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<1>
Accession Number
2012042481
Authors
Angiolillo D.J. Firstenberg M.S. Price M.J. Tummala P.E. Hutyra M. Welsby
I.J. Voeltz M.D. Chandna H. Ramaiah C. Brtko M. Cannon L. Dyke C. Liu T.
Montalescot G. Manoukian S.V. Prats J. Topol E.J.
Institution
(Angiolillo) Department of Cardiology, University of Florida,
Jacksonville, FL, United States
(Firstenberg) Division of Cardiothoracic Surgery, Ohio State University
Medical Center, Columbus, OH, United States
(Price, Topol) Division of Cardiovascular Diseases, Scripps Clinic and
Scripps Translational Science Institute, San Diego, CA, United States
(Tummala) Department of Cardiology, Northeast Georgia Heart Center,
Gainesville, GA, United States
(Hutyra) First Internal Clinic, Faculty Hospital Olomouc, Olomouc, Czech
Republic
(Welsby) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
(Voeltz) Department of Cardiology, Henry Ford Hospital, Detroit, MI,
United States
(Chandna) Department of Cardiology, Detar Hospital, Victoria, TX, United
States
(Ramaiah) Deptartment of Surgery, University of Kentucky, Lexington, KY,
United States
(Brtko) Deptartment of Cardiac Surgery, University Hospital, Hradec
Kralove, Czech Republic
(Cannon) Cardiac and Vascular Research Center of Northern Michigan,
Northern Michigan Regional Hospital, Petoskey, MI, United States
(Dyke) SouthEast Texas Cardiovascular Surgery Associates, Humble, TX,
United States
(Liu, Prats) Medicines Company, Parsippany, NJ, United States
(Montalescot) Groupe Hospitalier Pitie-Salpetriere, Universite Paris 6,
INSERM CMR 937, Paris, France
(Manoukian) Sarah Cannon Research Institute, Hospital Corporation of
America, Nashville, TN, United States
Title
Bridging antiplatelet therapy with cangrelor in patients undergoing
cardiac surgery: A randomized controlled trial.
Source
JAMA - Journal of the American Medical Association. 307 (3) (pp 265-274),
2012. Date of Publication: 18 Jan 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Thienopyridines are among the most widely prescribed medications,
but their use can be complicated by the unanticipated need for surgery.
Despite increased risk of thrombosis, guidelines recommend discontinuing
thienopyridines 5 to 7 days prior to surgery to minimize bleeding.
Objective: To evaluate the use of cangrelor, an intravenous, reversible
P2Y₁₂ platelet inhibitor for bridging thienopyridine-treated
patients to coronary artery bypass grafting (CABG) surgery. Design,
Setting, and Patients: Prospective, randomized, double-blind,
placebocontrolled, multicenter trial, involving 210 patients with an acute
coronary syndrome (ACS) or treated with a coronary stent and receiving a
thienopyridine awaiting CABG surgery to receive either cangrelor or
placebo after an initial open-label, dose-finding phase (n=11) conducted
between January 2009 and April 2011. Interventions Thienopyridines were
stopped and patients were administered cangrelor or placebo for at least
48 hours, which was discontinued 1 to 6 hours before CABG surgery. Main
Outcome Measures: The primary efficacy end point was platelet reactivity
(measured in P2Y₁₂ reaction units [PRUs]), assessed daily. The
main safety end point was excessive CABG surgery-related bleeding. Results
The dose of cangrelor determined in 10 patients in the open-label stage
was 0.75 mug/kg per minute. In the randomized phase, a greater proportion
of patients treated with cangrelor had low levels of platelet reactivity
throughout the entire treatment period compared with placebo (primary end
point, PRU <240; 98.8% (83 of 84) vs 19.0% (16 of 84); relative risk [RR],
5.2 [95% CI, 3.3-8.1] P<.001). Excessive CABG surgery-related bleeding
occurred in 11.8% (12 of 102) vs 10.4% (10 of 96) in the cangrelor and
placebo groups, respectively (RR, 1.1 [95% CI, 0.5-2.5] P=.763). There
were no significant differences in major bleeding prior to CABG surgery,
although minor bleeding episodes were numerically higher with cangrelor.
