EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 21

Results Generated From:
Embase <1980 to 2012 Week 16>
Embase (updates since 2012-04-12)

<1>
Accession Number
2012203323
Authors
D'Ascenzo F. Cerrato E. Biondi-Zoccai G. Moretti C. Omede P. Sciuto F.
Bollati M. Modena M.G. Gaita F. Sheiban I.
Institution
(D'Ascenzo, Cerrato, Moretti, Omede, Sciuto, Bollati, Gaita, Sheiban)
Division of Cardiology, University of Turin, S. Giovanni Battista
'Molinette' Hospital, Corso Bramante 88-90, Turin 10126, Italy
(Biondi-Zoccai, Modena) Division of Cardiology, University of Modena and
Reggio Emilia, Modena, Italy
Title
Acute coronary syndromes in human immunodeficiency virus patients: A
meta-analysis investigating adverse event rates and the role of
antiretroviral therapy.
Source
European Heart Journal. 33 (7) (pp 875-880), 2012. Date of Publication:
April 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims: Highly active antiretroviral therapy (HAART) dramatically reduces
human immunodeficiency virus (HIV)-associated morbidity and mortality, but
adverse effects of HAART are becoming an increasing challenge, especially
in the setting of acute coronary syndromes (ACS). We thus performed a
comprehensive review of studies focusing on ACS in HIV patients. Methods
and results: MEDLINE/PubMed was systematically screened for studies
reporting on ACS in HIV patients. Baseline, treatment, and outcome data
were appraised and pooled with random-effect methods computing summary
estimates [95% confidence intervals (CIs)]. A total of 11 studies
including 2442 patients were identified, with a notably low prevalence of
diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were
8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90%
(2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing
cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95%
CI), no deaths were recorded, with an incidence of 9.42% of acute
myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51;
95% CI) of percutaneous coronary revascularization. Moreover, pooled
analysis of the studies reporting incidence of acute myocardial infarction
in patients exposed to protease inhibitors showed an overall significant
risk of 2.68 (odds ratio 1.89, 3.89; 95% CI). Conclusion: Human
immunodeficiency virus patients admitted for ACS face a substantial
short-term risk of death and a significant long-term risk of coronary
revascularization and myocardial infarction, especially if receiving
protease inhibitors. Published on behalf of the European Society of
Cardiology. All rights reserved. The Author 2011.

<2>
Accession Number
2012180024
Authors
Ting R.-D. Keech A.C. Drury P.L. Donoghoe M.W. Hedley J. Jenkins A.J.
Davis T.M.E. Lehto S. Celermajer D. Simes R.J. Rajamani K. Stanton K.
Institution
(Ting, Keech, Donoghoe, Jenkins, Simes, Rajamani) National Health and
Medical Research Council Clinical Trials Centre, University of Sydney,
Sydney, NSW, Australia
(Ting, Keech, Celermajer, Rajamani) Department of Cardiology, Royal Prince
Alfred Hospital, Sydney, NSW, Australia
(Drury) Auckland Diabetes Centre, Auckland, New Zealand
(Hedley) Department of Internal Medicine, Wairau Hospital, Blenheim, New
Zealand
(Jenkins) Department of Medicine, University of Melbourne, Melbourne, VIC,
Australia
(Davis) School of Medicine and Pharmacology, University of Western
Australia, Perth, WA, Australia
(Lehto) Department of Medicine, Kuopio University Hospital, Kuopio,
Finland
(Stanton) Department of Endocrinology and Diabetes, Royal Perth Hospital,
Perth, WA, Australia
Title
Benefits and safety of long-term fenofibrate therapy in people with type 2
diabetes and renal impairment: The FIELD study.
Source
Diabetes Care. 35 (2) (pp 218-225), 2012. Date of Publication: February
2012.
Publisher
American Diabetes Association Inc. (1701 North Beauregard St., Alexandria
VA 22311, United States)
Abstract
OBJECTIVE - Diabetic patients with moderate renal impairment (estimated
glomerular filtration rate [eGFR] 30-59 mL/min/1.73 m²) are at
particular cardiovascular risk. Fenofibrate's safety in these patients is
an issue because it may elevate plasma creatinine. Furthermore, guidelines
regarding fenofibrate dosing in renal impairment vary internationally. We
investigated fenofibrate's effects on cardiovascular and end-stage renal
disease (ESRD) events, according to eGFR, in the Fenofibrate Intervention
and Event Lowering in Diabetes (FIELD) Study. RESEARCH DESIGN AND METHODS
- Type 2 diabetic patients (aged 50-75 years) with eGFR>30 mL/min/1.73
m² were randomly allocated to a fixed dose of fenofibrate (200
mg daily) (n = 4,895) or placebo (n = 4,900) for 5 years. Baseline renal
function (Modification of Diet in Renal Disease equation) was grouped by
eGFR (30-59, 60-89, and >=90 mL/min/1.73 m²). The prespecified
outcome was total cardiovascular events (composite of cardiovascular
death, myocardial infarction, stroke, and coronary/carotid
revascularization). Serious adverse events and instances of ESRD (plasma
creatinine >400 mumol/L, dialysis, renal transplant, or renal death) were
recorded. Analysis was by intention to treat. RESULTS - Overall,
fenofibrate reduced total cardiovascular events, compared with placebo
(hazard ratio 0.89 [95% CI 0.80-0.99]; P = 0.035). This benefit was not
statistically different across eGFR groupings (P = 0.2 for interaction)
(eGFR 30-59 mL/min/1.73 m²: 0.68 [0.47-0.97], P = 0.035; eGFR
>=90 mL/min/1.73 m²: 0.85 [0.70-1.02], P = 0.08). ESRD rates
were similar between treatment arms, without adverse safety signals of
fenofibrate use in renal impairment. CONCLUSIONS - Patients with type 2
diabetes andmoderate renal impairment benefit from long-term fenofibrate,
without excess drug-related safety concerns compared with those with no
ormild renal impairment. Fenofibrate treatment should not be
contraindicated in moderate renal impairment, suggesting that current
guidelines may be too restrictive. 2012 by the American Diabetes
Association.

