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<1>
Accession Number
2012001391
Authors
Zimmet H. Porapakkham P. Sata Y. Haas S.J. Itescu S. Forbes A. Krum H.
Institution
(Zimmet, Haas, Forbes, Krum) Department of Epidemiology and Preventive
Medicine, School of Public Health, Preventive Medicine Monash University,
99 Commercial Rd, Melbourne, VIC 3004, Australia
(Porapakkham) Department of Cardiothoracic Surgery, Chest Disease
Institute, Nonthaburi, Thailand
(Porapakkham) Department of Cardiology, Chest Disease Institute,
Nonthaburi, Thailand
(Sata) Department of Cardiovascular Dynamics, National Cerebral and
CardioVascular Center Research Institute, Osaka, Japan
(Itescu) Department of Medicine, University of Melbourne, St. Vincent's
Hospital, Melbourne, Australia
Title
Short-and long-term outcomes of intracoronary and endogenously mobilized
bone marrow stem cells in the treatment of ST-segment elevation myocardial
infarction: A meta-analysis of randomized control trials.
Source
European Journal of Heart Failure. 14 (1) (pp 91-105), 2012. Date of
Publication: January 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Bone marrow stem cell (BMSC) treatment of ST-segment elevation
myocardial infarction (STEMI) has been primarily via the intracoronary
route or via endogenous mobilization using granulocyte colony-stimulating
factor (G-CSF). Studies have provided conflicting results. We therefore
performed a meta-analysis of these treatments, examining short-and
long-term efficacy and safety. Methods and results Randomized controlled
trials (RCTs) of BMSC-based therapy for STEMI, delivered within 9 days of
reperfusion, were identified by systematic search. Random effects models
were used to calculate pooled effects of clinical outcomes, with
meta-regression to assess dependence of the magnitude of effect sizes on
study characteristics. Twenty-nine RCTs enrolling 1830 patients were
included. Intracoronary BMSC therapy resulted in an overall improvement in
left ventricular ejection fraction (LVEF) of 2.70% [95 confidence interval
(CI) 1.483.92; P < 0.001] in the short term and 3.31% (95% CI 1.874.75; P
< 0.001) longer term. Meta-regression suggested a doseresponse
relationship between quantity of CD34⁺ cells delivered and
increase in LVEF (P = 0.007). G-CSF treatment resulted in a trend towards
similar benefits (P = 0.20). No significant differences were observed in
pooled adverse outcome rates between intervention and control groups of
either treatment approach, except for lower revascularization rates with
intracoronary BMSC vs. control (odds ratio 0.68, 95% CI 0.470.97; P 0.03).
Conclusions Intracoronary BMSC therapy post-STEMI improves LVEF beyond
standard medical treatment, in both the short and longer term. G-CSF
treatment shows positive but non-significant trends. Both treatments
demonstrate safety comparable with conventional medical treatment. 2011
The Author.

<2>
Accession Number
2011702158
Authors
Garnock-Jones K.P.
Institution
(Garnock-Jones) Adis A Wolters Kluwer Business, 41 Centorian Drive,
Private Bag 65901, North Shore 0754, Auckland, New Zealand
Title
Esmolol: A Review of its Use in the Short-Term Treatment of
Tachyarrhythmias and the Short-Term Control of Tachycardia and
Hypertension.
Source
Drugs. 72 (1) (pp 109-132), 2012. Date of Publication: 2012.
Publisher
Adis International Ltd (41 Centorian Drive, Private Bag 65901, Mairangi
Bay, Auckland 10 1311, New Zealand)
Abstract
Supraventricular tachyarrhythmia (including atrial fibrillation),
hypertension and tachycardia in the perioperative setting, and acute
ischaemic heart disease are generally agreed to require rapid attention
and treatment. Prolonged tachyarrhythmia or hypertension can result in
significant morbidity, such as cerebrovascular events, myocardial
infarction and other end-organ damage. This article reviews the clinical
efficacy and tolerability of intravenous infusions of esmolol for the
short-term treatment of tachyarrhythmias and the short-term control of
tachycardia and hypertension, and provides an overview of the
pharmacological properties of the drug.Esmolol, a cardioselective
beta-blocker, has been proven effective in the control of elevated
haemodynamic parameters in patients with supraventricular tachyarrhythmia,
hypertension and tachycardia in the perioperative setting, and acute
ischaemic heart disease, as well as being associated with a reduced risk
of some clinical sequelae to increased haemodynamic parameters. Esmolol
is, moreover, generally well tolerated; while it is associated with an
increased risk of hypotension, this is rapidly reversible.Definitive
conclusions on the efficacy of esmolol are difficult to reach, as most
trials investigating esmolol have limitations such as small patient
populations, and few studies investigate the same parameters. Ideally,
several further studies would be beneficial; however, as esmolol is a well
established, older drug, these are less likely to occur.Despite this,
esmolol, as a fast-acting, rapidly reversible, easily titratable
beta-blocker, is an established option for the short-term treatment of
tachyarrhythmias and the short-term control of tachycardia and
hypertension. 2012 Adis Data Information BV. All rights reserved.

