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<1>
Accession Number
2012110646
Authors
Yalcin S. Ozgencil E. Serdaroglu H. Oba S. Enon S. Demiralp S.
Institution
(Yalcin, Ozgencil, Serdaroglu, Oba, Demiralp) Department of Anesthesiology
and ICU, Faculty of Medicine, Ankara University, Ankara, Turkey
(Yalcin) Department of Anesthesiology and ICU, Faculty of Medicine, Harran
University, Sanliurfa, Turkey
(Enon) Department of Thoracic Surgery, Faculty of Medicine, Ankara
University, Ankara, Turkey
Title
Anesthetics modulate oxidative stress during one-lung ventilation in lung
cancer patients: Comparison of target-controlled propofol infusion and
desflurane.
Source
African Journal of Pharmacy and Pharmacology. 6 (6) (pp 407-411), 2012.
Date of Publication: February 2012.
Publisher
Academic Journals (P.O. Box 5170-00200, Nairobi,Victoria Island 73023,
Nigeria)
Abstract
Lung injury following thoracic surgery is a relatively uncommon disease,
but has a major complication with high mortality. Many factors, including;
ischemia reperfusion injury and the use of one-lung ventilation (OLV) are
involved in this process. This study was conducted to compare the results
of target-controlled infusion (TCI) of propofol versus desflurane in the
aspect of oxidative stress in lung cancer patients operated with OLV.
Thirty patients with non-small cell lung cancer whom were operated with
OLV were studied. In propofol group (n = 15), anesthesia was based on
propofol and remifentanil, both simultaneously administered via
target-control infusion and in desflurane group (n = 15), anesthesia was
maintained with desflurane. Serum malondialdehyde (MDA) levels were
measured during operation and postoperatively. In each group, cases showed
a statistically significant increase in serum malondialdehyde levels
during operation as compared to baseline levels (P < 0.05 for both). The
mean baseline levels of MDA were not significantly different among groups,
although mean serum MDA levels were statistically significantly decreased
at 30 min OLV, at 5 min of reoxygenation and at postoperative 6 h
measurements in propofol group as compared to desflurane group (P < 0.01
for all). TCI of propofol maintained hemodynamic stability similar with
desflurane in lung cancer patients which underwent lobectomy with OLV.
Findings of the present study suggested that the oxidative stress during
OLV might be modified with anesthetic approach and that the favorable
results with propofol in view of oxidative stress might lead to the
preferred use of this drug as compared to desflurane for general
anesthesia with OLV. 2012 Academic Journals.

<2>
Accession Number
2012099489
Authors
Xie J.-J. Liao X.-L. Chen W.-G. Huang D.-D. Chang F.-J. Chen W. Luo Z.-L.
Wang Z.-P. Ou J.-S.
Institution
(Xie, Chen, Huang, Luo) Guangzhou First Municipal People's Hospital,
Guangzhou Institute of Clinical Medicine, Guangzhou Medical College,
Guangzhou, China
(Liao, Chang, Wang, Ou) Division of Cardiac Surgery, First Affiliated
Hospital, Sun Yat-sen University, 58 Zhong Shan Er Road, Guangzhou 510080,
China
(Chen) Department of Medical Statistics and Epidemiology, School of Public
Health, Sun Yat-sen University, Guangzhou, China
Title
Remote ischaemic preconditioning reduces myocardial injury in patients
undergoing heart valve surgery: Randomised controlled trial.
Source
Heart. 98 (5) (pp 384-388), 2012. Date of Publication: March 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To determine whether remote ischaemic preconditioning (RIPC) is
cardioprotective in patients undergoing heart valve replacement. Design:
Single-blinded, randomised controlled trial. Setting :Tertiary referral
hospital in China. Patients: Adult patients (31-72 years) undergoing
mitral valve, aortic valve or tricuspid valve surgery. Interventions:
Patients were randomised to either the RIPC (n=38) or control (n=35)
group. After induction of anaesthesia, patients in the RIPC group
underwent three 5 min cycles of right upper limb ischaemia, induced by an
automated cuff-inflator placed on the upper arm and inflated to 200 mm Hg.
Each cycle was interrupted by a 5 min period of reperfusion during which
time the cuff was deflated. The control group had only a deflated cuff
placed on the upper arm for 30 min. Main outcome measures: Serum troponin
I concentration was measured before surgery and at 6, 12, 24, 48, and 72 h
postoperatively. The cardiac function of all patients was followed
postoperatively. Results: Troponin I concentration was reduced in the RIPC
group (398.7+/-179.3 mug/l) compared with the control group (708.4+/-242.5
mug/l). Mean difference was 309.7+/-50.8 (95% CI 210.1 to 409.3,
p<0.0001). A greater improvement in postsurgical cardiac function was
noted in the RIPC group than in the control group. Conclusions: These data
indicate that RIPC reduces myocardial injury and improves cardiac function
in patients undergoing heart valve surgery. Trial registration number:
NCT01175681.

<3>
Accession Number
2012122857
Authors
Fakin R. Zimpfer D. Sodeck G.H. Rajek A. Mora B. Dumfarth J. Grimm M.
Czerny M.
Institution
(Fakin) Division of General Thoracic Surgery, University Hospital Bern,
University of Bern, Bern, Switzerland
(Zimpfer, Dumfarth, Grimm) Department of Cardiac Surgery, Medical
University of Vienna, Vienna, Austria
(Sodeck) Department of Emergency Medicine, Medical University of Vienna,
Vienna, Austria
(Rajek, Mora) Department of Cardiothoracic and Vascular Anesthesiology,
Medical University of Vienna, Vienna, Austria
(Czerny) Swiss Cardiovascular Center, University Hospital Bern, University
of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
Title
Influence of temperature management on neurocognitive function in
biological aortic valve replacement. A prospective randomized trial.
Source
Journal of Cardiovascular Surgery. 53 (1) (pp 107-112), 2012. Date of
Publication: February 2012.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. Aim of this study was to elucidate if postoperative neurocognitive
function after biological aortic valve replacement (AVR) can be influenced
by temperature management during cardiopulmonary bypass (CPB). Methods. In
this prospective randomized study, we measured the effect of mild
hypothermic (32degreeC, N.=30) vs. normothermic (37degreeC, N.=30) CPB on
neurocognitive function. All patients underwent elective isolated
biological AVR (mean age 67+/-8 years, mean additional EuroSCORE
5.6+/-2.4). Neurocognitive function was objectively measured by means of
objective P300 auditory-evoked potentials before surgery, one week and
four months after surgery. Clinical data and outcome were monitored.
Results. P300 evoked potentials were comparable between patients operated
with mild hypothermic (370+/-30 ms) and normothermic CPB (373+/-32 ms)
before surgery (P=0.85). P300 peak latencies were prolonged (=impaired) in
patients operated with normothermic (402+/-29, P<0.0001) as well as with
mild hypothermic CPB (405+/-30 ms, P<0.0001) one week after surgery. Even
four months after surgery, still impairment of P300 peak latencies could
be documented in either patients operated with normothermic (394+/-28 ms)
and mild hypothermic CPB (400+/-33 ms,) in repeated measures analysis of
variance (P=0.042). Group comparison revealed no difference between
patients operated with normothermic and mild hypothermic CPB at one week
(P=0.54) and four months (P=0.67) after surgery. Clinical data as well as
postoperative adverse events were comparable between the two groups.
Conclusion. Normothermic temperature management during CPB is non-inferior
to hypothermic in means of neuroprotection. Since patients after
biological aortic valve replacement show a subclinical but measurable
cognitive deficit up to four months after surgery, other factors have to
be addressed to add further benefit to the extremely good results of open
biological AVR.

