thromboembolic stroke in patients
undergoing corrective surgeries for atrial fibrillation. This review finds
in favour of warfarin discontinuation in selected patients at three months
post-procedure, emphasizing consideration of the patient's individual
risk-factor profile as paramount. This recommendation is in line with the
2010 guidelines for the management of atrial fibrillation produced by the
European Society of Cardiology. 2011 Published by European Association for
Cardio-Thoracic Surgery. All rights reserved.

<19>
Accession Number
2011682117
Authors
Sunderland N. Nagendran M. Maruthappu M.
Institution
(Sunderland) St Hugh's College, University of Oxford, St Margaret's Road,
Oxford, OX2 6LE, United Kingdom
(Nagendran, Maruthappu) Green Templeton College, University of Oxford,
Oxford, OX2 6H6, United Kingdom
Title
In patients with an enlarged left atrium does left atrial size reduction
improve maze surgery success?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 635-641),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was: In [adults undergoing a
maze procedure for Atrial Fibrillation (AF)], [does Left Atrial size
reduction] compared to [maze surgery alone] improve [maze surgery
success]? A total of 58 papers were found using the reported search, of
which eight represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group
studied, study type, relevant outcomes and results of these papers are
tabulated. Four out of eight papers compared a volume reduction technique
as an adjunct to the maze procedure to a maze procedure alone - all four
papers reported that atrial volume reduction significantly increased
restoration of sinus rhythm: 89.3% vs. 67.2%, P<0.001; 85% vs. 68%,
P<0.05; 84% vs. 68%, P<0.05; 90% vs. 69%, P<0.05. Three out of eight
papers had no control group but reported good rates of sinus rhythm
restoration at last follow-up - 90%, 92% and 89%, respectively - despite
the study population including atrial enlargement, a risk factor for
failure of a maze procedure. One paper reported no benefit of an atrial
reduction plasty in patients with a left atrium (LA) >70mm. An enlarged LA
is a risk factor for failure of a maze procedure, and various models of AF
suggest that reducing atrial mass and/or diameter may help to abolish the
re-entry circuits underlying AF. Furthermore, AF is uncommon when left
atrial diameter is <40mm, so there is at least some physiological basis
for atrial reduction surgery in aiding the success of a maze procedure.
The evidence suggests that patients with an enlarged (>=55mm) or giant
(>=75mm) LA who are at risk of failing to obtain sinus conversion after a
standard maze procedure may derive benefit from concomitant atrial
reduction surgery using either a tissue excision or a tissue plication
technique. However, the evidence is not strong since the papers available
are not readily comparable owing to substantial variations in the
populations and procedures involved. We therefore, emphasise the need for
prospective randomised studies in this area. 2011 Published by European
Association for Cardio-Thoracic Surgery. All rights reserved.

<20>
Accession Number
2011682116
Authors
Olland A. Falcoz P.-E. Kessler R. Massard G.
Institution
(Olland, Falcoz, Kessler, Massard) Strasbourg Lung Transplantation Team,
University Hospital, Strasbourg, France
(Olland, Falcoz, Massard) Department of Thoracic Surgery, University
Hospital, Strasbourg, France
(Kessler) Department of Pneumology, University Hospital, Strasbourg,
France
Title
Should cystic fibrosis patients infected with Burkholderia cepacia complex
be listed for lung transplantation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 631-634),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether lung transplantation remained a
beneficial treatment for cystic fibrosis (CF) patients infected or
colonized with Burkholderia cepacia complex (BCC) prior to lung
transplantation (LTx). Of the 25 papers found using a report search, five
presented the best evidence to answer the clinical question. The authors,
journal, date and country of publication, study type, group studied,
relevant outcomes and results of these papers are given. We conclude that,
on the whole, the five studies were clearly in favor of maintaining access
to LTx lists for BCC infected or colonized CF patients. In other words,
access to LTx should not be denied to BCC infected CF patients in that the
beneficial effects of LTx do not differ with respect to non-infected
patients: comparison showed neither a difference in survival nor a higher
mortality risk. However, results would differ for Burkholderia cenocepacia
infected CF patients prior to LTx: both short-and long-term survival are
significantly lower when B. cenocepacia infected patients are compared to
other BCC infected patients or non-infected patients. Hence, current
evidence shows that careful screening of all BCC suspected CF patients and
risk-aware multidisciplinary management should be achieved before listing
patients for LTx. This would allow identification of different bacterial
species (in particular, B. cenocepacia) present and optimize lung
transplantation survival outcomes. 2011 Published by European Association
for Cardio-Thoracic Surgery. All rights reserved.