<3>
Accession Number
2011701726
Authors
Boning A. Bruck M.
Institution
(Boning) Department of Cardiovascular Surgery, University Hospital Giessen
and Marburg, Rudolf-Buchheim-Strasse7, 35385 Giessen, Germany
(Bruck) Department of Cardiology and Nephrology, Lahn-Dill-Kliniken,
Wetzlar, Germany
Title
Heart valve prosthesis selection in patients with end-stage renal disease
requiring dialysis: A systematic review and meta-analysis.
Source
Heart. 98 (2) (pp 99), 2012. Date of Publication: January 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)

<4>
Accession Number
2011700922
Authors
Huen S.C. Parikh C.R.
Institution
(Huen, Parikh) Department of Medicine, School of Medicine, Yale
University, New Haven, United States
(Huen, Parikh) Clinical Epidemiology Research Center, Veterans Affairs
Medical Center, West Haven, CT, United States
Title
Predicting acute kidney injury after cardiac surgery: A systematic review.
Source
Annals of Thoracic Surgery. 93 (1) (pp 337-347), 2012. Date of
Publication: January 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Acute kidney injury (AKI) after cardiac surgery confers a significant
increased risk of death. Several risk models have been developed to
predict postoperative kidney failure after cardiac surgery. This
systematic review evaluated the available risk models for AKI after
cardiac surgery. Literature searches were performed in the Web of
Science/Knowledge, Scopus, and MEDLINE databases for articles reporting
the primary development of a risk model and articles reporting validation
of existing risk models for AKI after cardiac surgery. Data on model
variables, internal or external validation (or both), measures of
discrimination, and measures of calibration were extracted. The systematic
review included 7 articles with a primary development of a prediction
score for AKI after cardiac surgery and 8 articles with external
validation of established models. The models for AKI requiring dialysis
are the most robust and externally validated. Among the prediction rules
for AKI requiring dialysis after cardiac surgery, the Cleveland Clinic
model has been the most widely tested thus far and has shown high
discrimination in most of the tested populations. A validated score to
predict AKI not requiring dialysis is lacking. Further studies are
required to develop risk models to predict milder AKI not requiring
dialysis after cardiac surgery. Standardizing risk factor and AKI
definitions will facilitate the development and validation of risk models
predicting AKI. 2012 The Society of Thoracic Surgeons.

<5>
Accession Number
2011709494
Authors
Au A.G. Majumdar S.R. McAlister F.A.
Institution
(Au, Majumdar, McAlister) Division of General Internal Medicine,
Department of Medicine, University of Alberta, Edmonton, Canada
(McAlister) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
Title
Preoperative thienopyridine use and outcomes after Surgery: A systematic
review.
Source
American Journal of Medicine. 125 (1) (pp 87-99.e1), 2012. Date of
Publication: January 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Although studies have demonstrated excess risk of ischemic events if
aspirin is withheld preoperatively, it is unclear whether preoperative
thienopyridine use influences postoperative outcomes. We conducted a
systematic review of 37 studies (31 cardiac and 6 noncardiac surgery, 3
randomized, 34 observational) comparing postoperative outcomes in patients
who were versus were not exposed to thienopyridine in the 5 days before
surgery. Exposure to thienopyridine in the 5 days preceding surgery
(compared with no exposure) was not associated with any reduction in
postoperative myocardial infarction (23 studies, 12,872 patients, 3.4% vs
3.0%, odds ratio [OR] 0.98; 95% confidence interval [CI], 0.72-1.34), but
was associated with increased risks of stroke (16 studies, 10,265
patients, 1.9% vs 1.4%, OR 1.54; 95% CI, 1.08-2.20), reoperation for
bleeding (32 studies, 19,423 patients, 4.3% vs 1.8%, OR 2.62; 95% CI,
1.96-3.49), and all-cause mortality (28 studies, 22,990 patients, 3.7% vs
2.6%, OR 1.38; 95% CI, 1.13-1.69). Results were identical when analyses
were restricted to long-term users of thienopyridines who continued versus
held the medication in the 5 days before surgery. Although all
associations were similar in direction for the subset of patients
undergoing noncardiac surgery, 97% of the outcome data in this
meta-analysis came from cardiac surgery trials. These data support
withholding thienopyridines 5 days before cardiac surgery; there was
insufficient evidence to make definitive recommendations for elective
noncardiac surgery although the direction and magnitude of associations
were similar.

