EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
22486138
Authors
Heidari S.M. Saghaei M. Shafiee Z.
Institution
(Heidari) Department of Anesthesiology, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran.
Title
Effect of preoperative volume loading on the intraoperative variability of
blood pressure and postoperative nausea and vomiting.
Source
Medicinski arhiv. 66 (2) (pp 94-96), 2012. Date of Publication: 2012.
Abstract
Preoperative volume loading (PVL) in addition to counteract the decreases
in blood pressure during intraoperative period, also may decrease
postoperative nausea and vomiting (PONV). This study was designed to
investigate the effect of preoperative volume loading on the
intraoperative blood pressure variability and postoperative nausea and
vomiting. Thirty subjects scheduled for elective orthopedic procedures
randomly divided into case and control groups. The patients in the case
group received lactated Ringer 10 ml/kg before induction of general
anesthesia. Mean arterial blood pressure (MAP) and heart rate were
recorded in two groups every 3 minutes from induction of anesthesia until
five minutes after extubation. Variability of mean arterial blood pressure
and heart rate were defined as the standard deviation (SD) of the measured
values for each patient. Means of these individual SD values were compared
between two groups using Mann-Whitney U test. The mean variability of mean
arterial blood pressure and heart rate ware significantly lower in case
group (8.3 +/- 3 mmHg and 8.4 +/- 2.5 bpm vs. 13 +/- 6 mmHg and 11 +/- 2.6
bpm in control group; p < 0.5). The severity of nausea (measured as a
ten-point visual analog scale) was significantly lower in case group (1.2
+/- 0.9 vs. 3.9 +/- 1.8 in control group; p < 0.05). No patients in case
group developed postoperative vomiting (compared to 5 patients in control
group). The results of this study shows that preoperative volume loading
is associated with lower variability of blood pressure and heart rate
during operative period and also reduces the severity and incidence of
postoperative nausea and vomiting.

<2>
Accession Number
2012241039
Authors
Rognoni A. Lupi A. Sansa M. Secco G.G. Santagostino M. Bongo A.S.
Institution
(Rognoni, Lupi, Sansa, Secco, Santagostino, Bongo) Cardiologia 2, A.O.U.
Maggiore della Carita, Corso Mazzini 18, 28100 Novara, Italy
Title
Radial approach for percutaneous coronary intervention.
Source
Reviews on Recent Clinical Trials. 7 (2) (pp 127-132), 2012. Date of
Publication: May 2012.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
The transradial approach for percutaneous coronary intervention (both
diagnostic and therapeutic procedures) has gained progressive acceptance
in the last years. Transradial access has been shown, also, to have
several advantages over transfemoral approach; the radial artery is easily
compressible, thus bleeding is controllable and hemorrhagic complications
are significantly reduced. Furthermore, pe-riprocedural bleeding and
vascular complications after percutaneous coronary intervention are
associated with worse clinical outcomes and increased short and long -
mortality. With increasing experience and availability of dedicated
equipment this technique is now being increasingly used for complex
catheter intervention. The main purpose of this review is to highlight the
benefits, complications and problems with transradial approach compared
with conventional transfemoral approach. 2012 Bentham Science Publishers.

<3>
Accession Number
2012248554
Authors
Friedland S.N. Eisenberg M.J. Shimony A.
Institution
(Friedland, Eisenberg, Shimony) Divisions of Cardiology and Clinical
Epidemiology, McGill University, Jewish General Hospital, Montreal, ON,
Canada
(Shimony) Department of Cardiology, Soroka University Medical Center,
Ben-Gurion University, Beersheva, Israel
Title
Meta-analysis of randomized controlled trials on effect of cilostazol on
restenosis rates and outcomes after percutaneous coronary intervention.