<21>
Accession Number
2011682115
Authors
Sepehripour A.H. Jarral O.A. Shipolini A.R. McCormack D.J.
Institution
(Sepehripour) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Southmoor Road, Manchester M23 9LT, United Kingdom
(Jarral, Shipolini, McCormack) Department of Cardiothoracic Surgery, The
London Chest Hospital, Bonner Road, London E2 9JX, United Kingdom
Title
Does a 'no-touch' technique result in better vein patency?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 626-630),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether harvesting the saphenous vein (SV) as a
conduit for coronary artery bypass grafting (CABG) using a no-touch
technique would result in better patency rates. This technique involves
the harvest of the SV with a pedicle of peri-vascular tissue left intact
and the avoidance of distension of the vein prior to anastomosis. A total
of 405 papers were found using the reported searches of which eight
represented the best evidence to answer the clinical question. The
authors, date, journal, study type, population, main outcome measures and
results are tabulated. The studies found analysed the ultrastructural and
mechanical properties of the endothelium and vessel walls of the two
harvesting techniques; the protein and enzymatic expression and activity
observed; the early atherosclerotic changes detected; and the overall
patency of the grafts during short-and long-term angiographical follow-up.
Three small prospectively randomised studies compared the patency of
grafts harvested using the two techniques and found significant
improvements in graft patency using the no-touch harvesting technique in
comparison to both the conventional technique and more importantly
comparable to the left internal thoracic artery (LITA) patency. The most
favourable difference was that of graft patency after 8.5 years of
follow-up [90% vs. 76% (P=0.01), LITA patency 90%], and incidence of graft
stenosis [11% vs. 25% (P=0.006)]. These findings were supported by the
demonstrated improvements in the cellular integrity of the vessels and the
reduction in the mechanisms leading to graft failure seen in the no-touch
harvested SV grafts. These morphological and cellular analyses were
carried by five small comparative studies, demonstrating improved
endothelial integrity and reduced injury, decelerated atherosclerotic
processes, intact adventitial collagen layers, increase in the total area
of vasa vasorum, elevated endothelial nitric oxide synthase expression and
activity, and increased peri-vascular leptin levels and activity. We
conclude that there are clear enhancements in vessel wall properties at a
cellular level and angiographical evidence of superior graft patency when
the no-touch SV harvesting technique is employed. 2011 Published by
European Association for Cardio-Thoracic Surgery. All rights reserved.

<22>
Accession Number
2011682109
Authors
Marcucci G. Siani A. Accrocca F. Gabrielli R. Giordano A. Antonelli R.
Sbroscia A. Mounayergi F.
Institution
(Marcucci, Siani, Accrocca, Gabrielli, Giordano, Antonelli) Unit of
Vascular and Endovascular Surgery, San Paolo Hospital, Civitavecchia,
Rome, Italy
(Sbroscia) Unit of Anesthesia and Intensive Care, San Paolo Hospital,
Civitavecchia, Rome, Italy
(Mounayergi) Unit of Anesthesia and Intensive Care, European Hospital,
Rome, Italy
Title
Preserved consciousness in general anesthesia during carotid
endarterectomy: A six-year experience.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 601-605),
2011. Date of Publication: December 2011.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: We prospectively evaluated safety and efficacy from our
six-year results of general anesthesia (GA) using remifentanil conscious
sedation in carotid endarterectomy (CEA). Methods: From January 2005 to
December 2010, 625 consecutive CEAs were performed on 545 patients
(male/female 336/209, age 75+/-7years). After a superficial plexus block
with ropavacaine, GA was induced with an intravenous infusion of propofol,
using local lidocaine during tracheal intubation and a high-dose of
remifentanil, in all cases reducing and then stopping the remifentanil
infusion at the clamping time so that the patient would be awake and
collaborating within a few minutes, as in local anesthesia. Data on
postoperative morbidity and mortality, neurological complications, shunt
insertions and the responses to one-day and three-month questionnaires on
satisfaction were collected for all patients. Results: The 30-day
mortality was 0.32% (two patients). Only one major stroke (0.16%) and two
minor strokes (0.32%) occurred. A shunt was deployed in 83 cases (13.3%).
Eight patients (1.28%) reported cranial nerve injuries, and surgical
drainage for postoperative hematoma was performed in 11 patients (1.8%).
Thirty-one patients (4.6%) suffered postoperative nausea/vomiting. Almost
all patients were satisfied at the 24-h (94.6%) and three-month (>98%)
follow-up questionnaire. Conclusions: The six-year results for GA using
remifentanil conscious sedation were very satisfactory and highlighted the
advantages of both GA (hemodynamic stability and excellent control of
ventilation) and local anesthesia (ease of evaluation of neurological
status) in a calm and relaxed environment for both patient and surgeon.
2011 Published by European Association for Cardio-Thoracic Surgery. All
rights reserved.