<6>
Accession Number
2011706651
Authors
Harston A. Roberts C.
Institution
(Harston, Roberts) Department of Orthopaedic Surgery, University of
Louisville School of Medicine, 210 E. Gray Street, Louisville, KY 40202,
United States
Title
Fixation of sternal fractures: A systematic review.
Source
Journal of Trauma - Injury, Infection and Critical Care. 71 (6) (pp
1875-1879), 2011. Date of Publication: December 2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background: Traumatic sternal fractures occur in approximately 3% to 8% of
all blunt trauma patients. Most of these fractures are treated
conservatively, but a small number require operative intervention. Only a
few studies have reported operative fixation of sternal fractures, and no
investigation to our knowledge has systematically reviewed the literature
on this intervention. Methods: We conducted a systematic review of the
literature published from 1990 through September 2010 regarding the
treatment of traumatic sternal fractures. We analyzed the available
evidence regarding the surgical fixation of these fractures, the type of
fixation used, the timing of the surgery, complications, and patient
outcomes. Results: Twelve articles with 76 cases of surgically repaired
sternal fractures met our study criteria. The indications for surgery,
timing, and methods used for fixation were diverse. For instance, plates
were used in 52 patients and wiring was selected in 24 patients for
fixation. General and cardiothoracic surgeons treated the majority of
sternal fractures requiring operative fixation. No serious postoperative
complications were found in our review. Conclusions: Although the outcomes
were generally positive, only one-half of the articles documented patient
follow-up. In future studies, focus needs to be placed on long-term
results and specific indications for surgery. The first step toward a
standardized sternal fracture operative trial must be a prospective study
of incidence and nonoperative long-term outcomes. It is likely that as the
interest and demand for plate fixation increases, the demand for
orthopedic involvement with sternal fractures will also increase. 2011
Lippincott Williams & Wilkins.

<7>
Accession Number
2012002610
Authors
Mahmoud K. Ammar A.
Institution
(Mahmoud, Ammar) Department of Anesthesiology, Faculty of Medicine,
Minoufiya University, 3 Yaseen Abdelghaffar Street, Shebin Elkoam,
Minoufiya 32511, Egypt
Title
Immunomodulatory effects of anesthetics during thoracic surgery.
Source
Anesthesiology Research and Practice. 2011 , 2011. Article Number:
317410. Date of Publication: 2011.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. One-lung ventilation (OLV) during thoracic surgery may induce
alveolar cell damage and release of proinflammatory mediators. The current
trial was planned to evaluate effect of propofol versus isoflurane
anesthesia on alveolar and systemic immune modulation during thoracic
surgery.Methods. Fifty adult patients undergoing open thoracic surgery
were randomly assigned to receive propofol (n = 25) or isoflurane (n = 25)
anesthesia. The primary outcome measures included alveolar and plasma
concentrations of interleukin-8(IL-8) and tumour necrosis factor- (TNF-),
whereas secondary outcome measures were alveolar and plasma concentrations
of malondialdehyde (MDA), superoxide dismutase (SOD), and changes in
alveolar albumin concentrations and cell numbers. Results. Alveolar and
plasma concentrations of IL-8 and TNF- were significantly lower in the
isoflurane group, whereas alveolar and plasma concentrations of MDA were
significantly lower in the propofol group. Alveolar and plasma SOD levels
increased significantly in the propofol group whereas they showed no
significant change in the isoflurane group. Furthermore, the isoflurane
group patients developed significantly lower alveolar albumin
concentrations and cell numbers.Conclusion. Isoflurane decreased the
inflammatory response associated with OLV during thoracic surgery and may
be preferable over propofol in patients with expected high levels of
proinflammatory cytokines like cancer patients. Copyright 2011 Khaled
Mahmoud and Amany Ammar.