Source
American Journal of Cardiology. 109 (10) (pp 1397-1404), 2012. Date of
Publication: 15 May 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Cilostazol is a generic drug with antiplatelet and antiproliferative
effects. It is unclear whether adding cilostazol to standard dual
antiplatelet therapy (aspirin and clopidogrel) after percutaneous coronary
intervention reduces restenosis and improves the outcomes. We, therefore,
conducted a systematic review and meta-analysis. We systematically
searched the Cochrane Library, EMBASE, and MEDLINE databases for
randomized controlled trials comparing dual antiplatelet therapy with and
without cilostazol after percutaneous coronary intervention. The data were
pooled using random-effects models and stratified into short-term
(1-month), midterm (1- to 12-month), and long-term (<12-month) follow-up
durations. Twelve randomized controlled trials involving 5,655 patients
met our inclusion criteria. The addition of cilostazol to dual
antiplatelet therapy was not associated with a significant change in
target lesion revascularization (TLR) and target vessel revascularization
(TVR) at short-term follow-up. However, TLR and TVR were significantly
reduced at midterm follow-up (relative risk 0.57, 95% confidence interval
0.39 to 0.84, and relative risk 0.62, 95% confidence interval 0.47 to
0.83, respectively). Data regarding TLR and TVR at long-term follow-up
were limited and inconclusive. We did not find a difference in myocardial
infarction, mortality, or major bleeding at any follow-up duration. In
conclusion, the addition of cilostazol to dual antiplatelet therapy after
percutaneous coronary intervention has favorable effects on TLR and TVR at
1 to 12 months, with no differences in adverse outcomes at any follow-up
duration. 2012 Elsevier Inc.

<4>
Accession Number
22416600
Authors
Nuszkowski M.M. Deutsch N. Jonas R.A. Zurakowski D. Montague E. Holt D.W.
Institution
(Nuszkowski) Children's National Medical Center, Washington, DC
20010-2970, USA.
Title
Randomized trial of the Terumo Capiox FX05 oxygenator with integral
arterial filter versus Terumo Capiox Baby RX05 and Terumo Capiox AF02
arterial filter in infants undergoing cardiopulmonary bypass.
Source
The Journal of extra-corporeal technology. 43 (4) (pp 207-214), 2011. Date
of Publication: Dec 2011.
Abstract
The purpose of this clinical trial was to evaluate the effect of the
Terumo Capiox FX05 oxygenator with integrated arterial filter during
cardiopulmonary bypass (CPB) compared with the Terumo Capiox RX05 Baby RX
and arterial filter on inflammatory mediators and blood product
utilization. Forty patients weighing less than 10 kg who underwent
congenital heart surgery utilizing cardiopulmonary bypass were randomized
into either oxygenator group. The endpoints included measuring
inflammatory markers at six different time points (preoperative baseline,
CPB circuit being primed, 15 minutes after CPB initiation, status post
protamine administration, prior to transport to intensive care unit, and
within 12 to 24 hours post surgery), blood product utilization, extubation
time, and days until discharge. The inflammatory mediators showed no
significant differences between oxygenators at any time points. However,
looking at the inflammatory mediators of both the FX and RX groups
combined, a statistically significant difference was seen in interleukin
(IL)-6 at 12/24 hour post surgery (p < .001) versus baseline and all other
time points. IL-8 at status post protamine (p < .001) and 12/24 hours post
surgery (p < .001) demonstrated significant differences versus all other
time points, and IL-10 at status post protamine (p < .001) and prior to
leaving the operating room (p < .001) were statistically different
compared to all other time points. Cardiopulmonary bypass stimulates the
systemic inflammatory response through various components of the
extracorporeal system. This investigation did not find significant
differences in cytokines interferon-gamma, IL-1beta, IL-2, IL-4, IL-5,
IL-6, IL-8, IL-10, IL-12 p70, tumor necrosis factor (TNF)-alpha, and
TNF-beta when comparing these two oxygenators. It is well known that
various mechanisms contribute to the levels of cytokines circulating in a
patient's blood volume and many manipulations throughout cardiac surgery
have the ability to demonstrate anti-inflammatory interventions. Further
investigation is needed as to how modification of the extracorporeal
circuit may minimize increases in inflammatory mediators. Keywords:
infant, bypass, cytokines, blood, infant perfusion strategy.