<23>
Accession Number
2011626757
Authors
Phrommintikul A. Kuanprasert S. Wongcharoen W.
Institution
(Phrommintikul) Chiang Mai University, Chiang Mai, Thailand
Title
Influenza vaccination reduced cardiovascular events in patients
hospitalized with an acute coronary syndrome.
Source
Annals of Internal Medicine. 155 (10) (pp JC5-5), 2011. Date of
Publication: 20111115.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<24>
Accession Number
2011626751
Authors
Baigent C. Landray M.J. Reith C.
Institution
(Baigent) Clinical Trial Service Unit, Epidemiological Studies Unit
(CTSU), Oxford, England, United Kingdom
Title
Simvastatin plus ezetimibe reduced major atherosclerotic events in
patients with chronic kidney disease.
Source
Annals of Internal Medicine. 155 (10) (pp JC5-2), 2011. Date of
Publication: 20111115.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<25>
Accession Number
2011680664
Authors
Duvall W.L. Croft L.B. Ginsberg E.S. Einstein A.J. Guma K.A. George T.
Henzlova M.J.
Institution
(Duvall, Croft, Guma, George, Henzlova) Mount Sinai Division of Cardiology
(Mount Sinai Heart), Columbia University Medical Center, Mount Sinai
Medical Center, Box 1030, One Gustave L Levy Place, New York, NY 10029,
United States
(Ginsberg) Mount Sinai Department of Medicine, Division of Cardiology,
Department of Medicine, United States
(Einstein) Mount Sinai Medical Center, Division of Cardiology, Department
of Medicine, New York, NY, United States
Title
Reduced isotope dose and imaging time with a high-efficiency CZT SPECT
camera.
Source
Journal of Nuclear Cardiology. 18 (5) (pp 847-857), 2011. Date of
Publication: October 2011.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Background. In light of recent focus on diagnostic imaging, cardiac SPECT
imaging needs to become a shorter test with lower radiation exposure to
patients. Recently introduced Cadmium Zinc Telluride (CZT) cameras have
the potential to achieve both goals. Methods. During a 2-month period
patients presenting for a Tc-99m sestamibi SPECT MPI study were imaged
using a CZT camera using a low-dose rest-stress protocol (5 mCi rest and
15 mCi stress doses). Patients >=250 lbs or a BMI >=35 kg/m²
were excluded. Rest images were processed at 5- and 8-minute acquisition
times and stress images at 3- and 5-minute acquisition times. A subset of
patients had stress imaging performed using both conventional and CZT
SPECT cameras. Image acquisition times and SPECT camera images were
compared based on total counts, count rate, image quality, and summed rest
and stress scores. Twelve month clinical follow-up was also obtained.
Results. 131 patients underwent the study protocol (age 64.9 +/- 9.8
years, 54.2% male). There was no significant difference in image quality
and mean summed scores between 5- and 8- minute rest images and between 3-
and 5-minute stress images. When compared to a conventional SPECT camera
in 27 patients, total rest and stress perfusion deficits and calculated
LVEF were similar (r 5 0.94 and 0.96, respectively). At 12 months there
was a benign prognosis in patients with normal perfusion. The effective
dose was 5.8 mSv for this protocol which is 49.2% less than conventional
Tc-99m studies and 75.7% less than conventional Tl-201/Tc- 99m dual
isotope studies. Conclusions. New SPECT camera technology with low isotope
dose significantly reduces ionizing radiation exposure and imaging times
compared to traditional protocols while maintaining image quality and
diagnostic accuracy. (J Nucl Cardiol 2011;18:847-57.) 2011 American
Society of Nuclear Cardiology.

<26>
Accession Number
70614333
Authors
Pham C. Monagle P. Cameron F. Kantor S. Newall F.
Institution
(Pham, Monagle) Department of Paediatrics, University of Melbourne,
Australia
(Cameron, Kantor) Department of Endocrinology, Australia
(Newall) Department of Clinical Haematology, Royal Children's Hospital
Melbourne, Australia
Title
Comparison of bone mineral density in post-fontan children: Aspirin vs.
warfarin.
Source
Journal of Thrombosis and Haemostasis. Conference: 23rd Congress of the
International Society on Thrombosis and Haemostasis 57th Annual SSC
Meeting Kyoto Japan. Conference Start: 20110723 Conference End: 20110728.
Conference Publication: (var.pagings). 9 (pp 642), 2011. Date of
Publication: July 2011.
Publisher
Blackwell Publishing Ltd
Abstract
Warfarin is a commonly used vitamin K antagonist anticoagulant.
Bone-forming proteins also require vitamin K as an essential cofactor for
carboxylation and biologic activity. Long-term warfarin therapy has been
associated with reduced bone mineral density (BMD) and increased fracture
risk. This is of particular significance in children where bone accrual is
vital to achieve adequate peak bone mass in adulthood and reduce the risk
of osteoporosis and fractures. This effect of warfarin on BMD remains
uncertain; warfarin subjects have historically been compared to healthy
controls, so possibly the underlying condition is providing a confounding
effect on BMD. This is the first study to investigate warfarin's unique
contribution to BMD in a cohort of children with the same underlying
disease. In this follow-up study of a previous randomised controlled trial
(RCT), the BMD of children managed on warfarin vs. aspirin following
Fon-tan surgery for congenital heart disease was compared. As some aspirin
cases have since changed onto warfarin, an 'Intention to Treat' and a
'True' analysis were performed.