<3>
Accession Number
2012205462
Authors
Cittadini A. Napoli R. Monti M.G. Rea D. Longobardi S. Netti P.A. Walser
M. Sama M. Aimaretti G. Isgaard J. Sacca L.
Institution
(Cittadini, Napoli, Monti, Rea, Sacca) Department of Clinical Medicine and
Cardiovascular and Immunological Sciences, University Federico II, Naples,
Italy
(Longobardi) Merck Serono Group, Rome, Italy
(Netti) Interdisciplinary Research Centre on Biomaterials, University
Federico II, Naples, Italy
(Netti) Center for Advanced Biomaterial for Health Care, Interdisciplinary
Research Centre on Biomaterials, Italian Institute of Technology, Naples,
Italy
(Walser, Isgaard) Department of Internal Medicine, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Sama, Aimaretti) Department of Clinical and Experimental Medicine,
University A. Avogadro, Novara, Italy
Title
Metformin prevents the development of chronic heart failure in the SHHF
rat model.
Source
Diabetes. 61 (4) (pp 944-953), 2012. Date of Publication: April 2012.
Publisher
American Diabetes Association Inc. (1701 North Beauregard St., Alexandria
VA 22311, United States)
Abstract
Insulin resistance is a recently identified mechanism involved in the
pathophysiology of chronic heart failure (CHF). We investigated the
effects of two insulin-sensitizing drugs (metformin and rosiglitazone) in
a genetic model of spontaneously hypertensive, insulin-resistant rats
(SHHF). Thirty SHHF rats were randomized into three treatment groups as
follows: 1) metformin (100 mg/kg per day), 2) rosiglitazone (2 mg/kg per
day), and 3) no drug. Ten Sprague-Dawley rats served as normal controls.
At the end of the treatment period (12 months), the cardiac phenotype was
characterized by histology, echocardiography, and isolated perfused heart
studies. Metformin attenuated left ventricular (LV) remodeling, as shown
by reduced LV volumes, wall stress, perivascular fibrosis, and cardiac
lipid accumulation. Metformin improved both systolic and diastolic indices
as well as myocardial mechanical efficiency, as shown by improved ability
to convert metabolic energy into mechanical work. Metformin induced a
marked activation of AMP-activated protein kinase, endothelial nitric
oxide synthase, and vascular endothelial growth factor and reduced tumor
necrosis factor-alpha expression and myocyte apoptosis. Rosiglitazone did
not affect LV remodeling, increased perivascular fibrosis, and promoted
further cardiac lipid accumulation. In conclusion, long-term treatment
with metformin, but not with rosiglitazone, prevents the development of
severe CHF in the SHHF model by a wide-spectrum interaction that involves
molecular, structural, functional, and metabolic-energetic mechanisms.
2012 by the American Diabetes Association.

<4>
Accession Number
2012185841
Authors
Jilaihawi H. Kashif M. Fontana G. Furugen A. Shiota T. Friede G. Makhija
R. Doctor N. Leon M.B. Makkar R.R.
Institution
(Jilaihawi, Kashif, Furugen, Shiota, Friede, Makhija, Doctor, Makkar)
Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los
Angeles, CA 90048, United States
(Fontana) Lenox Hill Hospital, Heart and Vascular Institute of New York,
New York, NY, United States
(Leon) Columbia University Medical Center, New York, NY, United States
Title
Cross-sectional computed tomographic assessment improves accuracy of
aortic annular sizing for transcatheter aortic valve replacement and
reduces the incidence of paravalvular aortic regurgitation.
Source
Journal of the American College of Cardiology. 59 (14) (pp 1275-1286),
2012. Date of Publication: 03 Apr 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: In an effort to define the gold standard for annular sizing
for transcatheter aortic valve replacement (TAVR), we sought to critically
analyze and compare the predictive value of multiple measures of the
aortic annulus for post-TAVR paravalvular (PV) regurgitation and then
assess the impact of a novel cross-sectional computed tomographic (CT)
approach to annular sizing. Background: Recent studies have shown clear
discrepancies between conventional 2-dimensional (2D) echocardiographic
and CT measurements. In terms of aortic annular measurement for TAVR, such
findings have lacked the outcome analysis required to inform clinical
practice. Methods: The discriminatory value of multiple CT annular
measures for post-TAVR PV aortic regurgitation was compared with 2D
echocardiographic measures. TAVR outcomes with device selection according
to aortic annular sizing using a traditional 2D transesophageal
echocardiographyguided or a novel CT-guided approach were also studied.
Results: In receiver-operating characteristic models, cross-sectional CT
parameters had the highest discriminatory value for post-TAVR PV
regurgitation: This was with the area under the curve for [maximal
cross-sectional diameter minus prosthesis size] of 0.82 (95% confidence
interval: 0.69 to 0.94; p < 0.001) and that for [circumference-derived
cross-sectional diameter minus prosthesis size] of 0.81 (95% confidence
interval: 0.7 to 0.94; p < 0.001). In contrast, traditional
echocardiographic measures were nondiscriminatory in relation to post-TAVR
PV aortic regurgitation. The prospective application of a CT-guided
annular sizing approach resulted in less PV aortic regurgitation of grade
worse than mild after TAVR (7.5% vs. 21.9%; p = 0.045). Conclusions: Our
data lend strong support to 3-dimensional cross-sectional measures, using
CT as the new gold standard for aortic annular evaluation for TAVR with
the Edwards SAPIEN device. 2012 American College of Cardiology
Foundation.

<5>
Accession Number
2012185843
Authors
Herrmann H.C. Gertz Z.M. Silvestry F.E. Wiegers S.E. Woo Y.J. Hermiller J.
Segar D. Heimansohn D. Gray W. Homma S. Argenziano M. Wang A. Jollis J.
Lampert M.B. Alexander J. Mauri L. Foster E. Glower D. Feldman T.
Institution
(Herrmann, Gertz, Silvestry, Wiegers, Woo) University of Pennsylvania
Medical Center, Philadelphia, PA, United States
(Hermiller, Segar, Heimansohn) Care Group Heart Center, Indianapolis, IN,
United States
(Gray, Homma, Argenziano) Columbia University Medical Center, New York,
NY, United States
(Wang, Jollis, Glower) Duke University Medical Center, Durham, NC, United
States
(Lampert, Alexander, Feldman) Northshore University Health System,
Evanston, IL, United States
(Mauri) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Foster) University of California San Francisco, San Francisco, CA, United
States
Title
Effects of atrial fibrillation on treatment of mitral regurgitation in the
EVEREST II (Endovascular valve edge-to-edge repair study) randomized
trial.
Source
Journal of the American College of Cardiology. 59 (14) (pp 1312-1319),
2012. Date of Publication: 03 Apr 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to characterize patients with
mitral regurgitation (MR) and atrial fibrillation (AF) treated
percutaneously using the MitraClip device (Abbott Vascular, Abbott Park,
Illinois) and compare the results with surgery in this population.
Background: The EVEREST II (Endovascular Valve Edge-to-Edge Repair Study)
randomized controlled trial compared a less invasive catheter-based
treatment for MR with surgery, providing an opportunity to assess the
impact of AF on the outcomes of both the MitraClip procedure and surgical
repair. Methods: The study population included 264 patients with
moderately severe or severe MR assessed by an independent
echocardiographic core laboratory. Comparison of safety and effectiveness
study endpoints at 30 days and 1 year were made using both
intention-to-treat and per-protocol (cohort of patients with MR <=2+ at
discharge) analyses. Results: Pre-existing AF was present in 27% of
patients. These patients were older, had more advanced disease, and were
more likely to have a functional etiology. Similar reduction of MR to <=2+
before discharge was achieved in patients with AF (83%) and in patients
without AF (75%, p = 0.3). Freedom from death, mitral valve surgery for
valve dysfunction, and MR >2+ was similar at 12 months for AF patients
(64%) and for no-AF patients (61%, p = 0.3). At 12 months, MR reduction to
<2+ was greater with surgery than with MitraClip, but there was no
interaction between rhythm and MR reduction, and no difference in
all-cause mortality between patients with and patients without AF.
Conclusions: Atrial fibrillation is associated with more advanced valvular
disease and noncardiac comorbidities. However, acute procedural success,
safety, and 1-year efficacy with MitraClip therapy is similar for patients
with AF and without AF. 2012 American College of Cardiology Foundation.