<4>
Accession Number
2012122280
Authors
Prowle J.R. Calzavacca P. Licari E. Ligabo E.V. Echeverri J.E. Haase M.
Haase-Fielitz A. Bagshaw S.M. Devarajan P. Bellomo R.
Institution
(Prowle, Calzavacca, Licari, Ligabo, Echeverri, Bellomo) Department of
Intensive Care, Austin Health, Austin Hospital, Studley Road, Heidelberg,
VIC 3084, Australia
(Prowle) Intensive Care Unit, Royal London Hospital, Barts and the London
NHS Trust, London, United Kingdom
(Haase, Haase-Fielitz) Department of Nephrology and Hypertension and
Endocrinology and Metabolic Diseases, Otto-von-Guericke-University,
Magdeburg, Germany
(Bagshaw) Division of Critical Care Medicine, University of Alberta
Hospital, University of Alberta, Edmonton, AB, Canada
(Devarajan) Center for Acute Care Nephrology, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
Title
Pilot double-blind, randomized controlled trial of short-term atorvastatin
for prevention of acute kidney injury after cardiac surgery.
Source
Nephrology. 17 (3) (pp 215-224), 2012. Date of Publication: March 2012.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Aim: To test whether short-term perioperative administration of oral
atorvastatin could reduce incidence of postoperative acute kidney injury
(AKI) in cardiac surgical patients. Methods: We conducted a double-blind,
randomized controlled trial in 100 cardiac surgical patients at increased
risk of postoperative AKI. Patients were randomized to atorvastatin (40 mg
once daily for 4 days starting preoperatively) or identical placebo
capsule. Primary outcome was to detect a smaller absolute rise in
postoperative creatinine with statin therapy. Secondary outcomes included
AKI defined by the creatinine criteria of RIFLE consensus classification
(RIFLE R, I or F), change in urinary neutrophil gelatinase-associated
lipocalin (NGAL) concentration, requirement for renal replacement therapy,
length of stay in intensive care, length of stay in hospital and hospital
mortality. Results: Study groups were well matched. For each patient
maximal increase in creatinine during the 5 days after surgery was
assessed; median maximal increase was 28 mumol/L in the atorvastatin group
and 29.5 mumol/L in the placebo group (P = 0.62). RIFLE R or greater
occurred in 26% of patients with atorvastatin and 32% with placebo (P =
0.65). Postoperatively urine NGAL changes were similar (median NGAL:
creatinine ratio at intensive care unit admission: Atorvastatin group 1503
ng/mg, placebo group 1101 ng/mg; P = 0.22). Treatment was well tolerated
and adverse events were similar between groups. Conclusion: Short-term
perioperative atorvastatin use was not associated with a reduced incidence
of postoperative AKI or smaller increases in urinary NGAL.
(ClinicalTrials.gov NCT00910221). In this randomized, double-blind
clinical trial in 100 cardiac surgical patients at increased risk of
postoperative acute kidney injury, atorvastatin 40 mg/day given for 4 days
did not change the likelihood of elevation in serum creatinine or urinary
neutrophil gelatinase-associated lipocalin. 2011 Asian Pacific Society of
Nephrology.

<5>
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Accession Number
2012122961
Authors
Van Haren F.M.P. Sleigh J. Boerma E.C. La Pine M. Bahr M. Pickkers P. Van
Der Hoeven J.G.
Institution
(Van Haren) Australian National University Medical School, Intensive Care
Department, Canberra Hospital, PO Box 11, Canberra Woden, ACT 2606,
Australia
(Sleigh, La Pine, Bahr) Intensive Care Department, Waikato Hospital,
Hamilton, New Zealand
(Boerma) Intensive Care Department, Medical Centre Leeuwarden, Leeuwarden,
Netherlands
(Pickkers, Van Der Hoeven) Intensive Care Department, Radboud University
Nijmegen Medical Centre, Nijmegen, Netherlands
Title
Hypertonic fluid administration in patients with septic shock: A
prospective randomized controlled pilot study.
Source
Shock. 37 (3) (pp 268-275), 2012. Date of Publication: March 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
We assessed the short-term effects of hypertonic fluid versus isotonic
fluid administration in patients with septic shock. This was a
double-blind, prospective randomized controlled trial in a 15-bed
intensive care unit. Twenty-four patients with septic shock were
randomized to receive 250 mL 7.2% NaCl/6% hydroxyethyl starch (HT group)
or 500 mL 6% hydroxyethyl starch (IT group). Hemodynamic measurements
included mean arterial blood pressure (MAP), central venous pressure,
stroke volume index, stroke volume variation, intrathoracic blood volume
index, gastric tonometry, and sublingual microcirculatory flow as assessed
by sidestream dark field imaging. Systolic tissue Doppler imaging
velocities of the medial mitral annulus were measured using
echocardiography to assess left ventricular contractility. Log
transformation of the ratio MAP divided by the norepinephrine infusion
rate (log MAP/NE) quantified the combined effect on both parameters.
Compared with the IT group, hypertonic solution treatment resulted in an
improvement in log MAP/NE (P = 0.008), as well as an increase in systolic
tissue Doppler imaging velocities (P = 0.03) and stroke volume index (P =
0.017). No differences between the groups were found for preload
parameters (central venous pressure, stroke volume variation,
intrathoracic blood volume index) or for afterload parameters (systemic
vascular resistance index, MAP). Hypertonic solution treatment decreased
the need for ongoing fluid resuscitation (P = 0.046). No differences
between groups were observed regarding tonometry or the sublingual
microvascular variables. In patients with septic shock, hypertonic fluid
administration did not promote gastrointestinal mucosal perfusion or
sublingual microcirculatory blood flow in comparison to isotonic fluid.
Independent of changes in preload or afterload, hypertonic fluid
administration improved the cardiac contractility and vascular tone
compared with isotonic fluid. The need for ongoing fluid resuscitation was
also reduced. 2012 by the Shock Society.