<27>
Accession Number
70620818
Authors
Gada H. Kapadia S.R. Tuzcu E.M. Svensson L.G. Marwick T.H.
Institution
(Gada, Kapadia, Tuzcu, Svensson, Marwick) Cardiovascular Medicine,
Cleveland Clinic, Cleveland, OH, United States
Title
Transcatheter valve replacement is a cost-effective alternative to
conventional surgery in selected high-risk patients.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transfemoral transcatheter aortic valve replacement (TAVR) is
cost-effective for management of severe aortic stenosis (AS) in patients
with unacceptable risk for aortic valve replacement (AVR). However, the
relative cost-effectiveness of TAVR and tissue AVR is ill-defined in
high-risk patients where surgery is an option. We developed a Markov model
to inform the choice between transfemoral TAVR and AVR in high-risk
patients. Methods: A Markov model was developed to examine the progression
of patients between health states, defined as peri- and post-procedural,
post-complication, and death. The mean and variance of risks, transition
probabilities, utilities and cost of TAVR and AVR were derived from
meta-analysis of relevant registries, studies and trials. Outcome and cost
were derived from 10,000 simulations. Sensitivity analyses were based on
the likelihood of mortality, stroke, and other commonly observed outcomes.
Further analyses evaluated situations thought to favor tissue AVR or TAVR.
Results: In the reference case (age 80, peri-operative mortality of
transfemoral TAVR and AVR 5.8 vs 9.1%, annual mortality 22.2 vs 22.5%),
the utility of TAVR was greater than AVR (1.71 vs 1.64 QALY). As the cost
of TAVR was greater than AVR ($26,176 vs $19,361), the incremental
cost-effectiveness ratio (ICER) was $97,357/QALY. In sensitivity analyses,
variations in stroke, peri-operative and annual mortality are the main
drivers of variation in health outcomes. The current risk profile of
transfemoral TAVR offered net health benefits when peri-operative AVR
mortality was >5.2%, or stroke post-TAVR was <11.3% (Figure). In a
scenario analysis based only on operable PARTNER patients (Cohort A),
QALYs for TAVR and AVR were 1.69 and 1.63, with an ICER of $70,633/QALY.
Conclusion: TAVR may provide net health benefits at acceptable cost in
selected high-risk patients among whom AVR is the current procedure of
choice.

<28>
Accession Number
70620705
Authors
Samad F. Hakeem A. Kim J. Bhatti S. Mohamed A.W. Arif I. Leesar M. Helmy
T.
Institution
(Samad) Internal Medicine, Univ. of Medicine and Dentistry of New Jersey,
Newark, NJ, United States
(Hakeem, Kim, Bhatti, Mohamed, Arif, Leesar, Helmy) Cardiology, Univ. of
Cincinnati, Cincinnati, OH, United States
Title
Comparative effectiveness of PCI versus CABG for unprotected left main
stenosis-meta analysis of randomzed controlled trials.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background The established mode of revascularization for unprotected left
main disease is coronary artery bypass grafting (CABG). Percutaneous
coronary intervention (PCI) has been increasingly utilized as a viable
alternate. Objectives We sought to evaluate the comparative effectiveness
of PCI vs. CABG for left main disease by collating the evidence from four
published randomized controlled trials. Data Sources Pubmed, Cochrane
Register of Controlled Trials, conference proceedings, and internet-based
resources of clinical trials. Study Selection Randomized trials comparing
PCI vs. CABG for unprotected left main disease evaluating the outcomes of
interest [death, myocardial infarction (MI), stroke, revascularization and
their composite (MACE) were included. Results Four randomized trials
including 1611 participants (809 in PCI arm and 802 in CABG arm) formed
the data set. There was no significant difference in the two groups with
regards to baseline characteristics. The weighted mean age was 64 years
with 70% men and 32% diabetics. The mean SYNTAX score was 26 in both
groups. During a mean follow up of 15 months, the incidence of death was
3% in the PCI arm and 4.2% in the CABG arm [RR 0.75 (0.45, 1.25); p=0.27]
.Similarly, there was no difference in the incidence of MI [RR 1(0.57,
1.75); p=0.99] or MACE [RR 1.1 (0.8, 1.5); p=0.26]. PCI was associated
with a significant reduction in the risk of stroke [0.2% vs. 1.7%; RR
0.22(0.06, 0.76);p=0.02] but a higher risk of revascularization.[RR
2.09(1.49,2.92);p<0.001].There was no heterogeneity found amongst the
trials for these endpoints (I2=0%). Conclusion This meta analysis of
randomized studies demonstrates the safety and efficacy of PCI compared to
CABG for left main disease. While there was no difference in mortality, MI
or MACE, PCI confered an advantage of significant reduction in the risk of
stroke which was balanced by a higher rate of downstream
revascularization. PCI could hence be considered a viable option in
selected patients.