<6>
[Use Link to view the full text]
Accession Number
22057829
Authors
Matamis D. Pampori S. Papathanasiou A. Papakonstantinou P. Tsagourias M.
Galiatsou E. Koulouras V. Nakos G.
Institution
(Matamis) Intensive Care Unit, Papageorgiou General Hospital,
Thessalonica, Greece.
Title
Inhaled NO and sildenafil combination in cardiac surgery patients with
out-of-proportion pulmonary hypertension: acute effects on postoperative
gas exchange and hemodynamics.
Source
Circulation. Heart failure. 5 (1) (pp 47-53), 2012. Date of Publication: 1
Jan 2012.
Abstract
The goal of this study was to examine the effects of coadministration of
sildenafil and inhaled nitric oxide (iNO) in patients with
out-of-proportion pulmonary hypertension who underwent cardiac valve
replacement surgery. Twenty consecutive cardiac surgery patients with
out-of-proportion pulmonary hypertension were randomly assigned
postoperatively into 2 groups: group A received 10 ppm of iNO followed by
sildenafil (100 mg) orally 30 minutes later, and group B initially
received sildenafil (100 mg) orally followed by 10 ppm of iNO 60 minutes
later. Hemodynamic and gas exchange data were obtained at baseline, after
administration of either iNO or sildenafil alone, and at 90 minutes from
baseline. In group A, iNO resulted in a significant reduction in mean
pulmonary artery pressure (MPAP) and pulmonary vascular resistance index
(PVRI) (by 9.6% and 20.8%, respectively). In group B, sildenafil
administration also resulted in a significant decrease in mean arterial
pressure, MPAP, pulmonary artery occlusive pressure, PVRI, and systemic
vascular resistance index but also in the PaO(2)/inspired fraction of
oxygen ratio (by 18.7%, 22.0%, 15.7%, 31.6%, 21.3%, and 14%,
respectively). In both groups, the coadministration of the 2 drugs
resulted in a significant further reduction of mean arterial pressure,
MPAP, pulmonary artery occlusive pressure, systemic vascular resistance
index, and PVRI, whereas cardiac index and mixed venous oxygen saturation
remained unchanged. The hypoxemia after sildenafil administration in group
B improved after the coadministration of iNO, and thus PaO(2)/inspired
fraction of oxygen returned to values near baseline. In this study, the
postoperative coadministration of iNO and oral sildenafil in patients with
out-of-proportion pulmonary hypertension undergoing cardiac surgery is
safe and results in an additive favorable effect on pulmonary arterial
pressure and pulmonary vascular resistance, without systemic hypotension
and ventilation/perfusion mismatch.

<7>
Accession Number
20709514
Authors
Monti L.D. Lucotti P.C.G. Setola E. Rossodivita A. Pala M.G. Galluccio E.
LaCanna G. Castiglioni A. Cannoletta M. Meloni C. Zavaroni I. Bosi E.
Alfieri O. Piatti P.M.
Institution
(Monti, Galluccio, Bosi, Piatti) Cardiodiabetes and Core Laboratory,
Metabolic and Cardiovascular Science Division, San Raffaele Scientific
Institute, Via Olgettina 60, 20132 Milan, Italy
(Lucotti, Setola, Bosi) Internal Medicine Department, Cardio-Metabolic and
Clinical Trials Unit, Metabolic and Cardiovascular Science Division, San
Raffaele Scientific Institute, 20132 Milan, Italy
(Rossodivita, Pala, LaCanna, Castiglioni, Cannoletta, Meloni, Alfieri)
Cardio-thoraco-vascular Department, Metabolic and Cardiovascular Science
Division, San Raffaele Scientific Institute, 20132 Milan, Italy
(Bosi, Alfieri, Piatti) Vita-Salute San Raffaele University, Scientific
Institute San Raffaele, Milan, Italy
(Zavaroni) Internal Medicine and Biomedical Science Department, Parma
University, Parma, Italy
Title
Effects of chronic elevation of atrial natriuretic peptide and free fatty
acid levels in the induction of type 2 diabetes mellitus and insulin
resistance in patients with mitral valve disease.
Source
Nutrition, Metabolism and Cardiovascular Diseases. 22 (1) (pp 58-65),
2012. Date of Publication: January 2012.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background and aims: The relationship between atrial natriuretic peptide
(ANP), increased free fatty acid (FFA) and insulin resistance in patients
with mitral valve disease (MVD), a group characterised by elevated atrial
pressure and increased ANP levels, is not defined. The present study was
performed to evaluate, in MVD patients, the relationship between increased
ANP and FFA levels and insulin resistance and the role of mitral valve
replacement/repair in ameliorating these metabolic alterations.
Conversely, coronary heart disease (CHD) patients were evaluated before
and after coronary artery bypass grafting (CABG), since they are known to
be insulin resistant in the presence of chronic FFA increase. Methods and
results: Fifty MVD patients and 55 CHD patients were studied before and 2
months after surgery and compared with 166 normal subjects. Before
surgery, 56% of MVD patients had impaired glucose tolerance or newly
diagnosed type 2 diabetes after a standard oral glucose load and this
percentage decreased to 46% after surgery. In CHD, impaired glucose
tolerance (IGT) or newly diagnosed type 2 diabetic patients were 67% of
patients before and after CABG. In MVD, left atrial (LA) volume, ANP, FFA
incremental area and insulin levels were higher and Insulin Sensitivity
(IS) index significantly reduced while after surgery, LA volume, ANP and
FFA significantly decreased and IS index significantly improved. In CHD,
insulin resistance and hyperinsulinaemia were present both before and
after surgery with increased tumour necrosis factor (TNF)-alpha and
interleukin (IL)-6 levels. Conclusion: In MVD, a higher degree of abnormal
glucose tolerance and insulin resistance are associated to increased
levels of ANP and FFA, while these metabolic alterations are improved by
mitral valve replacement/repair surgery.Clinical Trial.gov registration
number NCT 00520962. 2010 Elsevier B.V.