<6>
Accession Number
2012121023
Authors
Oraby M. Youssef A.
Institution
(Oraby, Youssef) Cardiology Department, Suez Canal University Hospital,
Ismailia, Egypt
Title
Immediate and 18-month outcome of balloon mitral valvuloplasty: Comparison
of inoue and multi-track system.
Source
Journal of Interventional Cardiology. 25 (1) (pp 47-52), 2012. Date of
Publication: February 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Aims: To compare the immediate and 18-month clinical and echocardiographic
outcome of Inoue and multi-track system for balloon mitral valvuloplasty
(BMV). Methods: We included 78 consecutive patients with moderate to
severe rheumatic mitral stenosis (MS) [mitral valve area (MVA) < 1.5
cm²] and clinically indicated BMV. The first 42 consecutive
patients were assigned to Inoue BMV (group I), and the following 36
consecutive patients were assigned to multi-track system (group M).
Clinical and echocardiographic assessment was performed before,
immediately after, 3 months after, and 18 months after the procedure.
Results: The successful immediate result [MVA > 1.5 cm² and
mitral regurgitation (MR) < II/IV] was achieved in 40 (95.23%) patients of
group I and 34 (94.44%) patients of group M (P = 0.12). Immediately after
BMV, MVA increased from 0.9 +/- 0.4 to 1.7 +/- 0.5 cm² in group
I and from 0.8 +/- 0.2 to 1.9 +/- 0.3 cm² in group M (P <
0.01). Bilateral commissural splitting was significantly higher in group M
(P < 0.01). This was associated with higher incidence of mild commissural
mitral regurgitation. There were no significant differences of moderate to
severe MR. Both procedure and fluoroscopy time were significantly shorter
in group I (P < 0.001). Eighteen-month clinical and echocardiographic
evaluation was available for 66 (84.64%) patients with sustained immediate
clinical and echocardiographic improvements. Conclusions: Both Inoue and
the multi-track balloon systems achieved successful immediate and 18-month
results. The multi-track double balloon system produced significantly
larger MVA, with better bilateral commissurotomy, yet with longer
procedure and fluoroscopy times. 2011, Wiley Periodicals, Inc.

<7>
[Use Link to view the full text]
Accession Number
2012119866
Authors
Muramatsu T. Matsushita K. Yamashita K. Kondo T. Maeda K. Shintani S.
Ichimiya S. Ohno M. Sone T. Ikeda N. Watarai M. Murohara T.
Institution
(Muramatsu, Matsushita, Yamashita, Kondo, Maeda, Shintani, Murohara)
Department of Cardiology, Nagoya University Graduate, School of Medicine,
65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
(Ichimiya, Ohno) Yokkaichi Municipal Hospital, Yokkaichi, Japan
(Shintani) Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
(Sone) Ogaki Municipal Hospital, Ogaki, Japan
(Ikeda) Chunichi Hospital, Nagoya, Japan
(Watarai) Anjo Kosei Hospital, Anjo, Japan
Title
Comparison between valsartan and amlodipine regarding cardiovascular
morbidity and mortality in hypertensive patients with glucose intolerance:
NAGOYA HEART study.
Source
Hypertension. 59 (3) (pp 580-586), 2012. Date of Publication: March
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
It has not been fully examined whether angiotensin II receptor blocker is
superior to calcium channel blocker to reduce cardiovascular events in
hypertensive patients with glucose intolerance. A prospective,
open-labeled, randomized, controlled trial was conducted for Japanese
hypertensive patients with type 2 diabetes mellitus or impaired glucose
tolerance. A total of 1150 patients (women: 34%; mean age: 63 years;
diabetes mellitus: 82%) were randomly assigned to receive either
valsartan- or amlodipine-based antihypertensive treatment. Primary outcome
was a composite of acute myocardial infarction, stroke, coronary
revascularization, admission attributed to heart failure, or sudden
cardiac death. Blood pressure was 145/82 and 144/81 mm Hg, and
glycosylated hemoglobin was 7.0% and 6.9% at baseline in the valsartan
group and the amlodipine group, respectively. Both of them were equally
controlled between the 2 groups during the study. The median follow-up
period was 3.2 years, and primary outcome had occurred in 54 patients in
the valsartan group and 56 in the amlodipine group (hazard ratio: 0.97
[95% CI: 0.66-1.40]; P=0.85). Patients in the valsartan group had a
significantly lower incidence of heart failure than in the amlodipine
group (hazard ratio: 0.20 [95% CI: 0.06-0.69]; P=0.01). Other components
and all-cause mortality were not significantly different between the 2
groups. Composite cardiovascular outcomes were comparable between the
valsartan- and amlodipine-based treatments in Japanese hypertensive
patients with glucose intolerance. Admission because of heart failure was
significantly less in the valsartan group. 2012 American Heart
Association, Inc.