<5>
Accession Number
2012235686
Authors
Serraino G.F. Marsico R. Musolino G. Ventura V. Gulletta E. Sante P.
Renzulli A.
Institution
(Serraino, Marsico, Musolino, Renzulli) Department of Clinical and
Experimental Medicine, Cardiac Surgery Unit, University of Magna Graecia,
Campus 'S.Venuta', Viale Europa, 88100 Catanzaro, Italy
(Ventura, Gulletta) Department of Clinical and Experimental Medicine,
Clinical Pathology Unit, Italy
(Sante) University of Magna Graecia, Catanzaro, Department of
Cardiothoracic and Respiratory Sciences, AON Monaldi Second University of
Naples, Naples, Italy
Title
Pulsatile cardiopulmonary bypass with intra-aortic balloon pump improves
organ function and reduces endothelial activation.
Source
Circulation Journal. 76 (5) (pp 1121-1129), 2012. Date of Publication:
2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: We aimed to evaluate if the use of an intra-aortic balloon
pump (IABP) during cardioplegic arrest improves organ function and reduces
endothelial activation in patients undergoing coronary artery bypass graft
(CABG). Methods and Results: Five-hundred and one CABG patients were
randomized into 2 groups: (Group A n=270) linear cardiopulmonary bypass
(CPB); and (Group B n=231) automatic 80 beats/min IABP-induced pulsatile
CPB. We evaluated hemodynamic response, coagulation and fibrinolysis,
transaminase, bilirubin, amylase, lactate, renal function (estimated
glomerular filtration rate [eGFR], creatinine and any possibility of renal
insufficiency or failure), respiratory function and endothelial markers
(vascular endothelial growth factor [VEGF] and monocyte chemotactic
protein-1 [MCP-1]). IABP, which induced surplus hemodynamic energy, was
21,387+/-4,262 ergs/cm³. Group B showed lower chest drainage,
transfusions, international normalized ratio, and antithrombin III,
together with higher platelets, activated partial thromboplastin time,
fibrinogen and D-dimer. Transaminases, bilirubin, amylase, lactate were
lower in Group B; there were better results for eGFR in Group B from
ICU-arrival to 48 h, resulting in lower creatinine from ICU-arrival to 48
h. The necessity for renal replacement therapy was lower in Group B
Stage-3. Group B P_aO₂/F_iO₂ and
lung compliance improved with aortic de-clamping on the first day with
shorter intubation time. Group B showed lower VEGF and MCP-1. Conclusions:
Pulsatile flow by IABP improves whole-body perfusion and reduces
endothelial activation during CPB.

<6>
Accession Number
2012235685
Authors
Yamauchi T. Miyata H. Sakaguchi T. Miyagawa S. Yoshikawa Y. Takeda K.
Motomura N. Tsukihara H. Sawa Y.
Institution
(Yamauchi, Sakaguchi, Miyagawa, Yoshikawa, Takeda, Sawa) Department of
Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2
Yamadaoka, Suita 565-0871, Japan
(Motomura, Tsukihara) Department of Cardiac Surgery, Faculty of Medicine,
Graduate School of Medicine, University of Tokyo, Tokyo, Japan
(Miyata) Department of Healthcare Quality Assessment, Graduate School of
Medicine, University of Tokyo, Tokyo, Japan
Title
Coronary artery bypass grafting in hemodialysis-dependent patients:
Analysis of Japan Adult Cardiovascular Surgery Database.