<8>
[Use Link to view the full text]
Accession Number
2012191961
Authors
Ling X. Xiong J. Liang W. Schroder P.M. Wu L. Ju W. Kong Y. Shang Y. Guo
Z. He X.
Institution
(Ling, Liang, Wu, Ju, Kong, Shang, Guo, He) Organ Transplant Center, First
Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Er Road,
Guangzhou 510080, China
(Xiong) Department of Hepatobiliary Surgery, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
(Schroder) Department of Medical Microbiology and Immunology, University
of Toledo College of Medicine, Toledo, OH, United States
Title
Can immune cell function assay identify patients at risk of infection or
rejection? A meta-analysis.
Source
Transplantation. 93 (7) (pp 737-743), 2012. Date of Publication: 15 Apr
2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background. The Cylex ImmuKnow cell function assay (CICFA) is being
considered as a possible tool for identification of infection and
rejection in transplant recipients. However, the predictive capability of
CICFA is still unclear. Methods. Herein, we performed a meta-analysis to
assess the efficacy of CICFA in identifying risks of infection and
rejection posttransplantation. After a careful review of eligible studies,
sensitivity, specificity, and other measures of the accuracy of CICFA were
pooled. Summary receiver operating characteristic curves were used to
represent the overall test performance. Results. Nine studies met the
inclusion criteria. The pooled estimates for CICFA in identification of
infection risk were poor, with a sensitivity of 0.58 (95% confidence
interval [CI]: 0.52-0.64), a specificity of 0.69 (95% CI: 0.66-0.70), a
positive likelihood ratio of 2.37 (95% CI: 1.90-2.94), a negative
likelihood ratio of 0.39 (95% CI: 0.16-0.70), and a diagnostic odds ratio
of 7.41 (95% CI: 3.36-16.34). The pooled estimates for CICFA in
identifying risk of rejection were also fairly poor with a sensitivity of
0.43 (95% CI: 0.34-0.52), a specificity of 0.75 (95% CI: 0.72-0.78), a
positive likelihood ratio of 1.30 (95% CI: 0.74-2.28), a negative
likelihood ratio of 0.96 (95% CI: 0.85-1.07), and a diagnostic odds ratio
of 1.19 (95% CI: 0.65-2.20). Conclusion. The current evidence suggests
that CICFA is not able to identify individuals at risk of infection or
rejection. Additional studies are still needed to clarify the usefulness
of this test for identifying risks of infection and rejection in
transplant recipients. 2012 by Lippincott Williams & Wilkins.

<9>
Accession Number
2012196800
Authors
De Goede B. Klitsie P.J. Lange J.F. Metselaar H.J. Kazemier G.
Institution
(De Goede, Klitsie, Lange) Erasmus University Medical Center, Department
of Surgery, Medical Center, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
(Metselaar) Erasmus University Medical Center, Department of
Gastroenterology and Hepatology, Netherlands
(Kazemier) VUmc, University Medical Center, Department of Surgery, Medical
Center, P.O. BOX 7057, 1007 MB Amsterdam, Netherlands
Title
Morbidity and mortality related to non-hepatic surgery in patients with
liver cirrhosis; A systematic review.
Source
Best Practice and Research: Clinical Gastroenterology. 26 (1) (pp 47-59),
2012. Date of Publication: February 2012.
Publisher
Bailliere Tindall Ltd (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Background: The aim of this study is to review systematically morbidity
and mortality after non-hepatic surgery in patients with liver cirrhosis.
Methods: Comprehensive searches were conducted in PubMed, Embase and the
Cochrane Library for articles using the words: liver failure, hepatic
insufficiency, liver cirrhosis, cirrhosis, cirrhotic, surgical procedures,
operative complications, operative mortality, postoperative complications,
surgical complication, surgical risk, hernia. Results: Forty-six articles
were selected from 5247 included after the initial search. Level of
evidence provided in the articles varied greatly. Non-hepatic surgery of
patients with cirrhosis resulted in increased postoperative morbidity and
mortality compared to similar surgery for non-cirrhotic patients.
Cholecystectomy and umbilical and inguinal hernia correction were
associated with the lowest increased morbidity and mortality while
pancreatic surgery, cardiovascular, and trauma surgery correlated with the
highest. The preoperative model for end stage liver disease (MELD) and
Child-Turcotte-Pugh (CTP) scores appeared to be predictive of
postoperative risks. Portal hypertension and surgery in the emergency
setting were associated with extra increased mortality and morbidity
rates. Conclusion: This systematic review of the literature showed that in
patients with liver cirrhosis who undergo non-hepatic surgery,
postoperative morbidity and mortality rates varied greatly depending on
severity of the cirrhosis and the surgical procedure. However, the
majority of procedures can be safely performed in patients with low MELD
scores or CTP A cirrhosis without portal hypertension. 2012 Elsevier Ltd.
All rights reserved.

<10>
Accession Number
2012125905
Authors
Alamri H. Almoghairi A. Almasood A. Alotaibi M. Alonazi S.
Institution
(Alamri, Almoghairi, Almasood, Alotaibi, Alonazi) Adult Cardiology
Department, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
Title
Do we need premedication before coronary angiography? A controlled
clinical trial.
Source
Cardiology Research. 2 (5) (pp 224-228), 2011. Date of Publication:
October 2011.
Publisher
Elmer Press (8230 Boul Taschereau, CP 50577,Brossard, Quebec J4X 2S0,
Canada)
Abstract
Background: Premedication with benzodiazepines has been thought to reduce
patient anxiety, pain perception, and non-catheter-induced coronary spasms
and may increase procedure-related complications. We used to routinely
provide premedication with diazepam and chlorpheniramine before cardiac
catheterization procedures. However the benefi ts of such a treatment are
not well established here. Therefore, we designed this study to test
whether the routine use of premedication during coronary angiography is
needed. Methods: A total of 200 consecutive patients scheduled to undergo
either diagnostic or therapeutic coronary angiographic procedures were
randomized to receive either premedication with diazepam (5 mg) and
chlorpheniramine (4 mg) 60 minutes prior to their procedures (n = 100) or
no premedication (n = 100). The administration of intravenous midazolam
during the procedures was permitted at the operator's discretion. The
primary endpoints were anxiety and pain perception during the procedure.
Results: A total of 200 patients with similar baseline characteristics
were randomized into two groups. The fi rst group received oral
premedication with diazepam (5 mg) and chlorphenamine (4 mg) 60 minutes
prior to their procedures, and the other group did not receive
premedication. We observed no differences in periprocedural pain
perception (31% in the premedicated group versus 29% in the
non-premedicated group; P = 0.75) or anxiety (59% in the premedicated
group versus 50% in the non-premedicated group; P = 0.2). Interestingly,
local pain was more pronounced in the premedicated patients than in the
non-premedicated patients (30% versus 16%, respectively; P = 0.018). There
were no contrast-related reactions reported in either group. Conclusions:
Treatment with oral diazepam and chlorphenamine prior to cardiac
catheterization and percutaneous coronary intervention does not alter
rates of anxiety, periprocedural pain. Articles The authors. Journal
compilation Cardiol Res and Elmer Press.