<8>
Accession Number
2011705250
Authors
Kunisawa T. Ueno M. Kurosawa A. Nagashima M. Hayashi D. Sasakawa T. Suzuki
A. Takahata O. Iwasaki H.
Institution
(Kunisawa, Ueno, Kurosawa, Nagashima, Hayashi, Sasakawa, Suzuki, Takahata,
Iwasaki) Department of Anesthesiology and Critical Care Medicine,
Asahikawa Medical College, 2-1-1-1 Midorigaoka-higashi, Asahikawa,
Hokkaido 0788510, Japan
Title
Dexmedetomidine can stabilize hemodynamics and spare anesthetics before
cardiopulmonary bypass.
Source
Journal of Anesthesia. 25 (6) (pp 818-822), 2011. Date of Publication:
December 2011.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: We previously confirmed the effectiveness of dexmedetomidine
(DEX) for stabilizing hemodynamics as well as sparing anesthetics during
anesthetic induction in patients undergoing cardiac surgery (Kunisawa et
al. in J Clin Anesth 21:194-199, 1). In this study, we investigated
whether these effects of DEX continue until the start of cardiopulmonary
bypass (CPB). Methods: Twenty-two patients with mild to moderate
cardiovascular disease were randomized into two groups [DF2 group: DEX
dose of 0.7 mug/kg/h after initial dose and effect-site concentration
(ESC) of fentanyl of 2 ng/ml; PF4 group: saline and ESC of fentanyl of 4
ng/ml]. Propofol was administered for anesthetic induction and
maintenance. Hemodynamics, cardiovascular drugs, ESC of propofol, and
cardiovascular responses to skin incision (SI) and sternotomy (St) were
measured or calculated. Results: Blood pressure (BP) at the pre-/post-SI
periods was higher in the DEX group (137 +/- 17/140 +/- 16 mmHg) than in
the placebo group (85 +/- 9/109 +/- 24 mmHg). Percent increases in
cardiovascular response to SI or St were lower in the DEX group than in
the placebo group (for example, 1.9 +/- 2.2 vs. 27.4 +/- 19.9% in systolic
BP due to SI). ESCs of propofol at SI and St in the DEX group were lower
than those in the placebo group. Conclusions: DEX combined with 2 ng/ml
fentanyl before CPB can suppress the decrease in blood pressure at the
pre- and post-SI periods, can blunt the cardiovascular responses to SI and
St, and can spare the required ESC of propofol despite fentanyl
concentration, which was half of that in the placebo group. 2011 Japanese
Society of Anesthesiologists.

<9>
Accession Number
2011705798
Authors
Lomivorotov V.V. Efremov S.M. Shmirev V.A. Ponomarev D.N. Lomivorotov V.N.
Karaskov A.M.
Institution
(Lomivorotov, Efremov, Shmirev, Ponomarev, Lomivorotov, Karaskov)
Department of Anaesthesiology and Intensive Care, Academician E. N.
Meshalkin Novosibirsk State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
Title
Glutamine is cardioprotective in patients with ischemic heart disease
following cardiopulmonary bypass.
Source
Heart Surgery Forum. 14 (6) (pp E384-E388), 2011. Date of Publication:
December 2011.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: The aim of the present study was to investigate the
cardioprotective effects of the perioperative use of
N(2)-l-alanyl-l-glutamine (GLN) in patients with ischemic heart disease
(IHD) who undergo their operations under cardiopulmonary bypass (CPB).
Methods: This double-blind, placebo-controlled, randomized study included
50 patients who underwent cardiac surgery with CPB. Exclusion criteria
were a left ventricular ejection fraction <50%, diabetes mellitus, <3
months since the onset of myocardial infarction, and emergency surgery.
Patients in the study group (n = 25) received 0.4 g/kg GLN (Dipeptiven,
20% solution) per day. Patients in the control group (n = 25) were
administered a placebo (0.9% NaCl). The primary end point was the dynamics
of troponin I at the following stages: (1) prior to anesthesia, (2) 30
minutes after CPB, (3) 6 hours after CPB, (4) 24 hours after surgery, and
(5) 48 hours after surgery. Secondary end points included measurements of
hemodynamics with a Swan-Ganz catheter. Results: On the fi rst
postoperative day after the surgery, the median troponin I level was
signifi cantly lower in the study group than in the placebo group: 1.280
ng/mL (interquartile range [IQR], 0.840-2.230 ng/mL) versus 2.410 ng/mL
(IQR, 1.060-6.600 ng/mL) (P = .035). At 4 hours after cardiopulmonary
bypass (CPB), the median cardiac index was higher in the patients in the
study group: 2.58 L/min per m² (IQR, 2.34- 2.91 L/min per
m²) versus 2.03 L/min per m² (IQR, 1.76- 2.32 L/min
per m²) (P = .002). The median stroke index also was higher in
the patients who received GLN: 32.8 mL/m²(IQR, 27.8-36.0 mL/m
²) versus 26.1 mL/m² (IQR, 22.6- 31.8
mL/m²) (P = .023). The median systemic vascular resistance
index was signifi cantly lower in the study group than in the placebo
group: 1942 dyns/cm⁵ per m² (IQR, 1828-2209
dyns/cm⁵ per m²) versus 2456 dyn?s/cm5 per m2 (IQR,
2400- 3265 dyn?s/cm5 per m2) (P = .001). Conclusion: Perioperative
administration of GLN during the fi rst 24 hours has cardioprotective
effects in IHD patients following CPB. This technique enhances the
troponin concentration at 24 hours after surgery and is associated with
improved myocardial function. 2011 Forum Multimedia Publishing, LLC.