Conclusions: Among patients who discontinue thienopyridine therapy prior
to cardiac surgery, the use of cangrelor compared with placebo resulted in
a higher rate of maintenance of platelet inhibition. Trial Registration:
clinicaltrials.gov Identifier: NCT00767507. 2012 American Medical
Association. All rights reserved.

<2>
Accession Number
2012048144
Authors
Bortolotti U. Milano A.D. Frater R.W.M.
Institution
(Bortolotti) Cardio Thoracic and Vascular Department, University of Pisa
Medical School, Pisa, Italy
(Milano) Division of Cardiac Surgery, University of Verona Medical School,
Verona, Italy
(Frater) Department of Cardiothoracic Surgery and Pediatrics, Albert
Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United
States
Title
Mitral valve repair with artificial chordae: A review of its history,
technical details, long-term results, and pathology.
Source
Annals of Thoracic Surgery. 93 (2) (pp 684-691), 2012. Date of
Publication: February 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Mitral valve repair is considered the procedure of choice for correcting
mitral regurgitation in myxomatous disease, providing long-term results
that are superior to those with valve replacement. The use of artificial
chordae to replace elongated or ruptured chordae responsible for mitral
valve prolapse and severe mitral regurgitation has been the subject of
extensive experimental work to define feasibility, reproducibility, and
effectiveness of this procedure. Artificial chordae made of autologous or
xenograft pericardium have been replaced by chordae made of expanded
polytetrafluoroethylene (PTFE), a material with the unique property of
becoming covered by host fibrosa and endothelium. The use of artificial
chordae made of PTFE has been validated clinically over the past 2 decades
and has been an increasing component of the surgical armamentarium for
mitral valve repair. This article reviews the history, details of the
relevant surgical techniques, long-term results, and fate of artificial
chordae in mitral reconstructive surgery. 2012 The Society of Thoracic
Surgeons.

<3>
Accession Number
2012048143
Authors
Yu L. Gu T. Song L. Shi E. Fang Q. Wang C. Zhao J.
Institution
(Yu, Gu, Shi, Fang, Wang) Department of Cardiac Surgery, First Affiliated
Hospital, China Medical University, Nanjingbei St 155, Shenyang 110001,
China
(Song) Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan,
China
(Zhao) Molecular Cardiology Research Institute, Tufts Medical Center,
Boston, MA, United States
Title
Fibrin sealant provides superior hemostasis for sternotomy compared with
bone wax.
Source
Annals of Thoracic Surgery. 93 (2) (pp 641-644), 2012. Date of
Publication: February 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Purpose: The purpose of this study was to evaluate the hemostatic efficacy
and feasibility of direct injection of fibrin sealant into the sternal
marrow cavity in senior patients undergoing on-pump coronary artery bypass
grafting (CABG). Description: A total of 82 senior patients undergoing
on-pump CABG were randomized to the bone wax group (n = 40) or the fibrin
sealant group (n = 42) for the period July 2010 to January 2011.
Evaluation: The fibrin sealanttreated group had less chest drainage in the
first 24 hours (186.67 +/- 49.53 versus 333.75 +/- 60.49 mL), less total
chest drainage (326.19 +/- 67.24 versus 516 +/- 88.46 mL), less packed red
blood cell (PRBC) administration (3.6 +/- 1.25 versus 7.4 +/- 2.13 U),
less fresh frozen plasma (FFP) administration (5.52 +/- 1.64 versus 8.95
+/- 1.77 U), shorter intubation time (40.36 +/- 8.62 versus 46.25 +/-
10.46 hours), and shorter hospital stay (10.45 +/- 1.17 versus 11.03 +/-
1.37 days) compared with the bone wax group. No significant difference in
the incidence of postoperative complications was found. Conclusions:
Direct injection of fibrin sealant into the sternal marrow cavity
significantly reduces the amount of postoperative blood loss and offers an
attractive new treatment alternative for senior patients undergoing
on-pump CABG. 2012 The Society of Thoracic Surgeons.