<29>
Accession Number
70620703
Authors
Alam M. Shahzad S.A. Huang H.D. Chiang I.-H. Paniagua D. Kar B. Ramanathan
K.B. Shah A.R. Kleiman N.S. Jneid H.M.
Institution
(Alam, Huang, Chiang) Medicine, Section of Cardiology, Baylor College of
Medicine, Houston, TX, United States
(Shahzad) Critical Care, Al-Noor Specialist Hosp., Makkah, Saudi Arabia
(Paniagua, Kar, Jneid) Medicine, Section of Cardiology, Baylor College of
Medicine, Michael E. DeBakey VA Med. Cntr., Houston, TX, United States
(Ramanathan) Medicine, Section of Cardiology, Univ. of Tennessee Health
Sciences Cntr., Memphis, TN, United States
(Shah) Medicine, Section of Cardiology, Methodist DeBakey Heart and
Vascular Cntr., Houston, TX, United States
(Kleiman) Medicine, Section of Cardiology, Weill Cornell Med. College,
Methodist DeBakey Heart and Vascular Cntr., Houston, TX, United States
Title
Percutaneous coronary intervention with drug-eluting stents versus
coronary artery bypass graft surgery for unprotected left main coronary
artery stenosis: A meta-analysis of randomized clinical trials.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients with unprotected left main coronary artery (ULMCA)
stenosis are increasingly treated with PCI using DES. However, there is
paucity of long-term data from randomized clinical trials comparing PCI
with DES vs. CABG for ULMCA stenosis. Methods: We performed aggregate data
meta-analyses of clinical outcomes from randomized studies comparing PCI
with DES vs. CABG for ULMCA stenosis & reporting at least 12 months of
follow-up. A search of Medline & conference proceedings between 01/2003
and 04/2011 identified 4 studies (1,611 patients; PCI = 809 & CABG = 802).
Death, non-fatal myocardial infarction (MI), stroke, repeat
revascularization, MACCE (death, MI, repeat revascularization or stroke)
and composite safety outcome of death, MI or stroke were extracted at
30-days, 12-months, 24-months & 36-months. Summary odds ratios & 95%
confidence intervals were calculated using random-effects model. Results:
No major inter-group differences in baseline socio-demographic, clinical &
angiographic characteristics were observed. Compared with their CABG
counterparts, patients in the PCI arm had shorter Hospital stay (11.5 vs.
4.7 days, P < 0.05), and experienced a lower incidence of stroke at
30-days (OR 0.2, 95% CI 0.04 - 0.8), 12-months (OR 0.2, 95% CI 0.04 - 0.6)
and 24-months (OR 0.3, 95% CI 0.1 - 0.8). PCI was associated with a higher
incidence of repeat revascularization at 12-months (OR 2.2, 95% CI 1.5 -
3.2), 24-months (OR 2.0, 95% CI 1.4 - 2.8) and 36-months (OR 2.0, 95% CI
1.3 - 2.9). Both groups had comparable death, MI, MACCE and the composite
safety outcomes at follow-up (Table I). Conclusions: In randomized
clinical trials, revascularization of ULMCA stenosis with PCI using DES is
associated with a shorter Hospital stay, reduced rate of stroke but an
increased rate of repeat revascularization compared to CABG. Both
revascularization strategies had comparable mortality, MI, and MACCE
outcomes at intered.iate term follow-up.

<30>
Accession Number
70620506
Authors
Gemignani A.S. Kapoor M. Cohen S. Sharma S.C. Choudhary G. Wu W.-C.
Institution
(Gemignani, Cohen, Sharma, Choudhary, Wu) Cardiology, Providence VA Med.
Cntr., Brown Univ., Providence, RI, United States
(Kapoor) Internal Medicine, Rhode Island Hosp., Brown Univ., Providence,
RI, United States
Title
Preoperative renin-angiotensin system inhibitor use is associated with
worse clinical outcomes following cardiovascular surgery: Results of a
meta-analysis.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Use of renin-angiotensin system (RAS) inhibitors (ACE
inhibitors and ARBs) prior to cardiovascular surgery is common yet
controversial. RAS inhibitor use has the potential risks of hypotension
and kidney injury and the potential benefits of reduced cardiac ischemia
and arrhythmia. There is no consensus in the published literature
regarding the perioperative risk/benefit of RAS inhibitor use. Hence we
sought to evaluate the association between preoperative RAS inhibitor use
and postoperative mortality, acute kidney injury (AKI) and atrial
fibrillation (AF) by performing a systematic meta-analysis. Methods: We
included all randomized-controlled and observational studies with at least
2 weeks of RAS inhibitor use prior to cardiovascular surgery, and presence
of a control group, that reported mortality, AKI or AF as outcomes.
Studies prior to February 2011 identified from MEDLINE, Cochrane and NIH
databases were included in the analysis. Sensitivity analysis was
conducted based on trial design and ventricular function. We used the
Mantel-Haenszel fixed effect model for pooling the study results, a random
effects model was used for heterogeneous samples/results. Results: Of 310
published studies, we identified 14 studies (n=37145, mean age 65, 75%
male, LVEF range 52-61%) that met criteria for analysis. RAS inhibitor use
prior to cardiac surgery was 42% in our study population. In the pooled
analysis, preoperative use of RAS inhibitors was found to be associated
with increased postoperative mortality and AKI, but not AF (table).
Sensitivity analysis was consistent with the overall findings. Conclusion:
Use of RAS inhibitors prior to cardiac surgery is associated with
increased likelihood of postoperative mortality and AKI and not protective
against AF. It remains to be determined if preoperative discontinuation of
RAS inhibitors results in improved clinical outcomes.