<11>
Accession Number
2012198636
Authors
Kajimoto K. Miyauchi K. Yamamoto T. Daida H. Amano A.
Institution
(Kajimoto, Yamamoto, Amano) Department of Cardiovascular Surgery, Juntendo
University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
(Miyauchi, Daida) Department of Cardiology, Juntendo University School of
Medicine, Tokyo, Japan
Title
Meta-analysis of randomized controlled trials on the treatment of
unprotected left main coronary artery disease: One-year outcomes with
coronary artery bypass grafting versus percutaneous coronary artery
intervention with drug-eluting stent.
Source
Journal of Cardiac Surgery. 27 (2) (pp 152-157), 2012. Date of
Publication: March 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background and aim: Coronary artery bypass surgery (CABG) is the standard
treatment for left main coronary artery (LMCA) disease. However,
percutaneous coronary intervention using drug-eluting stents (DES-PCI) is
now widely used and is associated with improved outcomes following
coronary revascularization. The goal of this study was to assess early
outcomes associated with CABG and DES-PCI among patients with LMCA disease
through a meta-analysis of randomized controlled trials. Methods and
Results: After searching of electronic databases, three randomized
controlled trials with 2601 patients were identified. All-cause death
occurred in 3.3% with CABG and 3.6% with DES-PCI (odds ratio [OR], 0.92;
95% confidence interval [CI] = 0.60 to 1.40; p = 0.76). The incidence of
myocardial infarction was 2.6% with CABG and 3.8% with DES-PCI (OR, 0.67;
95% CI = 0.43 to 1.05; p = 0.10). Target vessel revascularization occurred
in 5.1% with CABG and 11.7% with DES-PCI (OR, 0.40; 95% CI = 0.29 to 0.55;
p < 0.0001). Major adverse cardiac and cerebrovascular events (MACCE)
occurred in 10.7% with CABG and 15.7% with DES-PCI (OR, 0.40; 95% CI =
0.29 to 0.55; p 0.0001). Conclusions: DES-PCI is a safe alternative to
CABG for the management of LMCA disease. However, CABG was superior to
DES-PCI in terms of MACCE and need for target vessel revascularization at
one year. Thus, CABG remains the standard of care for the treatment of
LMCA disease. 2012 Wiley Periodicals, Inc.

<12>
Accession Number
70715326
Authors
Banka G. Wu C. Morton J. Garber A.
Institution
(Banka, Wu, Morton, Garber) Stanford School of Medicine, Stanford, CA,
United States
(Banka, Wu, Morton, Garber) University of California Los Angeles, Los
Angeles, CA, United States
Title
Comparative effectiveness analysis of bariatric surgery versus medical
treatment ALONE for patients with BMIS between 30 and 35.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E1886), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Background: Bariatric surgery is currently restricted to those with a Body
Mass Index (BMI) >40 kg/m2 or a BMI >35 kg/m2 with obesity related
co-morbidities. However, there is a large population of class 1 obese
individuals (BMIs between 30 to 35 kg/m2) with obesity related
comorbidities. Offering bariatric surgery to these patients may be
cost-effective. Methods: Our goal was to assess the comparative
effectiveness of Laparoscopic Roux-en-Y Gastric Bypass (LARYGB) and
Laparoscopic Gastric Band (LAGB) versus non-surgical treatment for class 1
obese patients with hypertension, diabetes, and hyperlipidemia. We created
a cohort of 46 year-old patients diagnosed with diabetes, hypertension,
hyperlipidemia, and a BMI of 32.5 kg/m2. Quality Adjusted Life Years
(QALYs) were estimated using the United Kingdom Prospective Diabetes Study
(UKPDS) Computer Simulation Model. The inputs for the UKPDS model include
HbA1c, cholesterol, systolic blood pressure, age, and weight. Inputs for
the bariatric surgery treatment group were based on bariatric surgery
metaanalysis in patients with BMI >35. Bariatric surgery trials in
patients with BMI <35 showed that the outcomes were the same or better
than those reported in the meta-analysis in patients with BMI >35. Inputs
for the UKPDS for the medical treatment alone arm were from UKPDS and
Heart Protection studies. Surgery costs were derived from previous
cost-effectiveness studies. Medical treatment costs were assumed to be
driven by diabetes status.Yearly utilities and costs were discounted at a
rate of 3%. A one-way sensitivity analysis was also performed. Results:
The ICER of LAGB compared to the non-surgical cohort was $9092/QALY.
LARYGB was strictly dominated by LAGB in the base-case scenario and in the
one-way sensitivity analysis of LARYGB inputs. The ICER was sensitive to
changes in in BMI, HTN resolution, and cholesterol in the LAGB cohort.
Conclusion: Our study suggests that LAGB is more cost-effective than
LARYGB and medical treatment alone in class 1 obese diabetics with
hypertension and hyperlipidemia. Our results are sensitive to changes in
BMI, hypertension, and cholesterol post surgery.

<13>
Accession Number
70715041
Authors
Savarese G. Paolillo S. Costanzo P. Musella F. Marsico F. Perrone-Filardi
P.
Institution
(Savarese, Paolillo, Costanzo, Musella, Marsico, Perrone-Filardi)
Department of Internal Medicine, Cardiovascular and Immunological
Sciences, Federico II University, Naples, Italy
Title
Does 6-minute walk test predict clinical events in pulmonary arterial
hypertension? A meta-analysis of 22 studies.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E1601), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Background: 6-minute walk test (6MWT) is usually used as end-point in
clinical trials to assess the benefit of therapies in patients with
pulmonary arterial hypertension (PAH). The purpose of this study was to
verify whether improvement in 6MWT is associated with reduced incidence of
clinical outcomes in PAH. Methods: the MEDLINE and Cochrane databases, ISI
Web of Science and SCOPUS were searched for articles about PAH treatment
until August 2011. All randomized trials assessing functional capacity by
6MWT at baseline and at end of follow-up and including clinical end-points
(all-cause death, hospitalization for PAH and/or lung or heart-lung
transplantation, initiation of PAH rescue therapy) were included in
meta-analysis. Metaanalysis was performed to assess the influence of
treatments on outcomes. Meta-regression analysis was performed to test the
relationship between 6MWT changes and outcomes. The influence of baseline
patients' characteristics, 6MWT at baseline, Detsky quality score,
follow-up and study publication year were also explored. Macaskill's
modified test was used to assess the presence of publication bias.
Results: 22 trials enrolling 3,112 participants were included. Active
treatments led to significant reduction in the risk of all-cause death
(odds ratio [OR]:0.429; 95% confidence interval [CI]:0.277 to 0.664;
p<0.01), hospitalization for PAH and/or lung or heart-lung transplantation
(OR:0.442; CI:0.309 to 0.632; p<0.01), initiation of PAH rescue therapy
(OR:0.555; CI:0.347 to 0.889; p=0.01) and composite outcome (OR:0.400;
CI:0.313 to 0.510; p<0.01). In meta-regression analysis, no relationship
between 6MWT changes from baseline to end of follow-up and outcomes was
detected. Only baseline 6MWT values influenced the relationship between
changes in 6MWT and hospitalization for PAH and/or lung or heartlung
transplantation that became weakly significant (p=0.042). There was no
heterogeneity among trials included in meta-analysis. No publication bias
was detected. Conclusions: improvement in 6MWT, induced by pharmacological
treatment, does not reflect reduction in clinical outcomes.

