EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2012181762
Authors
Oddershede L. Andreasen J.J. Brocki B.C. Ehlers L.
Institution
(Oddershede, Andreasen, Brocki) Department of Cardiothoracic Surgery,
Aarhus University Hospital, Aalborg Hospital, Hobrovej 18-22, Aalborg
9100, Denmark
(Oddershede, Ehlers) Center for Improvement in Health Care, Faculty of
Social Sciences, Aalborg University, Aalborg East, Denmark
Title
Economic evaluation of endoscopic versus open vein harvest for coronary
artery bypass grafting.
Source
Annals of Thoracic Surgery. 93 (4) (pp 1174-1180), 2012. Date of
Publication: April 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: A short saphenous vein segment is commonly used as a conduit
for coronary artery bypass grafting, and clinicians must decide whether to
obtain it by performing open (OVH) or endoscopic vein harvest (EVH). We
conducted a health economic evaluation, using data on resource usage
collected alongside a randomized controlled trial, to investigate whether
EVH is cost-effective compared with OVH. Methods: Analyses were performed
in accordance with international guidelines for health economic
evaluations. We constructed 3 cost-levels as the current literature is
inconclusive as to which resource consumptions differ significantly
between harvesting methods. Outcomes were measured as purulent infections
avoided in the cost-effectiveness analysis and for the cost-utility
analysis we estimated quality-adjusted life-years gained. Results were
presented as incremental cost-effectiveness ratios: ie, the extra cost of
obtaining one extra quality-adjusted life-year and the extra cost of
avoiding one purulent infection. To handle uncertainties, we performed
bias corrected bootstrap analyses on 5,000 resamples and constructed
cost-effectiveness acceptability curves. Results: The incremental
cost-effectiveness ratio was $79,391/quality-adjusted life-year and
$1,970/purulent infection avoided when costs and outcomes within 35 days
postoperatively were compared. Within 35 days postoperatively, EVH was
less than 1% cost-effective at a willingness-to-pay threshold of
$50,000/quality- adjusted life-year. Conclusions: The EVH was not
cost-effective within 35 days postoperatively. Future studies should
investigate long-term cost effectiveness. 2012 The Society of Thoracic
Surgeons.

<2>
Accession Number
2012191997
Authors
Wang Y. Wu B. Shu X.
Institution
(Wang, Shu) Shanghai Institute of Cardiovascular Diseases, Zhongshan
Hospital, Fudan University, Shanghai, China
(Wu) Department of Transfusion, Zhongshan Hospital, Fudan University,
Shanghai, China
Title
Meta-analysis of randomized controlled trials comparing intracoronary and
intravenous administration of glycoprotein IIb/IIIa inhibitors in patients
with ST-elevation myocardial infarction.
Source
American Journal of Cardiology. 109 (8) (pp 1124-1130), 2012. Date of
Publication: 15 Apr 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Glycoprotein IIb/IIIa receptor inhibitors (GPIs) have been widely adopted
as an adjuvant regimen during primary percutaneous coronary intervention
in patients with ST-segment elevation myocardial infarction, but whether
intracoronary administration of these potent antiplatelet agents conveys
better efficacy and safety over the intravenous route has not been well
addressed. A meta-analysis was performed by a systematic search of the
published research for randomized controlled trials comparing
intracoronary versus intravenous administration of GPIs in patients with
ST-segment elevation myocardial infarction. Eight studies involving 686
patients in the intracoronary arm and 660 in the intravenous arm met the
inclusion criteria. Postprocedural Thrombolysis In Myocardial Infarction
(TIMI) grade 3 flow (odds ratio [OR] 1.46, 95% confidence interval [CI]
1.08 to 1.98, p <0.05) and myocardial reperfusion grade 2 or 3 (OR 1.78,
95% CI 1.29 to 2.46, p <0.001) were markedly more often achieved in
patients who received intracoronary boluses of GPIs than those receiving
the intravenous strategy. Intracoronary administration resulted in a
reduced incidence of mortality (OR 0.44, 95% CI 0.21 to 0.92, p <0.05),
target vessel revascularization (OR 0.53, 95% CI 0.29 to 0.99, p <0.05),
and the composite end point of major adverse cardiac events (OR 0.48, 95%
CI 0.31 to 0.76, p <0.005) at 30-day follow-up. No significant difference
was found in terms of major or minor bleeding (OR 1.14, p = 0.71, and OR
0.86, p = 0.47 respectively). In conclusion, intracoronary administration
of GPIs yielded favorable outcomes in postprocedural blood flow
restoration and 30-day clinical prognosis in patients with ST-segment
elevation myocardial infarction. The intracoronary use of GPIs can be
recommended as a preferred regimen during primary percutaneous coronary
intervention. 2012 Elsevier Inc. All rights reserved.