<4>
Accession Number
2011663572
Authors
Chan Y.-K. Stewart S. Calderone A. Scuffham P. Goldstein S. Carrington
M.J.
Institution
(Chan, Stewart, Calderone, Carrington) Preventative Health, Baker IDI
Heart and Diabetes Institute, St Kilda Rd Central, Melbourne, VIC 8008,
Australia
(Scuffham) School of Medicine, Griffith University, Brisbane, Australia
(Goldstein) School of Public Health and Community Medicine, University of
New South Wales, Sydney, Australia
Title
Exploring the potential to remain "young @ Heart": Initial findings of a
multi-centre, randomised study of nurse-led, home-based intervention in a
hybrid health care system.
Source
International Journal of Cardiology. 154 (1) (pp 52-58), 2012. Date of
Publication: 12 Jan 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Disease management programs have been shown to improve health
outcomes in high risk individuals in many but not all health care systems.
Methods: Young @ Heart is a multi-centre, randomised controlled study of a
nurse-led, home-based intervention (HBI) program vs. usual care (UC) in
privately insured patients in Australia aged >= 45 years following an
acute cardiac admission. Intensity of HBI is tailored to an individual's
clinical stability, management and risk profile. The primary endpoint is
the rate of all-cause stay during a mean of 2.5 years follow-up. Results:
A target of 602 adults (72% men) were randomised to HBI (n = 306) or UC (n
= 296); their initial profiles being well matched. At baseline, 71% were
overweight (body mass index 29.7 +/- 3.9 kg/m²) and 66% had an
elevated blood pressure (153 +/- 18/89 +/- 7 mm Hg). Over half had a
history of smoking and 39% had a sub-optimal total cholesterol level > 4
mmol/L. Overall, 62% (376 cases) were treated for coronary artery disease
(27% with multi-vessel disease and 39% underwent cardiac
revascularisation). A further 20% (120 cases) were treated for a cardiac
arrhythmia (predominantly atrial fibrillation) and 19% type 2 diabetes
mellitus. At 7-14 days post-discharge, 293 (96%) HBI patients received a
home visit triggering urgent clinical review and/or enhanced clinical
management in many patients. Conclusions: The Young @ Heart intervention
is a well accepted and potentially effective intervention to reduce
recurrent hospital stay in privately insured cardiac patients in
Australia.

<5>
Accession Number
2012011828
Authors
Yusuf A.M. Warkentin T.E. Arsenault K.A. Whitlock R. Eikelboom J.W.
Institution
(Yusuf, Arsenault, Whitlock, Eikelboom) Population Health Research
Institute, Hamilton, ON, Canada
(Warkentin, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Warkentin) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Whitlock) Department of Surgery, McMaster University, Hamilton, ON,
Canada
Title
Prognostic importance of preoperative anti-PF4/heparin antibodies in
patients undergoing cardiac surgery: A systematic review.
Source
Thrombosis and Haemostasis. 107 (1) (pp 8-14), 2012. Date of
Publication: January 2012.