<14>
Accession Number
70715036
Authors
Savarese G. Musella F. Carmen D. Cecere M. Losco T. Marciano C. Gargiulo
P. Perrone-Filardi P.
Institution
(Savarese, Musella, Carmen, Cecere, Losco, Marciano, Gargiulo,
Perrone-Filardi) Department of Internal Medicine, Cardiovascular and
Immunological Sciences, Federico II University, Naples, Italy
Title
Do changes in pulmonary hemodynamics predict clinical events in pulmonary
arterial hypertension? A meta-analysis of 17 studies.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E1596), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Background: Right heart catheterization remains the gold standard in
diagnosis and evaluation of pulmonary arterial hypertension (PAH). The aim
of this study was to verify whether changes in hemodynamics reflect the
incidence of clinical events in PAH patients. Methods: MEDLINE, Cochrane,
ISI Web of Science and SCOPUS database were searched for articles about
PAH treatment until November 2011. All randomized trials assessing
hemodynamics at baseline and at end of follow-up and including clinical
end-points (all-cause death, hospitalization for PAH and/or lung or
heart-lung transplantation, initiation of PAH rescue therapy) were
included. Meta-analysis was performed to assess the influence of
treatments on outcomes. Meta-regression analysis was performed to test the
relationship between hemodynamics (pulmonary artery pressure, pulmonary
vascular resistance, cardiac index and right atrial pressure) changes and
outcomes. The influence of baseline patients' characteristics,
hemodynamics at baseline, 6-minute walk distance (6MWD), Detsky quality
score, follow-up and study publication year were also explored.
Macaskill's modified test was used to assess the presence of publication
bias. Results: 17 trials enrolling 2,417 participants were included.
Active treatments led to significant reduction in the risk of all-cause
death (odds ratio [OR]: 0.533; 95% confidence interval [CI]: 0.341 to
0.833; p<0.01), hospitalization for PAH and/or lung or heart-lung
transplantation (OR: 0.384; CI: 0.218 to 0.674; p<0.01), initiation of PAH
rescue therapy (OR: 0.341; CI: 0.200 to 0.582; p<0.01) and composite
outcome (OR: 0.368; CI: 0.277 to 0.489; p<0.01). In meta-regression
analysis, no relationship between hemodynamics changes from baseline to
end of follow-up and outcomes was detected. No potential confounding
variable or publication bias was detected. There was no heterogeneity
among trials included in meta-analysis. Changes in pulmonary vascular
resistance correlated with changes in 6MWD (r=-0.63; p<0.01). Conclusions:
in PAH patients, improvement in pulmonary hemodynamics, induced by
pharmacological treatment, does not predict reduction in clinical
outcomes.

<15>
Accession Number
70714890
Authors
Zenati M. Biswas K. Laurie Shroyer A. Quin J. Haime M. Gaziano J.M. Taylor
K. Bhatt D.
Institution
(Zenati, Biswas, Laurie Shroyer, Quin, Haime, Gaziano, Taylor, Bhatt) VA
Boston/Harvard Medical School, Boston, MA, United States
Title
Long-term patency of coronary artery bypass vein grafts harvested
endoscopically: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E1450), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Background: Failure of saphenous vein grafts (SVG) used in CABG is
associated with increased rates of late major adverse cardiac events:
these include death, myocardial infarction and need for revascularization.
In the last 10 years endoscopic vein harvest (EVH) has become the
preferred method of venous conduit procurement in the United States, due
to the reduced rates of leg wound healing complications. However, sub
analysis from both the PREVENT and ROOBY Trials have identified increased
rates of late (>6 months) SVG failure compared with open vein harvest
(OVH). We report the results of a meta-analysis of the available long-term
SVG patency studies. Methods: A literature search (1996 to 2011)
identified 5 observational studies with angiographically documented
long-term SVG patency (one year in four studies and nine months in one
study) for both EVH and OVH vein grafts used for CABG. SVG failure was
expressed as the combination of angiographic occlusion and severe stenosis
(Fitzgibbon grades B+O). A forest plot was constructed. Results: There
were a total of 6,866 graft assessed by angiography in the five pooled
studies. There was some heterogeneity among the pooled studies (I2 =
63.7%; 95% CI = 0% - 84.1%). Both random (DerSimonian-Laird) and fixed
(Mantel-Haenszel) effects models showed significantly lower graft patency
with EVH. Given the presence of heterogeneity among the studies, the
random effect pooled OR was used to compare EVH with OVH. This showed an
OR of 1.62 (95% CI = 1.22 - 2.15; p = 0.0009). The fixed effect pooled OR
was 1.49 (95% CI = 1.33 - 1.68; p<0.0001). Conclusion: Available evidence
suggests compromised SVG patency when the conduit was harvested with the
EVH technique. A large, multicenter prospective randomized clinical trial
is warranted to more definitively determine the long-term safety and
efficacy of EVH in CABG.

<16>
Accession Number
70714399
Authors
Harrison R. Hasselblad V. Levin R. Mehta R. Harrington R. Alexander J.
Institution
(Harrison, Hasselblad, Levin, Mehta, Harrington, Alexander) Duke Clinical
Research Institute, Durham, NC, United States
Title
Levosimendan reduces mortality in patients with reduced ejection fraction
undergoing cardiac surgery: A meta-analysis of randomized clinical trials.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E959), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Background: Left ventricular systolic dysfunction is associated with
increased mortality in patients undergoing cardiac surgery. Levosimendan
has been shown in several small clinical trials to improve outcomes in
cardiac surgery. We performed a meta-analysis of trials investigating
levosimendan in patients with reduced ejection fraction (EF) undergoing
cardiac surgery. Methods: PubMed, Embase, and conference proceedings were
searched for clinical trials of perioperative levosimendan in patients
undergoing cardiac surgery. The company marketing levosimendan (Orion
Pharma) was also contacted regarding unpublished data. Randomized clinical
trials of patients with a mean EF <=40% were included in the analysis. Our
primary endpoint was study reported mortality out to 30 days. Results: 480
abstracts were reviewed. Nine studies, totaling 796 randomized patients,
were included in the analysis. Levosimendan was administered
preoperatively in one study, intraoperatively in five studies, and
postoperatively in three studies. Levosimendan was associated with reduced
morbidity and mortality (see table) as well as a decrease in postoperative
atrial fibrillation (odds ratio 0.35; 95% CI 0.27-0.58). Conclusion:
Levosimendan use was associated with improved morbidity and mortality in
patients with reduced ejection fraction undergoing cardiac surgery. These
data support the need for an adequately powered randomized clinical trial
of levosimendan in this patient population. (Table presented).