<8>
Accession Number
2012093716
Authors
Foroulis C.N. Anastasiadis K. Charokopos N. Antonitisis P. Halvatzoulis
H.V. Karapanagiotidis G.T. Grosomanidis V. Papakonstantinou C.
Institution
(Foroulis, Anastasiadis, Charokopos, Antonitisis, Halvatzoulis,
Karapanagiotidis, Papakonstantinou) Department of Thoracic and
Cardiovascular Surgery, Aristotle University Medical School, AHEPA
University Hospital, Stilponos Kiriakidi Street, Thessaloniki 54636,
Greece
(Grosomanidis) Department of Anaesthesiology and Intensive Care, Aristotle
University Medical School, AHEPA University Hospital, Thessaloniki, Greece
Title
A modified two-port thoracoscopic technique versus axillary
minithoracotomy for the treatment of recurrent spontaneous pneumothorax: A
prospective randomized study.
Source
Surgical Endoscopy and Other Interventional Techniques. 26 (3) (pp
607-614), 2012. Date of Publication: March 2012.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Background: Currently, most thoracic surgeons perform surgical pleurodesis
for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic
surgery (VATS). However, the superiority of VATS over axillary
minithoracotomy is not been established in prospective studies to date. A
modified two-port VATS technique and axillary minithoracotomy were
prospectively evaluated for possible differences in the short- and
long-term outcome for patients. Methods: In this study, 66 consecutive
patients underwent surgical pleurodesis for RSP through either a modified
two-port VATS procedure (group A, 33 patients) or axillary minithoracotomy
(group B, 33 patients). According to the study design (NCT01192217), the
patients were randomly assigned to the two groups, which were similar in
terms of age and body mass index. One-lung ventilation time, histology of
the available lung parenchyma specimens, early postoperative
complications, length of chest tube drainage and hospital stay, recurrence
rate, and a score for patient satisfaction with treatment based on the sum
of postoperative pain, dependent-arm mobilization, and return to full
activity subscores were evaluated. The follow-up period varied from 3 to
53 months (median, 30 months). Results: The one-lung ventilation and
operating times were significantly longer (p < 0.001) in group A than in
group B. The overall detection of blebs, bulla, or both was 51.5% in group
A and 63.8% in group B. The recurrence rate, complication rate,
postoperative chest tube drainage duration, postoperative hospital stay,
and incidence of chronic pain did not differ between the two groups. The
score for patient satisfaction with treatment was significantly higher in
group A than in group B (p < 0.001) according the subscores for better
dependent-arm mobilization and return to full activity. Conclusions:
Axillary minithoracotomy and VATS are equally effective for the treatment
of RSP, although the rate for resection of blebs, bulla, or both is higher
with the axillary minithoracotomy procedure. Although VATS is more time
consuming, it offers to the patient more satisfaction with treatment.
2011 Springer Science+Business Media, LLC.

<9>
Accession Number
2012113251
Authors
Santangeli P. Di Biase L. Burkhardt J.D. Bai R. Mohanty P. Pump A. Natale
A.
Institution
(Santangeli, Di Biase, Burkhardt, Bai, Mohanty, Pump, Natale) St. David's
Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States
Title
Examining the safety of amiodarone.
Source
Expert Opinion on Drug Safety. 11 (2) (pp 191-214), 2012. Date of
Publication: March 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Introduction: Amiodarone is the most widely used antiarrhythmic agent,
with demonstrated effectiveness against all the spectrum of cardiac
tachyarrhythmias. The risk of adverse effects acts as a limiting factor to
its utilization especially in the long term. This article systematically
reviews the published evidence on amiodarone versus placebo to examine its
safety as an antiarrhythmic drug. Areas covered: Authors collected data on
adverse effects reported in 49 randomized placebo-controlled trials with
amiodarone. Adverse effects were classified according to the organ/system
involved. Pooled estimates of the number needed to treat (NNT) and to harm
(NNH) versus placebo were calculated. Expert opinion: Amiodarone is
effective for both the acute conversion of atrial fibrillation (AF) (11
trials, NNT = 4 at 24 h; p = 0.003) and the prevention of postoperative AF
(18 trials, NNT = 8; p < 0.001), although with an increased risk of
bradycardia, hypotension, nausea or phlebitis (pooled NNH = 4; p < 0.001).
Amiodarone administration for the maintenance of sinus rhythm has a
favorable net clinical benefit (pooled NNT = 3; p < 0.001 versus pooled
NNH for either thyroid toxicity, gastrointestinal discomfort, skin
toxicity or eye toxicity = 11; p < 0.001). Treatment with amiodarone for
the prophylaxis of sudden cardiac death has less favorable net clinical
benefit (15 trials, NNT = 38; p < 0.001 versus NNH for either thyroid
toxicity, hepatic toxicity, pulmonary toxicity or bradycardia = 14; p <
0.001). Amiodarone treatment in this setting should be used in only
selected cases. 2012 Informa UK, Ltd.

<10>
Accession Number
2012114421
Authors
Chopra V. Wesorick D.H. Sussman J.B. Greene T. Rogers M. Froehlich J.B.
Eagle K.A. Saint S.
Institution
(Chopra, Wesorick, Sussman, Greene, Rogers, Froehlich, Eagle, Saint)
Division of General Internal Medicine, University of Michigan Health
System, Ann Arbor, MI, United States
(Chopra, Wesorick, Sussman, Greene, Rogers, Saint) Department of Internal
Medicine, University of Michigan Health System, Ann Arbor, MI, United
States
(Froehlich, Eagle) Department of Cardiovascular Medicine, University of
Michigan Health System, Ann Arbor, MI, United States
(Saint) Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, United
States
Title
Effect of perioperative statins on death, myocardial infarction, atrial
fibrillation, and length of stay: A systematic review and meta-analysis.
Source
Archives of Surgery. 147 (2) (pp 181-189), 2012. Date of Publication:
February 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Objective: To assess the influence of perioperative statin treatment on
the risk of death, myocardial infarction, atrial fibrillation, and
hospital and intensive care unit length of stay in statin-naive patients
undergoing cardiac or non-cardiac surgery. Data Sources: MEDLINE via
PubMed, EMBASE, Biosis, and the Cochrane Central Register of Controlled
Trials via Ovid. Additional studies were identified through hand searches
of bibliographies, trial Web sites, and clinical experts. Randomized
controlled trials reporting the effect of perioperative statins in
statin-naive patients undergoing cardiac and noncardiac surgery were
included. Study Selection: Two investigators independently selected
eligible studies from original research published in any language studying
the effects of statin use on perioperative outcomes of interest. Data
Extraction: Two investigators performed independent article abstraction
and quality assessment. Data Synthesis: Fifteen randomized controlled
studies involving 2292 patients met the eligibility criteria.
Random-effects meta-analyses of unadjusted and adjusted data were
performed according to the method described by DerSimonian and Laird.
Perioperative statin treatment decreased the risk of atrial fibrillation
in patients undergoing cardiac surgery (relative risk [RR], 0.56; 95% CI,
0.45 to 0.69; number needed to treat [NNT], 6). In cardiac and noncardiac
surgery, perioperative statin treatment reduced the risk of myocardial
infarction (RR, 0.53; 95% CI, 0.38 to 0.74; NNT, 23) but not the risk of
death (RR, 0.62; 95% CI, 0.34 to 1.14). Statin treatment reduced mean
length of hospital stay (standardized mean difference, -0.32; 95% CI,
-0.53 to -0.11) but had no effect on length of intensive care unit stay
(standardized mean difference, -0.08; 95% CI, -0.25 to 0.10). Conclusions:
Perioperative statin treatment in statin-naive patients reduces atrial
fibrillation, myocardial infarction, and duration of hospital stay. Wider
use of statins to improve cardiac outcomes in patients undergoing
high-risk procedures seems warranted. 2012 American Medical Association.
All rights reserved.