<3>
Accession Number
2012175353
Authors
Antolovic D. Rakow A. Contin P. Ulrich A. Rahbari N.N. Buchler M.W. Weitz
J. Koch M.
Institution
(Antolovic, Rakow, Contin, Ulrich, Rahbari, Buchler, Weitz, Koch)
Department of General, Visceral and Transplantation Surgery, University of
Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
Title
A randomised controlled pilot trial to evaluate and optimize the use of
anti-platelet agents in the perioperative management in patients
undergoing general and abdominal surgery - The APAP trial
(ISRCTN45810007).
Source
Langenbeck's Archives of Surgery. 397 (2) (pp 297-306), 2012. Date of
Publication: February 2012.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: Surgeons are increasingly confronted by patients on long-term
low-dose acetylsalicylic acid (ASA). However, owing to a lack of
evidence-based data, a widely accepted consensus on the perioperative
management of these patients in the setting of non-cardiac surgery has not
yet been reached. Primary objective was to evaluate the safety of
continuous versus discontinuous use of ASA in the perioperative period in
elective general or abdominal surgery. Methods: Fifty-two patients
undergoing elective cholecystectomy, inguinal hernia repair or
colonic/colorectal surgery were recruited to this pilot study. According
to cardiological evaluation, non-high-risk patients who were on longterm
treatment with low-dose ASA were eligible for inclusion. Patients were
allocated randomly to continuous use of ASA or discontinuation of ASA
intake for 5 days before until 5 days after surgery. The primary outcome
was the incidence of major haemorrhagic and thromboembolic complications
within 30 days after surgery. Results: A total of 26 patients were
allocated to each study group. One patient (3.8%) in the ASA continuation
group required re-operation due to post-operative haemorrhage. In neither
study group, further bleeding complications occurred. No clinically
apparent thromboembolic events were reported in the ASA continuation and
the ASA discontinuation group. Furthermore, there were no significant
differences between both study groups in the secondary endpoints.
Conclusions: Perioperative intake of ASA does not seem to influence the
incidence of severe bleeding in non-high-risk patients undergoing elective
general or abdominal surgery. Further, adequately powered trials are
required to confirm the findings of this study. Springer-Verlag 2011.

<4>
Accession Number
22338416
Authors
Iqbal J. Ghaffar A. Shahbaz A. Sami W. Khan J.S.
Institution
(Iqbal) Punjab Institute of Cardiology, Lahore, Pakistan.
Title
Postoperative arrhythmias after coronary artery bypass grafting: a
comparison between 'off pump' and 'on pump' CABG.
Source
Journal of Ayub Medical College, Abbottabad : JAMC. 22 (3) (pp 48-53),
2010. Date of Publication: 2010 Jul-Sep.
Abstract
Coronary artery bypass without cardiopulmonary bypass (CPB) has gained
popularity recently with the development of devices that allow for
improved exposure and standardization in off pump coronary artery bypass
surgery. Off pump coronary artery bypass surgery reduces some of the
morbidities traditionally attributed to CPB. The primary goal of off pump
coronary artery bypass surgery is to provide an equally comprehensive
operational result as the conventional operation. The purpose of the study
was to compare intra operative and postoperative arrhythmias in off pump
coronary artery bypass (OPCAB) verses conventional CABG. This study was a
sub-group as part of a randomised control trial and was conducted from
January 2006 to March 2007 at Punjab Institute of Cardiology. One hundred
patients were included in 'on pump' group-A, and 100 patients in off pump'
group-B. Thirty-three patients in group-A and 22 in group-B developed
arrhythmias. Twenty-six patients developed atrial fibrillation in group-A
and 16 patients in group-B. Mortality due to arrhythmias was 5, three were
in on pump group, and 2 were in off pump group. There is non-significant
tendency towards less frequency of postoperative arrhythmias in the off
pump patients as compared to on pump coronary artery bypass surgery
patients.