<17>
Accession Number
70714179
Authors
Graham E.M. Taylor S.N. Zyblewski S. Wolf B. Bradley S. Hollis B.W.
McGowan F.X. Atz A.
Institution
(Graham, Taylor, Zyblewski, Wolf, Bradley, Hollis, McGowan, Atz) Medical
University of South Carolina, Charleston, SC, United States
Title
Vitamin D status in neonates undergoing cardiac operations: Relationship
to cardiopulmonary bypass and outcomes.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E739), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Background: Emerging evidence suggests that altered vitamin D metabolism
has a role in multiple disease processes including ischemiareperfusion and
inflammation. Vitamin D status and its association with outcomes have been
unexplored in children with congenital heart disease or cardiac surgery
and cardiopulmonary bypass (CPB). The objective of this study is to test
two hypotheses: 1) Neonates with congenital heart disease have a high
incidence of vitamin D deficiency that differs by race; 2) Postoperative
outcomes are negatively associated with 25-hydroxyvitamin D [25(OH)D]
levels. Methods: A secondary analysis of a prospective randomized
controlled trial in 70 neonates undergoing cardiac surgery involving CPB
was performed. 25(OH)D levels were collected at 3 time points: in the
operating room prior to skin incision (baseline), at the cessation of CPB
and 24 hours post-operatively. Associations between these levels and
clinical outcomes were explored. Vitamin D deficiency was defined as a
25(OH)D level <20 ng/ml. Results: Mean (standard deviation) levels of
25(OH)D were 14.4 +/- 5.8, 17.0 +/- 4.3 and 14.1 +/- 4.8 ng/ml at the 3
time points respectively. Vitamin D deficiency was present in 84% (59/70)
of these neonates at baseline; concentrations in African-Americans (n =
20) were significantly lower than Caucasian/other (n = 50) (10.2 +/- 4.2
ng/ml vs. 16.0 +/- 5.6 ng/ml, p<0.0001). The 24 hour postoperative 25(OH)D
level correlated with a reduced postoperative inotropic requirement (r =
-0.316, p = 0.008). Conclusion: The unique findings of this study are
3-fold. First, vitamin D deficiency is prevalent in neonates with
congenital cardiac defects, regardless of race. Second, 25(OH)D levels are
not altered by CPB. Third, higher 24 hour postoperative 25(OH)D levels are
associated with a reduction in inotropic requirement in neonates
undergoing cardiac operations with CPB. These findings provide support
that vitamin D may play a role in myocardial injury and postoperative
recovery. The role of vitamin D in postoperative pediatric cardiac
operations warrants further investigation, and supplementation of mothers
and/or newborn infants with congenital heart disease may be in order.

<18>
Accession Number
70714126
Authors
Chatterjee S. Sardar P. Mukherjee D. Lichstein E. Aikat S.
Institution
(Chatterjee, Sardar, Mukherjee, Lichstein, Aikat) Maimonides Medical
Center, Brooklyn, NY, United States
(Chatterjee, Sardar, Mukherjee, Lichstein, Aikat) Gill Heart Institute,
University of Kentucky, Lexington, Lexington, KY, United States
Title
Optimal timing and route of amiodarone for prevention of post operative
atrial fibrillation after cardiac surgery - A network regression
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E686), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Introduction: There is no conclusive agreement on the optimal route or
timing of peri-operative amiodarone administration for prevention of post
operative atrial fibrillation(POAF). We attempted to evaluate if an oral
only regimen was as effective in preventing POAF after cardiac surgery, in
comparison to a regimen that included intravenous (IV) administration also
by a network meta-analysis of available data. We also attempted to assess
if pre-operative administration at least one day prior to surgery was
superior to post-operative prophylaxis (at least one day after
surgery)-and included studies had amiodarone administered from 6 days
before to 1 day after cardiac surgery. Methods: We searched PubMed,
EMBASE,and Cochrane Central Register of Controlled Trials' databases for
randomized controlled trials conducted between 1990 and 2011 that assessed
rates of POAF with amiodarone. The comparator was standard medical
therapy.Event rates were compared using a forest plot of relative risk
using a random effects model (Mantel-Haenszel); and Odd's ratio was
calculated in absence of heterogeneity. Finally an interaction Odd's ratio
was computed to assess efficacy of an oral only regimen compared to one
including intravenous administration. We also looked to assess if
pre-operative amiodarone was superior to post-op prophylaxis. Results:
Twenty three studies (total N = 3,950) met the inclusion-exclusion
criteria. Both regimens of amiodarone improved risk of POAF; oral only RR
0.59 (95% CI 0.49-0.70; p<0.01) and regimen including IV RR 0.57(95% CI
0.43-0.75, p<0.01). The interaction Odd's ratio was 1.17(95% CI 0.72-1.89,
p=0.533).However, pre-operative amiodarone was successful in prevention of
POAF (p<0.01), while post-operative prophylaxis was ineffective (p=0.09).
Univariate regression revealed that benefit of pre-operative amiodarone
was independent of the duration of therapy (p=0.98), beyond initiation 1
day prior to surgery. Conclusions: This systematic review suggests both
regimens are effective in prevention of POAF after cardiac surgery and
that pre-operative amiodarone irrespective of duration was effective in
preventing POAF while post-operative administration was not.