<11>
Accession Number
2012111589
Authors
Biancari F. Airaksinen K.E.J. Lip G.Y.H.
Institution
(Biancari) Division of Cardiothoracic and Vascular Surgery, Department of
Surgery, Oulu University Hospital, PO Box 21, 90029 Oulu, Finland
(Airaksinen) Division of Cardiology, Department of Internal Medicine,
Turku University Hospital, Turku, Finland
(Lip) University of Birmingham Centre for Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom
Title
Benefits and risks of using clopidogrel before coronary artery bypass
surgery: Systematic review and meta-analysis of randomized trials and
observational studies.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (3) (pp 665-675.e4),
2012. Date of Publication: March 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The benefits and risks associated with the use of clopidogrel
before coronary artery bypass grafting are controversial, and these were
investigated in the present meta-analysis. Methods: A systematic
literature search was performed to identify studies on the use of
clopidogrel before coronary artery bypass grafting. Meta-analysis was
performed according to the Cochrane Handbook for Systematic Reviews.
Results: The literature search yielded 3 prospective randomized studies
and 17 observational studies with valid data. Randomized studies were post
hoc analyses of the Clopidogrel as Adjunctive Reperfusion Therapy
(CLARITY), Clopidogrel for the Reduction of Events During Observation
(CREDO), and Clopidogrel in Unstable Angina to Prevent Recurrent Ischemic
Events trials. Meta-analysis based on these data showed a nonsignificant
reduced risk of immediate postoperative composite end point (death,
myocardial infarction, or stroke) in the clopidogrel group (risk ratio
[RR], 0.77; 95% confidence interval [CI], 0.58-1.04). Data from the CREDO
and CLARITY trials showed a similar risk of death (RR, 0.81; 95% CI,
0.20-3.37), myocardial infarction (RR, 0.58; 95% CI, 0.25-1.33), and major
bleeding according to Thrombolysis in Myocardial Infarction criteria (RR,
1.48; 95% CI, 0.72-3.04). Meta-analysis of observational studies showed
that preoperative exposure to clopidogrel was associated with an increased
risk of death (RR, 1.30; 95% CI, 1.02-1.67), reoperation for bleeding (RR,
1.88; 95% CI, 1.37-2.58), blood loss (mean difference, 157.8 mL; 95% CI,
61.9-253.6), need of packed red blood cell transfusion (RR, 1.23; 95% CI,
1.10-1.37), and increased use of blood products. A significantly reduced
risk of postoperative myocardial infarction was observed among patients
taking clopidogrel (RR, 0.63; 95% CI, 0.48-0.82). Conclusions: Contrary to
the findings of post hoc analyses of randomized trials, observational
studies showed that recent exposure to clopidogrel before coronary artery
bypass grafting is associated with increased risk of postoperative death,
reoperations for bleeding, blood loss, and need of blood transfusions.
Copyright 2012 by The American Association for Thoracic Surgery.

<12>
Accession Number
2012093370
Authors
Aggarwal V. Kapoor P.M. Choudhury M. Kiran U. Chowdhury U.
Institution
(Aggarwal, Kapoor, Choudhury, Kiran) Department of Cardiac Anaesthesia,
All India Institute of Medical Sciences, C.N. Centre, New Delhi-110 029,
India
(Chowdhury) Department of Cardiac Surgery, All India Institute of Medical
Sciences, New Delhi, India
Title
Utility of Sonoclot analysis and tranexamic acid in tetralogy of Fallot
patients undergoing intracardiac repair.
Source
Annals of Cardiac Anaesthesia. 15 (1) (pp 26-31), 2012. Date of
Publication: January-March 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Sonoclot analysis is a point of care test to monitor the coagulation
process, presenting a comprehensive evaluation of the clot formation and
retraction as well as platelet function. This randomized double-blinded
study was designed to investigate the utility of Sonoclot analysis in
monitoring the coagulation profile as also the antifibrinolytic effects of
tranexamic acid administered in patients with tetralogy of Fallot
undergoing intracardiac repair. Eighty of a total 94 patients were
randomly divided into two groups of 40 each. In the study group, TA was
administered thrice at a dosage of 10 mg/kg, i.e. before CPB, on CPB and
after CPB, whereas in the control group, placebo was administered at the
same time intervals. Sonoclot analysis and D-dimer measurement were
performed at baseline and following heparin neutralisation. An additional
variable, DR ₁₅ (diminishing rate of clot strength at 15 min
postmaximal clot strength), was calculated from the Sonoclot graph and was
compared with d-dimer levels as a measure of fibrinolysis. The three
Sonoclot variables, i.e. activated clotting time, clot rate and platelet
function, were deranged at baseline in all the patients. Post-CPB, the
change in these variables was not significant. ACT, clot rate and platelet
function showed no significant (P > 0.05) difference in both the groups at
both the time intervals. DR ₁₅ and d-dimer values were
comparable at baseline in both the groups. However, a significant (P <
0.05) difference was seen in these variables in the control group as
compared with the TA group following heparin neutralisation. To conclude,
Sonoclot analysis is a useful, point of care method for the monitoring of
coagulation and fibrinolysis in patients with tetralogy of Fallot
undergoing intracardiac repair.

<13>
Accession Number
2012093366
Authors
Sundar A.S. Kodali R. Sulaiman S. Ravullapalli H. Karthekeyan R. Vakamudi
M.
Institution
(Sundar, Kodali, Sulaiman, Ravullapalli, Karthekeyan) Department of
Cardiac Anaesthesiology, Sri Ramachandra Medical College and Research
Institute, No. 1, Ramachandra Nagar, Porur, Chennai-116, India
(Vakamudi) Department of Anaesthesiology and Critical Care, Sri
Ramachandra Medical College and Research Institute, Porur, Chennai, India
Title
The effects of preemptive pregabalin on attenuation of stress response to
endotracheal intubation and opioid-sparing effect in patients undergoing
off-pump coronary artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 15 (1) (pp 18-25), 2012. Date of
Publication: January-March 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
The clinical study was designed to evaluate and compare single
preoperative dose of pregabalin to a placebo regarding hemodynamic
responses to laryngoscopy and endotracheal intubation, to assess
perioperative fentanyl requirement and any side-effects. It was a
randomized, double-blind, placebo-controlled, parallel assignment,
efficacy study. The study was done at a tertiary university hospital. This
study was a comparison between two groups of 30 adult patients scheduled
for elective off pump coronary artery bypass surgery. In the control
group, the patients were given placebo capsules, and in the pregabalin
group, the patients were given pregabalin 150 mg capsule orally 1 h before
surgery. The patients were compared for hemodynamic changes before the
start of the surgery, after induction, 1, 3, and 5 min after intubation.
Additionally, fentanyl requirement during surgery and the first
postoperative day was also compared. The present study shows that a single
oral dose of 150 mg pregabalin given 1 h before surgery attenuated the
pressor response to tracheal intubation in adults, but the drug did not
show any effect on perioperative opioid consumption and was devoid of
side-effects in the given dose.