<10>
Accession Number
2011705269
Authors
Shimizu K. Toda Y. Iwasaki T. Takeuchi M. Morimatsu H. Egi M. Suemori T.
Suzuki S. Morita K. Sano S.
Institution
(Shimizu, Toda, Iwasaki, Morimatsu, Egi, Suemori, Suzuki, Morita)
Department of Anesthesiology and Resuscitology, Okayama University
Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama 700-8558, Japan
(Sano) Department of Cardiovascular Surgery, Okayama University Hospital,
2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama 700-8558, Japan
(Takeuchi) Pediatric Operating Suite and Intensive Care, Jichi Children's
Medical Center Tochigi, Jichi Medical University, 3311-1 Yakushiji,
Shimono, Tochigi 329-0498, Japan
Title
Effect of tranexamic acid on blood loss in pediatric cardiac surgery: A
randomized trial.
Source
Journal of Anesthesia. 25 (6) (pp 823-830), 2011. Date of Publication:
December 2011.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: The benefit of tranexamic acid (TXA) in pediatric cardiac surgery
on postoperative bleeding has varied among studies. It is also unclear
whether the effects of TXA differ between cyanotic patients and acyanotic
patients. The aim of this study was to test the benefit of TXA in
pediatric cardiac surgery in a well-balanced study population of cyanotic
and acyanotic patients. Methods: A total of 160 pediatric patients
undergoing cardiac surgery with cardiopulmonary bypass (81 cyanotic, 79
acyanotic) were included in this single-blinded, randomized trial at a
tertiary care university-affiliated teaching hospital. Eighty-one children
(41 cyanotic, 40 acyanotic) were randomly assigned to a TXA group, in
which they received 50 mg/kg of TXA as a bolus followed by 15 mg/kg/h
infusion and another 50 mg/kg into the bypass circuit. The other 79
patients were randomly assigned to a placebo group. The primary end point
was the amount of 24-h blood loss. Results: The amount of 24-h blood loss
was significantly less in the TXA group than in the placebo group [mean
(95% confidence interval): 18.6 (15.8-21.4) vs. 23.5 (19.4-27.5) ml/kg,
respectively; mean difference -4.9 (-9.7 to -0.01) ml/kg; p = 0.049]. This
effect of TXA was already significant at 6 h [9.5 (7.5-11.5) vs. 13.2
(10.6-15.9) ml/kg, respectively; mean difference -3.47 (-7.0 to -0.4)
ml/kg; p = 0.027]. However, there was no significant difference in the
amount of blood transfusion between the groups. There was also no
statistical difference in the effect of TXA in each cyanotic and acyanotic
subgroup. Conclusion: TXA can reduce blood loss in pediatric cardiac
surgery but not the transfusion requirement ( http://ClinicalTrials.gov
number NCT00994994). 2011 Japanese Society of Anesthesiologists.