Source
Circulation Journal. 76 (5) (pp 1115-1120), 2012. Date of Publication:
2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Perioperative risk during coronary artery bypass grafting
(CABG) is reportedly high in patients with chronic renal disease. We aimed
to determine postoperative mortality and morbidity and identify the
perioperative risk factors of mortality during CABG in hemodialysis
(HD)-dependent patients. Methods and Results: From the Japan Adult
Cardiovascular Surgery Database, we compared 1,300 HD-dependent chronic
renal failure patients with 18,387 non-HD patients who all underwent
isolated CABG between January 2005 and December 2008. The operative
mortality and mortality, including major morbidity, was 4.8% vs. 1.4% and
23.1% vs. 13.7% in the HD and non-HD groups, respectively. Preoperative
predictors of operative mortality included age, chronic obstructive
pulmonary disease, peripheral arterial disease, congestive heart failure,
arrhythmia, preoperative inotropic agent requirement, New York Heart
Association class IV, urgent or emergency operation, poor left ventricular
function, aortic valve regurgitation (>2), and mitral valve regurgitation
(>3). Postoperative predictors of operative mortality included stroke,
infection, prolonged ventilation, pneumonia, heart block, and
gastrointestinal complications. Conclusions: Compared with non-HD
patients, CABG in HD patients was associated with high mortality and
morbidity rates. An appropriate surgical strategy and careful
perioperative assessment and management for prevention of respiratory and
gastrointestinal complications might contribute to improved clinical
outcomes after CABG in these patients.

<7>
Accession Number
2012237080
Authors
Wei G. Fang Y. Yaqi R. Lin C. Ningfu W.
Institution
(Wei, Fang, Yaqi, Lin, Ningfu) Department of Cardiology, Nanjing Medical
University, Hangzhou First People's Hospital, #261 Huansha Road, Hangzhou,
310006, China
Title
Clinical outcomes of zotarolimus-eluting stents versus the first
generation sirolimus-eluting stents and paclitaxel-eluting stents: A
meta-analysis of randomized trials.
Source
International Journal of Cardiology. 157 (1) (pp 152-156), 2012. Date of
Publication: 17 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<8>
Accession Number
2012237063
Authors
Gray W.A. Yeung A.C. Cutlip D.E. Popma J.J. Fitzgerald P.J. Williams D.O.
Heuer H. O'Shaughnessy C.D. Overlie P.A. Mann J.T. Cannon L.A. Hermiller
J.B. Henry T.D. Whitbourn R. Stuckey T.D. Midei M.G. Coe J. Schwartz L.B.
Institution
(Gray) Columbia University Medical Center, New York, NY, United States
(Yeung, Fitzgerald) Stanford University Medical Center, Palo Alto, CA,
United States
(Cutlip) Harvard Clinical Research Institute, Boston, MA, United States
(Popma) Brigham and Women's Hospital, Boston, MA, United States
(Williams) Rhode Island Hospital, Providence, RI, United States
(Heuer) St. Johannes Hospital, Dortmund, Germany
(O'Shaughnessy) Eyria Memorial Hospital (EMH), Regional Medical Center,
Elyria, OH, United States
(Overlie) Lubbock Heart Hospital, Lubbock, TX, United States
(Mann) Wake Medical Hospital, Raleigh, NC, United States
(Cannon) Northern Michigan Hospital, Petosky, MI, United States
(Hermiller) Heart Center of Indianapolis, Indianapolis, IN, United States
(Henry) Abbott Northwestern Hospital, Minneapolis, MN, United States
(Whitbourn) St. Vincent's Hospital, Melbourne, Australia
(Stuckey) Moses H. Cone Memorial Hospital, Greensboro, NC, United States
(Midei) St. Joseph Medical Center, Towson, MD, United States
(Coe, Schwartz) Abbott Laboratories, 200 Abbott Park Road, AP52-2, Abbott
Park, IL 60064-6215, United States
Title
A randomized, controlled, multi-center trial comparing the safety and
efficacy of zotarolimus-eluting and paclitaxel-eluting stents in de novo
lesions in coronary arteries: Final results of the ZoMaxx II trial.