<5>
Accession Number
2012178553
Authors
Hong D.M. Jeon Y. Lee C.-S. Kim H.J. Lee J.-M. Bahk J.-H. Kim K.-B. Hwang
H.Y.
Institution
(Hong, Jeon, Lee, Kim, Lee, Bahk) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, 110-744, South Korea
(Kim, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul, South Korea
Title
Effects of remote ischemic preconditioning with postconditioning in
patients undergoing off-pump coronary artery bypass surgery - Randomized
controlled trial -.
Source
Circulation Journal. 76 (4) (pp 884-890), 2012. Date of Publication: 2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Myocardial injury is associated with an adverse outcome after
off-pump coronary artery bypass graft surgery (OPCAB). The authors
conducted a randomized controlled trial to evaluate whether remote
ischemic preconditioning (RIPC) with remote ischemic postconditioning
(RIPostC) reduces myocardial injury in patients undergoing OPCAB. Methods
and Results: Seventy patients scheduled for OPCAB were randomly assigned
to an RIPC+RIPostC group (n=35) or a control group (n=35). In the
RIPC+RIPostC group, 4 cycles of 5-min ischemia and 5-min reperfusion were
done on a lower limb before anastomoses (RIPC) and after anastomoses
(RIPostC). RIPC+RIPostC significantly reduced postoperative serum troponin
I levels (P=0.001). The area under the curve for postoperative troponin I
was 48.7% lower in the RIPC+RIPostC group (median [interquartile range],
21.3hng^-1ml^-1,
16.5-53.1hng^-1ml^-1 vs.
41.5hng^-1ml^-1,
24.6-90.2hng^-1ml^-1, P=0.020). There was no
significant difference in creatinine levels and
PaO₂/F_iO₂ ratios between the 2 groups.
Conclusions: RIPC+RIPostC by lower limb ischemia decreased postoperative
myocardial enzyme elevation by almost half postoperatively in patients
undergoing OPCAB.

<6>
Accession Number
2012182508
Authors
Karkouti K. Wijeysundera D.N. Yau T.M. McCluskey S.A. Chan C.T. Wong P.-Y.
Crowther M.A. Hozhabri S. Beattie W.S.
Institution
(Karkouti, Wijeysundera) Department of Anesthesia, Institute of Health
Policy, Management, and Evaluation, University of Toronto, Toronto, ON,
Canada
(Karkouti, Yau) Toronto General Research Institute, University Health
Network, Toronto, ON, Canada
(Wijeysundera) Keenan Research Centre, Li Ka Shing Knowledge Institute,
Steet Michael's Hospital, Toronto, ON, Canada
(Yau) Department of Surgery, Peter Munk Cardiac Centre, University of
Toronto, Toronto, ON, Canada
(McCluskey, Hozhabri, Beattie) Department of Anesthesia, Toronto General
Hospital, University of Toronto, Canada
(Chan) Department of Medicine, University Health Network, University of
Toronto, Canada
(Wong) Department of Laboratory Medicine and Pathobiology, University
Health Network, University of Toronto, Canada
(Crowther) Department of Medicine, Division of Hematology, McMaster
University, Hamilton, ON, Canada
Title
Advance targeted transfusion in anemic cardiac surgical patients for
kidney protection: An unblinded randomized pilot clinical trial.
Source
Anesthesiology. 116 (3) (pp 613-621), 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
Introduction: Acute kidney injury (AKI) is a serious complication of
cardiac surgery, and preoperative anemia and perioperative erythrocyte
transfusion are important risk factors. Prophylactic erythrocyte
transfusion in anemic patients may, therefore, protect against AKI.
Methods: In this unblinded, parallel-group, randomized pilot trial, 60
anemic patients (hemoglobin 10-12 g/dL) undergoing cardiac surgery with
cardiopulmonary bypass were randomized (1:1) to prophylactic transfusion
(2 units of erythrocytes transfused 1 to 2 days before surgery (n=29) or
standard of care (transfusions as indicated; n = 31). Between-group
differences in severity of perioperative anemia, transfusion, and AKI
(more than 25% drop in estimated glomerular filtration rate) were
measured. The relationships between transfusion, iron levels, and AKI were
also measured. Results: Perioperative anemia and erythrocyte transfusions
were lower in the prophylactic transfusion group-median (25th, 75th
percentiles) for nadir hemoglobin was 8.3 (7.9, 9.1) versus 7.6 (6.9, 8.2)
g/dL (P = 0.0008) and for transfusion was 0 (0, 2) versus 2 (1, 4) units
(P = 0.0002)-but between-group AKI rates were comparable (11 patients per
group). In 35 patients with iron studies, perioperative transfusions were
directly related to postoperative transferrin saturation (correlation
coefficient 0.6; P = 0.0002), and high (more than 80%) transferrin
saturation was associated with AKI (5/5 vs. 8/30; P = 0.005), implicating
transfusion-related iron overload as a cause of AKI. Conclusions: In
anemic patients, prophylactic erythrocyte transfusion reduces
perioperative anemia and erythrocyte transfusions, and may reduce plasma
iron levels. Adequately powered studies assessing the effect of this
intervention on AKI are warranted. Copyright 2012, the American Society
of Anesthesiologists, Inc.