<14>
Accession Number
2012110227
Authors
Zellweger M.J. Kaiser C. Jeger R. Brunner-La Rocca H.-P. Buser P. Bader F.
Mueller-Brand J. Pfisterer M.
Institution
(Zellweger, Kaiser, Jeger, Brunner-La Rocca, Buser, Bader, Pfisterer)
Division of Cardiology, University Hospital, Petersgraben 4, 4031 Basel,
Switzerland
(Mueller-Brand) Division of Nuclear Medicine, University Hospital, Basel,
Switzerland
(Brunner-La Rocca) Department of Cardiology, University Hospital,
Maastricht, Netherlands
Title
Coronary artery disease progression late after successful stent
implantation.
Source
Journal of the American College of Cardiology. 59 (9) (pp 793-799), 2012.
Date of Publication: 28 Feb 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to define the importance of 5-year coronary
artery disease (CAD) progression after successful stenting. Background:
Safety concerns regarding first-generation drug-eluting stents mandate
5-year follow-up studies. However, only limited data exist on the
long-term importance of CAD progression relative to late stentrelated
problems. Methods: This study followed for 5 years, 428 consecutive
patients randomized to drug-eluting versus bare-metal stents with
successful stenting documented by freedom from symptoms/events and no
ischemic perfusion defects (PDs) after 6 months. Rest/stress scintigraphic
scans were repeated after 60 months. Late events and new PDs in areas
remote from stented vessels indicated CAD progression. Results: During
follow-up, 110 of 428 (25.7%) patients had 150 clinical events: 43
patients (10%) died, 36 (8.4%) suffered a myocardial infarction, and 71
(16.6%) needed repeat revascularization. Event rates were lower in remote
versus target-vessel areas (9.8% vs. 14.3%, p = 0.019). Remote myocardial
infarction and repeat revascularization accounted for 46 of 124 (37.1%)
nonfatal events and were similar for both stent types. Five-year
scintigraphic studies in patients without follow-up events showed 23.3%
new PDs, 71% of which were asymptomatic. Remote defects accounted for
37.5% PDs and were similar for both stent types. Conclusions: Even 5 years
after stenting, target-vessel events and/or new PDs remained more frequent
than CAD progression assessed by remote events and/or new PDs. Still,
remote events accounted for almost 40% of all events with a similar rate
of additional new PDs, often silent, and independent of stent type. This
documents the importance of CAD progression and stresses the need to
differentiate remote from target-vessel events/PDs in long-term stent
safety studies. (Basel Stent Kosten-Effektivitts Trial [BASKET];
ISRCTN75663024) 2012 American College of Cardiology Foundation.

<15>
Accession Number
2012119941
Authors
Ko Y.-G. Kim J.-S. Kim B.-K. Choi D. Hong M.-K. Jeon D.W. Yang J.-Y. Ahn
Y.K. Jeong M.H. Yu C.W. Yun K.-H. Lim D.-S. Jang Y.
Institution
(Ko, Kim, Kim, Choi, Hong, Jang) Severance Cardiovascular Hospital, Yonsei
University Health System, Seoul, South Korea
(Jeon, Yang) National Health Insurance Corporation, Ilsan Hospital,
Goyang, South Korea
(Ahn, Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Yu) Sejong General Hospital, Bucheon, South Korea
(Yun) Wonkwang University Hospital, Iksan, South Korea
(Lim) Korea University, Anam Hospital, Seoul, South Korea
Title
Efficacy of drug-eluting stents for treating in-stent restenosis of
drug-eluting stents (from the Korean des ISR multicenter registry study
[KISS]).
Source
American Journal of Cardiology. 109 (5) (pp 607-613), 2012. Date of
Publication: 01 Mar 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
There is currently no established standard treatment for in-stent
restenosis (ISR) after the implantation of a drug-eluting stent (DES). The
aim of this study was to investigate the efficacy of DES versus balloon
angioplasty (BA) for the treatment of DES ISR in a multicenter registry
cohort. After matching propensity scores of 805 patients with DES ISR
treated with either DES (n = 422) or BA (n = 383), 268 matched pairs were
selected and analyzed for major adverse cardiac events, a composite of
death, myocardial infarction, and target-vessel revascularization, as the
primary end point. Baseline clinical and lesion characteristics of the
matched pairs were similar. Survival free of major adverse cardiac events
at 2 years was higher with DES compared to BA (88.9% vs 78.7%, p <0.001),
mainly because of higher TVR-free survival (92.4% vs 81.0%, p <0.001).
Among various baseline variables, BA (hazard ratio 2.546, 95% confidence
interval 1.412 to 4.593, p = 0.002) was the most important independent
risk factor for recurrent target vessel revascularization, followed by
acute coronary syndromes as the clinical presentation of DES ISR, and
previous implantation of a sirolimus-eluting stent. Survival free of
death, myocardial infarction, or stent thrombosis did not differ between
the 2 groups. Whereas there was no significant difference in survival free
of target vessel revascularization between DES and BA for focal ISR
lesions, DES was superior to BA in diffuse ISR lesions (94.3% vs 75.2% at
2 years, p <0.001). In conclusion, compared to BA, the implantation of DES
was safe and more effective in the treatment of DES ISR. 2012 Elsevier
Inc.