Publisher
Schattauer GmbH (Hoelderlinstr 3 Stuttgart D-70174, Germany)
Abstract
It was the objective of this study to obtain best estimates of the
prevalence of anti-PF4/heparin antibodies in patients not suspected to
have clinical heparin-induced thrombocytopenia (HIT) prior to undergoing
cardiac surgery and to determine whether preoperative antibody status and
antibody class is predictive of postoperative thromboembolic outcomes,
non-thromboembolic outcomes, length of stay, and mortality. PubMed and
EMBASE online databases were searched up to July 2011, and we included
studies involving adults undergoing cardiac surgery examining the
relationship between preoperative anti-PF4/heparin antibodies (ELISA) and
postoperative clinical outcomes. Five studies involving a combined total
of 2,332 patients met our inclusion criteria. Preoperative
anti-PF4/heparin antibodies were detected in 5-22% of patients. No study
demonstrated an association between preoperative anti-PF4/heparin
antibodies and postoperative thromboembolic outcomes or mortality. Three
studies demonstrated a statistically significant association between
preoperative anti-PF4/heparin antibodies and length of stay while two
showed an association with non-thromboembolic complications. In the one
study that examined outcomes by anti-PF4/heparin antibody class, IgM
antibodies predicted non-thromboembolic complications and length-of-stay.
None of the studies reported prior heparin exposure, and most studies did
not examine the relationship of the absolute value of antibody titres
(ELISA OD) and risk, nor the incidence of true/clinical HIT in
preoperative positive or negative patients. In conclusion, pre-formed
anti-PF4/heparin antibodies are common in patients undergoing cardiac
surgery, but the available literature does not support that they predict
postoperative thromboembolic complications or death. There does appear to
be an association between anti-PF4/heparin antibodies and
non-thromboembolic adverse events, but a causal relationship is unlikely.
Schattauer 2012.

<6>
Accession Number
2012052746
Authors
Mazza A. Rigatelli G. Piva M. Rampin L. Cardaioli P. Giordan M. Roncon L.
Zattoni L. Zuin M. Al-Nahhas A. Rubello D. Ramazzina E. Ravenni R.
Casiglia E.
Institution
(Mazza, Zuin, Ramazzina) Department of Internal Medicine, Santa Maria
Della Misericordia Hospital, Rovigo, Italy
(Rigatelli, Cardaioli, Giordan) Interventional Cardiology Unit, Division
of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
(Piva) Unit of Nephrology, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Rampin, Rubello) Service of Nuclear Medicine and PET/CT Centre,
Department of Imaging, Santa Maria Della Misericordia Hospital, Rovigo,
Italy
(Roncon) Division of Cardiology, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Zattoni) Department of Imaging, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Al-Nahhas) Department of Nuclear Medicine, Hammersmith Hospital, London,
United Kingdom
(Casiglia) Department of Clinical and Experimental Medicine, University of
Padua, Padua, Italy
(Ravenni) Department of Neuroscience, Santa Maria Della Misericordia
Hospital, Rovigo, Italy
Title
In high risk hypertensive subjects with incidental and unilateral renal
artery stenosis percutaneous revascularization with stent improves blood
pressure control but not glomerular filtration rate.
Source
Minerva Cardioangiologica. 59 (6) (pp 533-542), 2011. Date of
Publication: December 2011.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. In high-risk hypertensive subjects (HTs) with incidental unilateral
renal artery stenosis (RAS), the effectiveness of percutaneous
revascularization with stent (PR-STENT) on blood pressure (BP) and
glomerular filtration rate (GFR) is not established. Methods. Eighteen HTs
aged 65.7+/-9.2 years with angiographically diagnosed unilateral RAS
(260%) were randomized to receive PR-STENT (N=9) or to NO-STENT (N=9). BP
(mercury sphygmomanometer) and GFR (^99mTc-DTPA clearances
during renal scintigraphy) were evaluated yearly for three years.
Echo-Doppler of renal arteries was performed to verify the anatomic
patency and flow velocities of the reperfused artery. Analysis of variance
compared BP and GFR values changes from baseline to the follow-up;
differences for continuous variables were evaluated between groups with
the Tukey's post hoc test after adjustment for age, change of BP between
baseline and at the follow-up, GFR and body mass index (BMI). Results.
Baseline systolic BP and GFR values were not different between groups. The
significantly greater GFR increase observed in PR-STENT than in NO-STENT
at univariate analysis at the end of follow-up (62.5+/-19.2 vs.