<19>
Accession Number
70713789
Authors
Cerisano G. Buonamici P. Valenti R. Sciagra R. Raspanti S. Carrabba N.
Santini A. Dovellini E.V. Antoniucci D.
Institution
(Cerisano, Buonamici, Valenti, Sciagra, Raspanti, Carrabba, Santini,
Dovellini, Antoniucci) Careggi Hospital, Florence, Italy
Title
Early short-term doxycycline therapy in patients with acute myocardial
infarction and left ventricular dysfunction and the ominous progression to
adverse remodeling (TIPTOP). A randomized controlled trial.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E349), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Background: Experimental studies have shown that doxycycline (DOX)
attenuates post-myocardial infarction (MI) remodeling through matrix
metalloproteinase inhibition, and exerts protective effects on myocardial
ischemia/reperfusion injury. We assessed the effect of DOX on left
ventricular (LV) remodeling in patients with acute ST-elevation MI (STEMI)
and moderate LV dysfunction treated with primary coronary intervention
(PCI). Methods: Single-blinded, randomized, phase III trial
(ClinicalTrial.gov Identifier: NCT00469261). Patients with acute STEMI and
LV ejection fraction < 40 % successfully treated with primary PCI and
stenting, were randomly assigned to oral DOX (100 mg at admission and then
100 mg b.i.d. for 7 days) in addition to standard therapy [DOX group] or
to standard care [control group]. Echo LV end-diastolic and end-systolic
volumes index (EDVi and ESVi) were determined at baseline, pre-discharge,
1 and 6 months. 99mTc Sestamibi SPECT infarct size/severity, and coronary
infarct-related artery (IRA) patency were assessed at 6 months. The
primary end-point was echo % LVEDVi (baseline to 6 months). Based on
experimental results, we calculated a sample size of 110 patients (55 per
group), assuming that DOX would reduce % LVEDVi > 50% as compared to
standard therapy, considering an attrition rate of 15%, and a statistical
power of 90% with a type I error <= = .05. The secondary end-point was
scintigraphic infarct size/severity. Results: Out 110 patients enrolled,
97 (88%) completed 6-month echo follow-up (DOX group 51 patients, control
group 46 patients). The 2 groups were well balanced on baseline clinical
and procedural characteristics. IRA patency rate at follow-up was 99% in
the entire patient cohort. At 6 month % LVEDVi was signficantly lower in
DOX group than in control group: - 5 +/- 27% vs + 25 +/- 41%, respectively
(p < .001). Infarct size and severity were inferior in DOX group than in
control group: 10 +/- 12% vs 16 +/- 15%, p = .04, and 0.5 +/- 0.1 vs 0.4
+/- 0.2, p = .01, respectively. Conclusions: In patients with acute STEMI
and LV dysfunction, early short-term DOX therapy was associated with a
lower LV remodeling and smaller infarct size/severity, as compared to
standard therapy.

<20>
Accession Number
70713668
Authors
Genereux P. Head S. Van Mieghem N. Kodali S. Kirtane A. Xu K. Moses J.
Smith C. Serruys P. Kappetein A. Leon M.
Institution
(Genereux, Head, Van Mieghem, Kodali, Kirtane, Xu, Moses, Smith, Serruys,
Kappetein, Leon) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, NY, United States
(Genereux, Head, Van Mieghem, Kodali, Kirtane, Xu, Moses, Smith, Serruys,
Kappetein, Leon) Hopital du Sacre-Coeur de Montreal, Universite de
Montreal, Montreal, Canada
Title
Clinical outcomes after transcatheter aortic valve replacement (TAVR)
using valve academic research consortium (VARC) definitions: A weighted
meta-analysis of 3,519 patients from 17 studies.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E228), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Backgrounds: Recently, the published Valve Academic Research Consortium
(VARC) definitions have helped to add uniformity for reporting outcomes
after Transcatheter Aortic Valve Replacement (TAVR). We sought to perform
a weighted meta-analysis to determine rates of major outcomes after TAVR
using VARC definitions and to evaluate their current use in the
literature. Methods: A comprehensive search of multiple electronic
databases from January 1st 2011 through October 12th 2011 was conducted
using predefined criteria. We included studies reporting at least one
outcome using VARC definitions. Results: A total of 17 studies including
3,519 patients met inclusion criteria and were included in the analysis.
The pooled estimate rate of outcomes were determined according to VARC's
definitions: device success: 92.1%, 95%CI [88.7,95.5]; all cause 30-day
mortality: 7.8%, 95%CI [5.5,11.1]; myocardial infarction: 1.1%, 95% CI
[0.2,2.0]; acute kidney injury stage II-III: 7.5%, 95%CI [5.1,11.4]; life
threatening bleeding: 15.6%, 95% CI [11.7,20.7]; major vascular
complication: 11.9%, 95% CI [8.6,16.4]; major stroke 3.2%, 95%CI
[2.1,4.8]; and new permanent pace maker (PPM) implantation: 13.9%, 95% CI
[10.6,18.9]. Medtronic CorevalveTM prosthesis use was associated with a
significant higher rate of PPM implantation compared to the Edwards's
prosthesis (28.9%, 95% CI [23.0,36.0] vs. 4.9%, 95% CI [3.9,6.2], p value
< 0.0001). The 30-day safety composite endpoint rate was 32.7%, 95%CI
[27.5,38.8] and the 1-year total mortality was 22.1%, 95% CI [17.9,26.9].
Conclusion: VARC definitions have already been used by the TAVR clinical
research community, establishing a new standard for reporting clinical
outcomes. Future revisions of the VARC definitions are needed based upon
evolving TAVR clinical experiences.

<21>
Accession Number
70713478
Authors
Shah R. Bhuriya R. Molnar J. Singh M. Shah T. Jawad E. Khosla S.
Institution
(Shah, Bhuriya, Molnar, Singh, Shah, Jawad, Khosla) Rosalind Franklin
University, Chicago Medical Scool, Chicago, IL, United States
Title
Very late stent thrombosis with bare metal stents compared to drug eluting
stents after primary percutaneous coronary intervention for st-segment
elevation myocardial infarction: A meta analysis of prospective clinical
trials.
Source
Journal of the American College of Cardiology. Conference: 61th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.12 Chicago, IL United States. Conference
Start: 20120324 Conference End: 20120327. Conference Publication:
(var.pagings). 59 (13 SUPPL. 1) (pp E38), 2012. Date of Publication: 27
Mar 2012.
Publisher
Elsevier USA
Abstract
Background: Controversy persists regarding the incidence of very late
stent thrombosis (VLST) with bare metal stents (BMS) compared to drug
eluting stents (DES) after primary percutaneous coronary intervention
(PCI) for ST-segment elevation myocardial infarction (STEMI). We performed
a meta-analysis of prospective clinical trials comparing this outcome
between BMS and DES. Methods: We performed a systematic literature search
for prospective clinical trials comparing this outcome between BMS and
DES. All prospective clinical trials with a minimum follow up of 2 years
were included. Stent thrombosis was defined as per classification set by
academic research consortium. A two-sided alpha error of less than 0.05
was considered to be statistically significant (p<0.05). Results: We found
9 prospective clinical trials with a follow up of 2-15 years comparing the
effects of DES and BMS in STEMI, enrolling a total of 6854 patients.
Median duration of follow up was 3 years. The studies were homogeneous;
therefore the Mantel-Haenszel fixed-effect model was used to calculate
relative risk (RR). Incidence of very late stent thrombosis was 1.35% in
patients treated with BMS and 2.0% in patients treated with DES with a RR
of 0.50 with 95% CI 0.33-0.76 (P = 0.001). Conclusion: Although the
incidence of very late stent thrombosis after coronary revascularization
is low, drug-eluting stents appear to increase the risk for very late
thrombosis. (Table presented).