<16>
Accession Number
2012113976
Authors
Adamkova V. Kacer P. Mraz J. Suchanek P. Pickova J. Kralova Lesna I.
Skibova J. Kozak P. Maratka V.
Institution
(Adamkova, Kacer, Suchanek, Kralova Lesna, Skibova) Department of
Preventive Cardiology, Institute for Clinical and Experimental Medicine,
Videnska 1958/19, 140 21 Prague 4-Krc, Czech Republic
(Mraz, Pickova, Kozak) University of South Bohemia, Faculty of Fisheries
and Protection of Waters, Ceske Budejovice, Czech Republic
(Maratka) Spa Podebrady, Czech Republic
Title
The consumption of the carp meat and plasma lipids in secondary prevention
in the heart ischemic disease patients.
Source
Neuroendocrinology Letters. 32 (SUPPL. 2) (pp 17-20), 2011. Date of
Publication: 2011.
Publisher
Maghira and Maas Publications (P.O. Box 26132, Stockholm S-100 41, Sweden)
Abstract
OBJECTIVES: Omega-3 fatty acids (FA) have been shown to be protective
against cardiovascular diseases (CVD). The effect of the consumption of
carp meat on CVD risk factors has not yet been examined in detail. We
ascertained the influence of a diet enriched with carp meat with an
elevated content of omega-3FA (200 g twice weekly for 4 weeks) in a group
of subjects after cardiac revascularization surgery for ischemic heart
disease with a follow-up spa treatment. DESIGN: After cardiac
revascularization surgery, the probands consumed either a standard spa
diet (56 individuals, 41 males, 15 females, age 41-80 years) or a diet
enriched with two portions of carp meat (87 individuals, 64 males, 23
females, age 50-82 years). The differences in body mass index
(kg/m²), blood pressure, plasma lipids and C-reactive protein
(CRP) of the groups were analyzed. RESULTS: In the group with a higher
consumption of carp meat, significantly greater improvements in lipid
parameters in comparison to the standard spa diet were detected (total
cholesterol p<0.001, triglycerides p<0.001, LDL-C p<0.001, CRP p<0.001,
HDL-C p<0.001). No differences between these groups in blood pressure and
body mass index were found. CONCLUSION: We conclude that the diet enriched
with carp meat significantly improved plasma lipid parameters in patients
after major cardiac revascularization surgery. 2011 Neuroendocrinology
Letters.

<17>
Accession Number
70675718
Authors
Kramer C.K. Rodrigues T.C. Canani L.H. Gross J.L. Azevedo M.J.
Institution
(Kramer, Rodrigues, Canani, Gross, Azevedo) Endocrinology Division,
Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
Title
Diabetic retinopathy predicts all-cause mortality and cardiovascular
events in both type 1 and 2 diabetes mellitus: A meta-analysis of
observational studies.
Source
Endocrine Reviews. Conference: 93rd Annual Meeting and Expo of the
Endocrine Society, ENDO 2011 Boston, MA United States. Conference Start:
20110604 Conference End: 20110607. Conference Publication: (var.pagings).
32 (3 Meeting Abstracts) , 2011. Date of Publication: June 2011.
Publisher
Endocrine Society
Abstract
The association of diabetic retinopathy (DR) with death and/or
cardiovascular events has been investigated, but its predictive role for
these outcomes is still debatable. Therefore, the aim of this study was to
investigate the association of DR with all-cause mortality and
cardiovascular events in patients with type 2 and type 1 diabetes by a
systematic review and meta-analysis. The electronic databases Medline and
Embase were searched up until April/2010 for cohort studies that evaluated
DR in type 2 or type 1 diabetic patients and reported total mortality
and/or fatal and non-fatal cardiovascular events (myocardial infarction,
angina pectoris, myocardial revascularization procedures, ischemic changes
on a conventional 12-lead electrocardiogram, transient ischemic attack,
nonfatal stroke, or lower leg amputation). Two independent reviewers
performed data extraction. Pooled effect estimates were obtained by using
random-effect meta-analysis. A total of 20 studies fulfilled inclusion
criteria and were included, providing data from 19,234 patients. In
patients with type 2 diabetes (n = 14,896) the presence of any degree of
DR increased the risk for all-cause mortality and/or cardiovascular events
by 2.34 (95%CI 1.96-2.80) as compared with patients without DR. The
positive likelihood ratio of any DR for all-cause mortality and/or
cardiovascular events was 1.78 (95%CI 1.57-2.00). In patients with type 1
diabetes (n = 4,438) the corresponding risk for all-cause mortality and/or
cardiovascular events was 4.10 (95%CI 1.50-11.18) and the positive
likelihood ratio was 1.80 (95%CI 1.20-2.70). In 15 included studies, the
risk determined by DR was also adjusted for possible confounders. The
results did not change when an additional meta-analysis including these
adjusted odds ratios was performed. DR was also predictive for all-cause
mortality in both type 2 (OR 2.41; 95%CI 1.87-3.10) and type 1 (OR 3.65;
95%CI 1.05-12.66) diabetes. Links between DR and studied outcomes were not
addressed by the current meta-analysis, but it demonstrated that the
presence of DR can help to identify patients with increased risk for
adverse outcomes. In conclusion, DR predicts all-cause mortality and
cardiovascular events in both type 2 and type 1 diabetes.

<18>
Accession Number
70674551
Authors
Quantz M.A.
Institution
(Quantz) LondonONCanada
Title
Does incisional vac therapy (IVAC) reduce wound complications in high risk
patients?.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 145D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Surgical site infections (SSI) remain prevalent in a
population of patients that are becoming older with more comorbidities.
Superficial sternal infections account for significant morbidity
(occasionally mortality) and resource utilization in patients undergoing
cardiac surgery. VAC therapy (KCI Canada) improves wound healing and
patient outcomes. The same processes that make VAC therapy on open wounds
may also provide enhanced healing to closed incisions (Incisional
VACIVAC). We examined the outcomes of IVAC therapy and Prevena, a new
self-contained incision management system (KCI Canada), on wound
infection, dehiscence and mediastinitis in a population at high risk for
wound complications. CONCLUSION: This initial experience with incisional
vacuum therapy in patients at high risk for wound complications is
positive. Prevena is particularly appealing as it facilitates patient
mobility and can be used in the outpatient setting. Future work should
include a randomized controlled trial to determine the efficacy and cost
effectiveness of this novel therapy.