<31>
Accession Number
70620456
Authors
Goto S.-N. Takagi H.
Institution
(Goto, Takagi) Cardiovascular Surgery, Shizuoka Med. Cntr., Sunto-gun,
Japan
Title
Lower survival after drug-eluting stents than coronary artery bypass
grafting for unprotected left main and/or multivessel disease: A
meta-analysis of randomized trials and risk-adjusted observational
comparative studies.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Backgrounds: Previous meta-analyses of raw data from randomized trials and
observational comparative studies have demonstrated no significant
difference in survival between drug-eluting stents (DES) and coronary
artery bypass grafting (CABG) for patients with unprotected left main
(ULMD) and/or multivesssel disease (MVD) (double-vessel [2VD] and
triple-vessel disease [3VD]). Raw data from observational studies,
however, are unadjusted and susceptible to confounding. Methods: To
attempt to control for confounding in observational studies, we performed
a meta-analysis of randomized trials and risk-adjusted observational
comparative studies (providing adjusted hazard ratios [HRs] using
propensity score and/or multivariate Cox proportional hazards regression
analyses) of DES versus CABG for survival in patients with ULMD and/or
MVD. Study-specific estimates were combined in a random-effects model.
Results: Our comprehensive search identified 3 randomized trials and 21
risk-adjusted observational comparative studies. Pooled analysis of 32 HRs
for all-cause death from all studies (36,574 patients) demonstrated a
significantly higher mortality with DES than CABG (HR, 1.22; 95%
confidence interval [CI], 1.04-1.42; P=0.01). Exclusion of any single HR
from the analysis did not substantively alter the overall results of our
analysis. When data were pooled separately in MVD (both 2VD and
3VD)-studies (31,325 patients) and ULMD-studies (4,214 patients), DES were
associated with a significantly higher mortality than CABG for MVD (HR,
1.34; 95% CI, 1.11-1.61; P=0.002), not for ULMD (HR, 0.93; 95% CI,
0.69-1.25; P=0.74). Separately pooled analysis of 3VD-studies (14,196
patients) and 2VD-studies (15,137 patients) demonstrated a significantly
higher mortality with DES than CABG for 3VD (HR, 1.49; 95% CI, 1.17-1.89;
P=0.001), not for 2VD (HR, 1.25; 95% CI, 0.82-1.89; P=0.29). Conclusions:
The present meta-analysis of randomized trials and risk-adjusted
observational comparative studies suggests that DES are associated with
lower survival than CABG for high-risk (ULMD and/or MVD) patients, mainly
due to lower survival for patients with 3VD.

<32>
Accession Number
70620450
Authors
Jang J.-S. Chung S.-R. Jin H.-Y. Seo J.-S. Yang T.-H. Park B. Kim D.-K.
Kim K.-H. Seol S.-H. Kim D.-I. Kim D.-S.
Institution
(Jang, Chung, Jin, Seo, Yang, Kim, Kim) Cardiology, Inje Univ., Busan Paik
Hosp., Busan, South Korea
(Park, Kim, Kim, Seol, Kim) Cardiology, Inje Univ., Haeundae Paik Hosp.,
Busan, South Korea
Title
Comparison between drug-eluting stents and coronary artery bypass grafting
for unprotected left main coronary artery disease: A pooled analysis of
three randomized trials and six observational studies.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The clinical outcomes for unprotected left main coronary
artery (ULMCA) disease between coronary artery bypass grafting (CABG) and
drug-eluting stents (DES) remain controversial. The objective of this
study was to compare the safety and efficacy of percutaneous coronary
intervention (PCI) using DES with CABG in patients with ULMCA disease.
Methods: Databases were searched for clinical studies that reported
outcomes after PCI with DES and CABG for the treatment of ULMCA disease.
The end points of this meta-analysis were mortality; the composite of
death, myocardial infarction, or stroke; and target vessel
revascularization at 1-year follow-up. The pooled effects were calculated
using fixed-effects model (Mantel-Haenszel method) or random effects
models (Dersimonian and Laird method). Results: Nine clinical studies (3
randomized trials and 6 observational studies) with 4,989 patients were
involved in this study. At 1-year follow-up, there was no significant
difference between the DES and CABG groups in the risk for death (odds
ratio [OR] 0.78, 95% confidence interval [CI] 0.49 to 1.23, p=0.29) or the
composite end point of death, myocardial infarction, or stroke (OR 0.79,
95% CI 0.62 to 1.02, p=0.07). Target vessel revascularization was
significantly higher in the DES group compared to the CABG group (OR 3.01,
95% CI 2.33 to 3.88, p<0.001). Conclusions: Our meta-analysis indicates
that there are no significant differences in the safety between DES and
CABG for the treatment of ULMCA disease. In selected cases with ULMCA
disease, PCI with DES is emerging as a good alternative.