42.24+/-17.6, P<0.02) disappeared after adjustment for confounding
factors. However, systolic BP remained significantly lower in PR-STENT
than in NO-STENT (140.1+/-4.6 vs. 170.0+/-8.3, P<0.0001) also after
adjustment for age, GFR and BMI. Conclusion. PR-STENT reduces systolic BP
without improving GFR. Due to the strong association between high BP and
renal dam-age, this study raises the question on whether PR-STENT should
be performed in all HTs with unilateral and incidental RAS.

<7>
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Accession Number
2012050182
Authors
Voeks J.H. Howard G. Roubin G.S. Malas M.B. Cohen D.J. Sternbergh III W.C.
Aronow H.D. Eskandari M.K. Sheffet A.J. Lal B.K. Meschia J.F. Brott T.G.
Institution
(Voeks) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
(Howard) Department of Biostatistics, University of Alabama at Birmingham,
Birmingham, AL, United States
(Roubin) Department of Cardiovascular Medicine, Lenox Hill Hospital, New
York, NY, United States
(Malas) Department of Vascular and Endovascular Surgery, Johns Hopkins
Bayview Medical Center, Johns Hopkins Hospital, Baltimore, MD, United
States
(Cohen) Saint Luke's Mid America Heart and Vascular Institute, Kansas
City, MO, United States
(Sternbergh III) Vascular and Endovascular Surgery, Ochsner Health
Systems, New Orleans, LA, United States
(Aronow) Michigan Heart and Vascular Institute, Ypsilanti, MI, United
States
(Eskandari) Division of Vascular Surgery, Northwestern Memorial Hospital,
Chicago, IL, United States
(Sheffet) Department of Surgery, UMDNJ-New Jersey, Medical School, Newark,
NJ, United States
(Lal) Vascular Surgery, University of Maryland, Medical Center, Baltimore,
MD, United States
(Meschia, Brott) Department of Neurology, Mayo Clinic, 4500 San Pablo Rd.,
Griffin Bldg., Jacksonville, FL 32224, United States
Title
Age and outcomes after carotid stenting and endarterectomy: The Carotid
Revascularization Endarterectomy Versus Stenting Trial.
Source
Stroke. 42 (12) (pp 3484-3490), 2011. Date of Publication: December
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background and Purpose: High stroke event rates among carotid artery
stenting (CAS)-treated patients in the Carotid Revascularization
Endarterectomy Versus Stenting Trial (CREST) lead-in registry generated an
a priori hypothesis that age may modify the relative efficacy of CAS
versus carotid endarterectomy (CEA). In the primary CREST report, we
previously noted significant effect modification by age. Here we extend
this investigation by examining the relative efficacy of the components of
the primary end point, the treatment-specific impact of age, and
contributors to the increasing risk in CAS-treated patients at older ages.
Methods: Among 2502 CREST patients with high-grade carotid stenosis,
proportional hazards models were used to examine the impact of age on the
CAS-to-CEA relative efficacy, and the impact of age on risk within
CAS-treated and CEA-treated patients. Results: Age acted as a treatment
effect modifier for the primary end point (P interaction=0.02), with the
efficacy of CAS and CEA approximately equal at age 70 years. For CAS, risk
for the primary end point increased with age (P<0.0001) by 1.77-times (95%
confidence interval, 1.38-2.28) per 10-year increment; however, there was
no evidence of increased risk for CEA-treated patients (P=0.27). Stroke
events were the primary contributor to the overall effect modification (P
interaction=0.033), with equal risk at 64 years. The treatment-by-age
interaction for CAS and CEA was not altered by symptomatic status (P=0.96)
or by sex (P=0.45). Conclusions:Outcomes after CAS versus CEA were related
to patient age, attributable to increasing risk for stroke after CAS at
older ages. Patient age should be an important consideration when choosing
between the 2 procedures for treating carotid stenosis. Clinical Trial
Registration: URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00004732. 2011 American Heart Association, Inc.