<19>
Accession Number
70674550
Authors
Chan V. Mesana L. Mesana T.G. Ruel M.
Institution
(Chan, Mesana, Mesana, Ruel) OttawaONCanada
Title
Heart valve prosthesis selection in patients with end-stage renal failure
requiring dialysis: A systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 145D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Data describing heart valve prosthesis selection in patients
with end-stage renal disease (ESRD) on dialysis is scarce. A formal
summary of the available literature currently does not exist. The
objectives of this study were to perform a: 1) systematic review of
studies describing valve replacement in patients with ESRD on dialysis; 2)
quantitative meta-analysis comparing survival and valve-related outcomes
following valve replacement with bioprostheses versus mechanical
prostheses in this population. CONCLUSION: A meta-analysis of the
published literature suggests that there is no survival difference between
bioprostheses and mechanical prosthesis in patients with ESRD on dialysis.
Bioprostheses, however, were associated with fewer valve-related
complications. Bioprostheses are therefore recommended for patients with
ESRD on dialysis requiring heart valve replacement.

<20>
Accession Number
70674386
Authors
Sun J.C. Lamy A. Teoh K. Sheth T. Landry D. Jung H. Yusuf S. Eikelboom
J.W.
Institution
(Sun, Lamy, Teoh, Sheth, Landry, Jung, Yusuf, Eikelboom) HamiltonONCanada
Title
Randomized trial of fondaparinux versus heparin to prevent graft failure
after coronary artery bypass grafting: The fonda CABG pilot study.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 114D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Thrombotic occlusion is the major mechanism of early coronary
artery bypass graft (CABG) failure. Fondaparinux is effective for the
prevention of death, myocardial infarction (MI), and stroke in patients
with acute coronary syndrome (ACS) but has not been studied for the
prevention of graft failure and major cardiovascular (CV) events
post-CABG. We performed a pilot randomized controlled trial (RCT) to
assess the feasibility of comparing the efficacy and safety of
fondaparinux versus heparin for prevention of graft failure and major CV
events in patients undergoing CABG. CONCLUSION: One in 10 patients
undergoing CABG have at least one occluded graft at 30 days and one in 20
grafts is blocked at 30 days. Fondaparinux appears to be a safe
alternative to heparin after CABG and it seems feasible to conduct a
definitive RCT using CT angiography to evaluate the effect of fondaparinux
treatment on graft patency.

<21>
Accession Number
70674320
Authors
Afilalo J. Rasti M. Ohayon S. Eisenberg M.J.
Institution
(Afilalo, Rasti, Ohayon, Eisenberg) MontrealQCCanada
Title
Meta-regression of off-pump versus on-pump coronary artery bypass surgery.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 101D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The benefits of off-pump coronary artery bypass surgery
(OPCAB) continue to be debated, with prior meta-analyses suggesting a
reduction in atrial fibrillation and stroke, and a promising trend towards
reduction in myocardial infarction and death. These observed benefits may
be affected by a host of secondary factors such as age, comorbidities and
completeness of revascularization. There has yet to be a metaregression of
OPCAB (which can control for secondary factors), and prior meta-analyses
were published before five recent trials including the two largest trials
to date. Our objective was to perform a meta-regression of the
contemporary evidence for OPCAB. CONCLUSION: Contrary to previous trends,
our synthesis of the current body of evidence does not support
improvements in death, myocardial infarction, or stroke with OPCAB. The
benefit of OPCAB for reducing postoperative atrial fibrillation remains
significant. Moreover, our metaregression does not support the commonly
held hypothesis that OPCAB reduces stroke in elderly patients or those
with prior stroke, nor that OPCAB increases myocardial infarction in
trials with fewer number of grafts placed.

<22>
Accession Number
70674074
Authors
Fedak P.M. Kasatkin A. Kieser T.M. Maitland A. Borsato G. Frohlich D.C.
Narine K. King K.M.
Institution
(Fedak, Kasatkin, Kieser, Maitland, Borsato, Frohlich, Narine, King)
CalgaryABCanada
Title
A randomized controlled trial of adhesiveenhanced sternal closure to
improve postoperative functional recovery: Sternal innovative closure with
kryptonite (STICK) trial.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 54D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Unstable median sternotomy closure can lead to significant
morbidity such as sternal dehiscence and infection. Post-operative
functional recovery, incisional pain, and respiratory mechanics are also
influenced by early sternal stability. We previously established a
proof-ofconcept in human cadaveric sternum where conventional wire
cerclage was augmented with a novel biocompatible bone adhesive.
Mechanical strength was increased and pathologic sternal displacement
(>2mm) during physiologic distracting forces (i.e. coughing) was
prevented. We report herein the initial results of a randomized clinical
trial (STICK-RCT) examining the effects of adhesive-enhanced sternal
closure on functional post-operative recovery and early outcomes.
CONCLUSION: Adhesive-enhanced sternal closure is a novel cardiac surgery
innovation. These RCT data represent a worldwide first-in-man series.
Adhesive-enhanced closure is a safe and simple addition to conventional
wire closure with demonstrated benefits on functional recovery respiratory
capacity, incisional pain, and analgesic requirements. Longer follow-up is
necessary to further evaluate bony in-growth, osteosynthesis and potential
late complications. A larger multi-center RCT to examine the potential of
the adhesive to prevent major sternal complications is warranted.

<23>
Accession Number
70674050
Authors
Yamashita M.H. Cook R.C. Kearns M.J. Ramanathan K. Gin K. Humphries K.H.
Institution
(Yamashita, Cook, Kearns, Ramanathan, Gin, Humphries) VancouverBCCanada
Title
Prophylactic magnesium does not prevent atrial fibrillation after cardiac
surgery: A meta-analysis and comprehensive review of randomized trials.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 49D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Atrial fibrillation (AF) after cardiac surgery is a common
complication that is associated with an increased risk of death, stroke
and longer hospital stays. Previous trials have shown widely divergent
results while meta-analyses have concluded that magnesium prevents
postoperative AF, although with a significant degree of heterogeneity.
Recently, the largest randomized controlled trial (RCT) published to date
concluded that magnesium sulphate is not protective against AF following
cardiac surgery. The objective of this study was to conduct a new
meta-analysis to include the results of this large RCT and to investigate
the heterogeneity in previous meta-analyses. CONCLUSIONS: When the
evidence is restricted to high quality RCTs prophylactic magnesium is not
effective in preventing AF following cardiac surgery. Although a pooled
effect estimate using all published studies suggests that magnesium may
prevent postoperative AF, there is a significant degree of heterogeneity
and evidence of publication bias which requires further investigation.
Limiting the meta-analysis to high quality RCTs decreases the
heterogeneity and is likely a better indicator of the real effect of
prophylactic magnesium on the incidence of AF post cardiac surgery. The
available evidence also suggests that magnesium has no effect on the
incidence of stroke, 30 day all-cause mortality or length of hospital
stay.