<33>
Accession Number
70618838
Authors
Pilbrow A.P. Pearson J.F. McNoe L. Ellis K.L. Black M.A. Sweet W.E. Wilson
Tang W.H. Troughton R.W. Richards A.M. Moravec C.S. Cameron V.A.
Institution
(Pilbrow, Ellis, Troughton, Richards, Cameron) Medicine, Univ. of Otago
Christchurch, Christchurch, New Zealand
(Pearson) Public Health and General Practice, Univ. of Otago Christchurch,
Christchurch, New Zealand
(McNoe, Black) Biochemistry, Univ. of Otago, Dunedin, New Zealand
(Sweet, Wilson Tang, Moravec) Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
Title
Chromosome 1Q41 and 3Q22.3 coronary artery disease risk loci are
associated with altered cardiac gene expression profiles in normal and
Diseased Heart.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Meta-analyses of genome-wide association studies have confirmed
association of chromosomal loci 1q41 and 3q22.3 with coronary artery
disease (CAD). Although these loci are located in close proximity to the
melanoma inhibitory activity family, member 3 gene (MIA3) for 1q41
(rs17465637) and muscle RAS gene (MRAS) for 3q22.3 (rs9818870), the
mechanisms underlying these associations are unclear. To understand
pathways by which these loci might influence CAD risk, we investigated
associations between genotype and global gene expression in heart tissue
from 110 heart-transplant patients and 108 donors (no diagnosed heart
disease). Genotyping was performed with Taqman assays and gene expression
profiles generated with Affymetrix microarrays. Associations were analyzed
with additive (1q41) or recessive (3q22.3) models and unadjusted p-values
have been reported. In patients, the 1q41 minor (protective) allele was
associated with less previous history of myocardial infarction (p=0.001)
and with altered expression of 781 genes (p<0.05), whilst 2971 genes were
altered in donors (p<0.05) including MIA3 (+1.07-fold, p=0.008).
Differentially expressed genes with 1q41 were enriched for immune response
pathways in patients (p=3.2x10-8) and donors (p=2.1x10-8) and for
cytoskeleton remodeling (p=3.5x10-13) and cell adhesion (p=5.0x10-8)
processes in donors only, consistent with a reported role of MIA3 in
reducing monocyte adhesion. Having two copies of the 3q22.3 minor (risk)
allele was associated in patients with lower cardiac output (p=0.037),
higher systemic vascular resistance (p=0.022) and with altered expression
of 622 genes, (p<0.05), with 622 genes also altered in donors (p<0.05)
including MRAS (+1.58-fold, p=0.0009). Genes differentially expressed
between 3q22.3 genotypes were enriched for cell adhesion and muscle
contraction processes in patients (p=1.3x10-4, p=1.1x10-2 respectively)
and donors (p=5.8x10-5, p=8.2x10-5 respectively), and formed regulatory
networks with MRAS. A subset of genes was altered in both patients and
donors (1q41, 159 genes; 3q22.3, 36 genes). These data suggest that
networks of genes may be altered in association with 1q41 and 3q22.3 in
heart, both before and after disease onset, and may influence risk of CAD.

<34>
Accession Number
70618604
Authors
Langkilde A.M. Sugg J. Johannson P. Ying L. List J. Parikh S.
Institution
(Langkilde) R and D, Astra Zeneca, Molndal, Sweden
(Sugg) Clinical Science, Astra Zeneca, Wilmington, DE, United States
(Johannson) R and D, Astra Zeneca, Sodertalje, Sweden
(Ying) Global Biometric Science, Bristol-Myers Squibb, Hopewell, NJ,
United States
(List) Rsch. and Development, Bristol-Myers Squibb, Princeton, NJ, United
States
(Parikh) Clinical Development, Cardiovascular, Astra Zeneca, Wilmington,
DE, United States
Title
A meta-analysis of cardiovascular outcomes in clinical trials of
dapagliflozin.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of
cardiovascular (CV) disease. Dapagliflozin (DAPA), a selective SGLT2
inhibitor, is currently under evaluation for the treatment of T2DM. DAPA
reduces hyperglycemia by promoting renal glucose excretion, independent of
insulin secretion or action, also reducing weight and blood pressure. In
response to FDA recommendations for new T2DM therapies, a pre-specified
meta-analysis was conducted of data from 14 phase 2/3 studies (n=6228) to
assess the CV safety of all DAPA doses (2.5 to >10mg/d) pooled (n=4287),
relative to all comparators (active or placebo) pooled (n=1941). CV events
were systematically identified from investigator reports of adverse events
and adjudicated by an independent committee. Adjudication was blinded to
treatment allocation and conducted prospectively for the majority of
trials. The primary end point was a composite of time to first event of CV
death, myocardial infarction (MI), stroke, or hospitalization for unstable
angina. The secondary end point included the primary end point, unplanned
coronary revascularization, and hospitalization for heart failure.
Baseline characteristics were balanced between groups: mean age=56 years,
body mass index=31.5 kg/m², and T2DM duration=6 years.
Characteristics mirrored CV risk in the general T2DM population and
included hypertension (62%), dyslipidemia (49%), smoking history (40%),
and CV disease history (19%). A total of 78 primary end point events were
confirmed with a stratified event rate (subjects with events/1000 subject
years) of 11.3 for DAPA vs 16.6 for comparators. The estimated hazard
ratio (HR) using a Cox proportional hazards method was 0.674 (98% CI:
0.385, 1.178; 95% CI: 0.421, 1.078). Analyses of the secondary end point
(HR: 0.632; 95% CI: 0.416, 0.959) and of a composite CV death, MI, and
stroke end point (HR: 0.596; 95% CI: 0.357, 0.996) were consistent with
primary results. Analyses by dose (DAPA 2.5, 5 and 10 mg) were comparable
to overall results. Review of data from the 4-month safety update
confirmed the conclusions from the initial pre-specified analysis. The
results suggest that DAPA is not associated with an increase in CV risk,
and are consistent with a potential reduction in CV risk.