Source
International Journal of Cardiology. 157 (1) (pp 96-101), 2012. Date of
Publication: 17 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background/Objectives: The purpose of this prospective, randomized,
single-blind controlled clinical trial was to compare the effectiveness of
a zotarolimus-eluting stent (ZoMaxx) with a paclitaxel-eluting coronary
stent (Taxus Express²) in patients with angina pectoris and a
single native coronary artery lesion between 10-28 mm in length and
2.5-3.75 mm in diameter. Methods: Patients were enrolled at 75
international institutions between June 2005 and November 2006. Results:
1099 (1672 originally planned) patients received 557 ZoMaxx and 542 Taxus
stents: cohorts were well-matched for diabetes (27% vs. 27%), reference
vessel diameter (2.73 +/- 0.46 mm vs. 2.74 +/- 0.45 mm) and lesion length
(14.8 +/- 6.7 mm vs. 14.3 +/- 6.4 mm). Nine month clinical and
angiographic follow-up was available in 1052/1099 (96%) and 649/836 (78%)
patients, respectively. The safety profiles for the two stents (myocardial
infarction (MI), cardiac death and/or target vessel revascularization
(TVR)) were similar (ZoMaxx 8.7% vs. Taxus 6.9%, p = NS). The primary
endpoint of 9-month TVR occurred more frequently after treatment with
ZoMaxx (6.8%) as compared with Taxus (4.2%), therefore the primary
clinical endpoint was not met. However, the 9-month in-segment late lumen
loss for ZoMaxx (0.29 +/- 0.47 mm) and Taxus (0.22 +/- 0.41 mm, p = NS)
were similar, thus satisfying the primary angiographic endpoint. Secondary
endpoints of the rates of in-segment and in-stent binary restenosis were
also similar (5.9% vs. 5.8%, 7.8% vs. 7.9%, respectively). Conclusions: At
9 months, the ZoMaxx stent failed to achieve the primary endpoint of
non-inferiority in TVR to the Taxus stent, but safety endpoints were equal
between the two stent systems. 2011 Elsevier Ireland Ltd. All rights
reserved.

<9>
Accession Number
2012237059
Authors
Hermanides R.S. Ottervanger J.P. Dambrink J.-H.E. Dill T. Van Houwelingen
G. Ten Berg J.M. Kolkman E. Hamm C. Van't Hof A.W.J.
Institution
(Hermanides, Ottervanger, Dambrink, Van't Hof) Isala Klinieken, Department
of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, Netherlands
(Dill, Hamm) Kerckhoff-Klinik, Bad Nauheim, Germany
(Van Houwelingen) Medisch Spectrum Twente, Enschede, Netherlands
(Ten Berg) St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Kolkman) Diagram BV, Zwolle, Netherlands
Title
Risk of bleeding after prehospital administration of high dose tirofiban
for ST Elevation Myocardial Infarction.
Source
International Journal of Cardiology. 157 (1) (pp 86-90), 2012. Date of
Publication: 17 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: In most patients with ST-elevation myocardial infarction
(STEMI), antiplatelet drugs are already administrated in the ambulance,
before hospital admission. We investigated the safety of prehospital
initiation of a high dose of the glycoprotein IIb/IIIa inhibitor tirofiban
on top of aspirin, clopidogrel and heparin. Methods: It concerns a
sub-analysis of the On-TIME 2 trial. 1398 patients were enrolled and 1275
patients (91.2%) had clinical follow up. Non CABG-related bleeding was
defined according to the TIMI criteria. Logistic regression was used to
determine predictors of 30-day bleeding. The independent association
between bleeding and mortality (30-day and 1-year) was evaluated using Cox
proportional Hazard models. Results: Bleeding (major or minor) was
observed in 47 patients (3.7%), with only 13 patients (1%) with major
bleeding. The strongest independent determinants of bleeding were age (OR
1.05, 95% CI 1.01-1.08, p = 0.011), Killip class > 1 at admission (OR 2.5,
95% CI 1.2-5.3, p = 0.020) and intra aortic balloon pump (IABP) use (OR
4.2, 95% CI 1.6-11.1, p = 0.003). High dose tirofiban was not an
independent predictor of bleeding (OR 1.7, 95% CI 0.9-3.2, p = 0.116).