<8>
Accession Number
2012040438
Authors
Udelsmann A. Maciel F.G. Servian D.C.M. Reis E. de Azevedo T.M. Melo
M.D.S.
Institution
(Udelsmann) Anesthesiology Dept. of the Faculdade de Ciencias Medicas
(FCM) of Univ. de Campinas (Unicamp), Brazil
(Maciel) R3, Unicamp, Brazil
(Servian, Reis, de Azevedo) Anesthesiology Sector of the Hospital das
Clinicas da Unicamp, Brazil
(Melo) Student in Surgical Sciences at FCM/Unicamp, Physician of the
Anesthesiology Sector of Hospital das Clinicas da Unicamp, Brazil
Title
Methadone and Morphine during Anesthesia Induction for Cardiac Surgery.
Repercussion in Postoperative Analgesia and Prevalence of Nausea and
Vomiting.
Source
Revista Brasileira de Anestesiologia. 61 (6) (pp 695-701), 2011. Date of
Publication: November 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background and objectives: Pain is an aggravating factor in postoperative
morbidity and mortality especially in large size surgeries. Methods to
effectively fend pain collide with elevated costs and for this reason they
are not accessible in every service. The option would be the use of an
opioid with long half-life, such as methadone. The objective of the
present study was to compare the requirements of postoperative analgesia
in patients who received methadone, morphine, or placebo during anesthetic
induction, besides the prevalence of postoperative nausea and vomiting.
Methods: Fifty-five patients scheduled for cardiac surgery were divided
into three groups and they received during anesthetic induction 20. mg of
methadone, 20. mg of morphine, or placebo. At the end of surgery, patients
were transferred to the ICU where the following parameters were evaluated:
duration of anesthesia, time until extubation, time until the need of the
first analgesic, number of doses required in 24 hours, assessment of
analgesia by the patient, and prevalence of nausea/vomiting. Results:
Differences in the duration of anesthesia and time until extubation were
not observed. The first dose of analgesic in patients who received
methadone was administered later than in patients in the other two groups.
The need of analgesics in the methadone group was lower, quality of
analgesia was better, and prevalence of nausea and vomiting was also
lower. Conclusions: Methadone during anesthetic induction was effective
for analgesia in large size surgeries. Lower incidence of nausea and
vomiting was observed in the methadone group and therefore it is a low
cost option available among us that should be stimulated. 2011 Elsevier
Editora Ltda.

<9>
Accession Number
2012044343
Authors
Campanella A. Bergamasco L. Macri L. Asioli S. Devotini R. Scipioni S.
Barbaro S. Rispoli P. Rinaldi M.
Institution
(Campanella, Devotini, Rinaldi) Thoracic and Cardiovascular Department,
Division of Cardiac Surgery, San Giovanni Battista of Turin Hospital,
University of Turin, Corso Bramante 84, 10126 Turin, Italy
(Bergamasco) Physics Department, University of Turin, Corso Bramante 84,
10126 Turin, Italy
(Macri, Asioli) Biomedical Sciences and Human Oncology Department,
Division of Third Pathological Anatomy, San Giovanni Battista of Turin
Hospital, University of Turin, Corso Bramante 84, 10126 Turin, Italy
(Scipioni, Barbaro) Sanitary Direction Department, Division of Hospital
Hygiene and Management of Sanitary Technologies, San Giovanni Battista of
Turin, Corso Bramante 84, 10126 Turin, Italy
(Rispoli) Thoracic and Cardiovascular Department, Division of Vascular
Surgery, San Giovanni Battista of Turin Hospital, University of Turin,
Corso Bramante 84, 10126 Turin, Italy
Title
Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for
coronary artery bypass grafting surgery: study protocol for a randomized
controlled trial.