<35>
Accession Number
70618327
Authors
Magnus P.C. Chaisson K. Kramer R.S. Ross C.S. Boss R.A. Agha S.A. Helm
R.E. Horton S.R. Hofmaster P. Westbrook B.M. Duquette D. Quinn R.D. Russo
L. Jones C. Brown J.R. Malenka D.J.
Institution
(Magnus, Agha, Malenka) Cardiology, Dartmouth-Hitchcock Med. Cntr,
Lebanon, NH, United States
(Chaisson) Cardiovascular Services, Concord Hosp, Concord, NH, United
States
(Kramer, Quinn) Cardiothoracic Surgery, Maine Med. Cntr, Portland, ME,
United States
(Ross, Brown) Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth Med. Sch., Lebanon, NH, United States
(Boss) Cardiology, Concord Hosp, Concord, NH, United States
(Helm) Cardiothoracic Surgery, Portsmouth Regional Hosp, Portsmouth, NH,
United States
(Horton, Russo) Cardiovascular Services, Central Maine Med. Cntr,
Lewiston, ME, United States
(Hofmaster) Quality Improvement, Eastern Maine Med. Cntr, Bangor, ME,
United States
(Westbrook) Cardiac Services, Catholic Med. Cntr, Manchester, NH, United
States
(Duquette) Cardiovascular Services, Portsmouth Regional Hosp, Portsmouth,
NH, United States
(Jones) Cardiovascular Services, Maine Med. Cntr, Portland, ME, United
States
Title
Causes of 30-day readmission after cardiac surgery in Northern New
England.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background. There is a high rate of readmission within 30 days following
discharge from a hospitalization for cardiac surgery. This is associated
with increased morbidity, mortality, and cost of care. A systematic review
of the medical record could identify details of the process of care and
causes of readmission that are actionable and could lead to a decrease in
rates of readmission. Methods. From our regional registry of open heart
surgery, we identified 268 consecutive patients readmitted within 30 days
(mean=11 days) of their index procedure. Trained health professionals
systematically abstracted the records of their index and readmission
hospitalizations, information that was merged to existing registry data.
Results. Readmitted patients had more comorbid conditions at the time of
their index procedure and were more likely to have valve surgery (30.2% v
23.2%). Early follow-up appointments were recommended for all patients but
variably scheduled (CT surgery 54.1%; PCP 1.1%). A minority of patients
(23.1%) were seen as outpatients prior to their readmission. Infections
(24%), effusions (20%), and rhythm disturbances (16%) were the most common
primary causes of readmission (Figure). Common secondary causes of
readmission included CHF/SOB (28%) and effusions (18%). Conclusions. Root
cause analysis of causes of readmission following open heart surgery is
feasible. Our pilot study suggests that more attention to volume status
and management of effusions could substantially decrease rates of
readmission.

<36>
Accession Number
70618025
Authors
Romero J. Kahan J. Gonzalez W. Garcia M.J.
Institution
(Romero, Kahan, Gonzalez) College of Physicians and Surgeons, St. Luke's
Roosevelt Hosp., Columbia Univ., New York, NY, United States
(Garcia) Cardiology, Montefiore Med. Cntr., Albert Einstein College of
Medicine, New York, NY, United States
Title
Magnetic resonance imaging assessing viability in patients with chronic
ventricular dysfunction due to coronary artery disease undergoing
revascularization. A meta-analysis of prospective clinical trials.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2011 Orlando, FL United States. Conference Start: 20111112 Conference End:
20111116. Conference Publication: (var.pagings). 124 (21 SUPPL. 1) ,
2011. Date of Publication: 22 Nov 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The best test to evaluate myocardial viability in patients
being contemplated for revascularization has not been determined. Magnetic
resonance has emerged as a valuable tool for assessing it. Objectives: The
purpose of this study was to evaluate the sensitivity, specificity,
negative and positive predictive values (PPV/NPV) of cardiac magnetic
resonance imaging (CMR) assessing myocardial viability. Three different
techniques were evaluated: 1) End-diastolic wall thickness (EDWT), 2) Low
dose dobutamine (LDD), and 3) Contrast delayed-enhancement (DE). Methods:
A systematic review of Medline, Cochrane, and Embase for all the
prospective trials assessing myocardial viability in subjects with chronic
left ventricular dysfunction using CMR was perforMed. using a hierarchical
meta-analytical model. Results: A total of 23 studies of cardiac magnetic
resonance evaluating myocardial viability with 628 patients fulfilled the
inclusion criteria. Eleven studies used DE CMR, nine studies used LDD CMR
and three studies used EDWT. The DE CMR studies included a 50% of LV wall
hyper-enhancement as a cut-off to determine viability. The mean
sensitivity and specificity were 95% and 52%, whereas the PPV and NPV were
67% and 90%. LDD CMR used a two-millimeter change in LV wall motion during
low-dose dobutamine infusion (5-10 mcg/kg/min) as a cut-off. In these
studies the mean weighted sensitivity and specificity were 81% and 91%,
whereas the PPV and NPV were 93% and 72% respectively. The cut-off used
for EDWT was six millimeters. The mean weighted sensitivity and
specificity were 96% and 40%, and the PPV and NPV were 66% and 80%
respectively. Conclusion: DE CMR provides the highest sensitivity and NPV
of any diagnostic modality and LDD CMR provides the best specificity and
PPV of any other test. Combining these two modalities might be therefore
clinically meaningful to improve clinical outcomes and guiding management
in patients being contemplated for revascularization.