Source
Trials. 12 , 2011. Article Number: 243. Date of Publication: 18 Nov
2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: In coronary artery bypass grafting surgery, arterial conduits
are preferred because of more favourable long-term patency and outcome.
Anyway the greater saphenous vein continues to be the most commonly used
bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is
increasingly being investigated in order to reduce the morbidity
associated with conventional open vein harvesting, includes postoperative
leg wound complications, pain and patient satisfaction. However, to date
the short and the long-term benefits of the endoscopic technique remain
controversial. This study provides an interesting opportunity to address
this gap in the literature.Methods/Design: Endoscopic Saphenous harvesting
with an Open CO₂System trial includes two parallel vein
harvesting arms in coronary artery bypass grafting surgery. It is an
interventional, single centre, prospective, randomized, safety/efficacy,
cost/effectiveness study, in adult patients with elective planned and
first isolated coronary artery disease. A simple size of 100 patients for
each arm will be required to achieve 80% statistical power, with a
significant level of 0.05, for detecting most of the formulated
hypotheses. A six-weeks leg wound complications rate was assumed to be 20%
in the conventional arm and less of 4% in the endoscopic arm. Previously
quoted studies suggest a first-year vein-graft failure rate of about 20%
with an annual occlusion rate of 1% to 2% in the first six years, with
practically no difference between the endoscopic and conventional
approaches. Similarly, the results on event-free survival rates for the
two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5%
cross-over rate, the goal is to enrol 230 patients from a single Italian
cardiac surgery centre.Discussion: The goal of this prospective randomized
trial is to compare and to test improvement in wound healing, quality of
life, safety/efficacy, cost-effectiveness, short and long-term outcomes
and vein-graft patency after endoscopic open CO₂harvesting
system versus conventional vein harvesting.The expected results are of
high clinical relevance and will show the safety/efficacy or
non-inferiority of one treatment approach in terms of vein harvesting for
coronary artery bypass grafting surgery.Trial registration:
www.clinicalTrials.gov NCT01121341. 2011 Campanella et al; licensee
BioMed Central Ltd.

<10>
Accession Number
2012033331
Authors
Wang K.-Y. Wang H.-W. Xin L.-F. Wang Y.-W. Xue Y.-L.
Institution
(Wang, Wang, Xin, Wang, Xue) Department of Anesthesiology, TEDA
International Cardiovascular Hospital, Tianjin 300457, China
Title
Evaluation of high-concentration sevoflurane for induction and
nasotracheal intubation without muscle relaxant for infants with different
pulmonary blood flow undergoing surgery for congenital heart diseases.
Source
Chinese Medical Journal. 124 (24) (pp 4144-4148), 2011. Date of
Publication: 20111220.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Inhalational anesthesia with sevoflurane for endotracheal
intubation without muscle relaxant is now used widely for pediatric
patients. This study assessed the efficacy and safety of induction with
high concentration sevoflurane and of nasotracheal intubation without
muscle relaxant in infants with increased or decreased pulmonary blood
flow (PBF) and undergoing surgery for congenital heart diseases. Methods
Fifty-five infants aged 2-12 months, weighing 4.7-10.0 kg, and scheduled
for congenital cardiac surgery were enrolled. Subjects were divided into
those with increased (IPBF group, n=29) and decreased (DPBF group, n=26)
pulmonary blood flow. All infants received inhalational induction with 8%
sevoflurane in 100.0% oxygen at a gas flow rate of 6 L/min. Nasotracheal
intubation was performed 4 minutes after induction. Sevoflurane
vaporization was decreased to 4.0% for placement of a peripheral
intravenous line and invasive hemodynamic monitors. Five minutes later,
sedatives and muscle relaxant were administered and the vaporizer was
adjusted to 2% for maintenance of anesthesia. Bispectral index (BIS)
scores, circulatory parameters, satisfactory and successful intubation
ratios, adverse reactions, and complications of intubation were recorded.
Results Times to loss of lash and pain reflexes were longer for the DPBF
group (P <0.01). Satisfactory intubation ratios were 93.1% and 61.5% for
the IPBF and DPBF groups, respectively (P=0.008). Successful intubation
ratios were 96.6% and 76.9% for the IPBF and DPBF groups, respectively
(P=0.044). Following sevoflurane inhalation, blood pressures decreased
significantly in the IPBF group but remained stable in the DPBF group. BIS
scores declined to similar stable values, and a "nadir BIS" was recorded
for both groups. No obvious adverse reactions or complications of
intubation were noted perioperatively. Conclusions Induction with high
concentration sevoflurane, although faster for infants with IPBF, is safe
for infants with IPBF or DPBF. However, nasotracheal intubation without
muscle relaxant after induction with high concentration sevoflurane is
less successful and less satisfactory for infants with DPBF and should be
used with caution in this patient group.

<11>
Accession Number
70647913
Authors
Berger J.S. Sallum R.H. Katona B.G. Maya J. Ranganathan G. Mwamburi M.
Institution
(Berger) New York University Medical Center, New York, NY, United States
(Sallum, Ranganathan) United BioSource Corporation, Lexington, MA, United
States
(Katona, Maya) Astra Zeneca LP, Wilmington, DE, United States
(Mwamburi) Tufts University, School of Medicine, Boston, MA, United States
Title
Meta-analysis of the relationship between aspirin dosing and efficacy and
bleeding outcomes in medically managed patients with acute coronary
syndromes (ACS).
Source
Pharmacotherapy. Conference: 2011 Annual Meeting of the American College
of Clinical Pharmacy Pittsburgh, PA United States. Conference Start:
20111016 Conference End: 20111019. Conference Publication: (var.pagings).
31 (10) (pp 320e-321e), 2011. Date of Publication: October 2011.
Publisher
Pharmacotherapy Publications Inc.
Abstract
PURPOSE: Acetylsalicylic acid (ASA) dosing guidelines for ACS treatment
are inconsistent and lack supporting data. This analysis evaluated the
relationship between ASA maintenance dosing and clinical outcomes in
patients with ACS who did not undergo revascularization and are managed
medically. METHODS: A meta-analysis was conducted with random-effects
modeling to estimate the frequency of clinical outcomes for low (75-149
mg) and high (150-325 mg) doses of ASA, using data from worldwide clinical
and observational trials published from Jan 1995 to Feb 2010, available
from PubMed, EMBASE and Current Contents. Clinical outcomes measured were:
revascularization rate (overall rate, percutaneous coronary intervention
[PCI] or coronary artery bypass graft [CABG]), cardiovascular (CV) death,
all-cause death, myocardial infarction (MI), stroke, and bleeding at 1, 3,
6 and 12 months. RESULTS: Sixty-eight studies including 207,523 patients
were accepted and appraised for quality using Oxford Centre for Evidence-
Based Medicine scoring. Significant heterogeneity was seen in the results
(quantified using the Cochran's Q statistics and the I²
measures), due to differences in enrolment procedures, medical management
regimens and timing of administration, study designs and some
inconsistencies in the definitions of bleeding and MACE. At one month, the
incidence of clinical outcomes with high- and low-dose ASA groups were
4.9% and 5.0% for MI; 6.3% and 3.7% for revascularization; 1.4% and 1.3%
for stroke; 5.5% and 3.4% for CV death; 5.7% and 4.3% for all cause death;
and 4.0% and 1.7% for major bleeding, respectively. Meta regression
demonstrated a significant association between aspirin dose and major
bleeding (p=0.037). Further data will be presented at the meeting.
CONCLUSIONS: This analysis suggests that in patients receiving medical
management for ACS, major bleeding occurred more frequently in patients
who received higher doses of ASA. ASA dose does not have a statistically
significant impact on the other outcomes analyzed.