Bleeding was associated with an increased risk of 30-day mortality (HR
5.5, 95% CI 1.6-7.8, p < 0.001) and one-year mortality (HR 3.2, 95% CI
1.4-7.2, p = 0.005). Conclusion: Prehospital use of high dose tirofiban is
safe and associated with a low risk of bleeding. Age, Killip class > 1,
IABP use, but not high dose tirofiban are independent determinants of
bleeding in STEMI patients. Bleeding is independently associated with
30-day and 1-year mortality. 2010 Elsevier Ireland Ltd. All rights
reserved.

<10>
Accession Number
2012237054
Authors
Andreini D. Pontone G. Mushtaq S. Annoni A. Formenti A. Bertella E.
Parolari A. Agostoni P. Bartorelli A. Ballerini G. Fiorentini C. Pepi M.
Institution
(Andreini, Pontone, Mushtaq, Annoni, Formenti, Bertella, Parolari,
Agostoni, Bartorelli, Ballerini, Fiorentini, Pepi) Centro Cardiologico
Monzino IRCCS, Department of Cardiovascular Sciences, University of Milan,
Milan, Italy
Title
Diagnostic performance of two types of low radiation exposure protocol for
prospective ECG-triggering multidetector computed tomography angiography
in assessment of coronary artery bypass graft.
Source
International Journal of Cardiology. 157 (1) (pp 63-69), 2012. Date of
Publication: 17 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Multidetector computed tomography (MDCT) is useful in
evaluation of coronary artery bypass graft (CABG). However, radiation
exposure is a reason for concern. We compared diagnostic performance and
effective dose of a new dedicated post-processing reconstruction algorithm
with BMI-adapted scanning protocol (MDCT-XTe) vs. standard prospective
ECG-triggering protocol (MDCT-XT) and retrospective ECG-triggering
(MDCT-Helical), compared to invasive coronary angiography (ICA), in the
assessment of grafts and nongrafted or distal runoff coronary arteries.
Methods: One hundred and nineteen patients with 277 grafts were randomized
to Group 1 based on BMI-adapted scanning protocol with prospective
ECG-triggering (40 patients), Group 2 with prospective ECG-triggering (39
patients) and Group 3 (40 patients) with retrospective ECG-triggering.
Data were acquired using 64-slice MDCT. Results: MDCT correctly assessed
the patency of all CABG in 3 groups. After comparison with ICA, MDCT was
able to correctly detect the occlusion or stenosis of CABG in all groups,
with the exception of one case of Group 3. In Group 3 sensitivity,
specificity, positive predictive value, negative predictive value and
accuracy of CABG evaluation were 100%, 98.4%, 96.7%, 100% and 98.9%,
respectively. In Groups 1 and 2 the diagnostic accuracy of CABG evaluation
was 100%. Effective radiation dose was 3.5 +/- 1.4 mSv in Group 1 vs. 7.4
+/- 2.6 mSv in Group 2 vs. 27.8 +/- 9.4 mSv in Group 3. Conclusions: Our
results indicated that MDCT-XTe and MDCT-XT have a diagnostic performance
in the evaluation of CABG similar to MDCT-Helical, with a significant
reduction of radiation exposure, specially for MDCT-XTe. 2010 Elsevier
Ireland Ltd. All rights reserved.

<11>
Accession Number
2012236860
Authors
Balaban F. Yagar S. Ozgok A. Koc M. Gullapoglu H.
Institution
(Balaban, Yagar, Ozgok, Koc, Gullapoglu) Department of Anesthesiology and
Reanimation, Turkiye Yuksek Ihtisas Education and Research Hospital,
Sihhiye 06100, Ankara, Turkey
Title
A randomized, placebo-controlled study of pregabalin for postoperative
pain intensity after laparoscopic cholecystectomy.
Source
Journal of Clinical Anesthesia. 24 (3) (pp 175-178), 2012. Date of
Publication: May 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Study Objective: To determine the efficacy of two different doses (150 mg
and 300 mg) of preoperative pregabalin on pain relief and total opioid
consumption after laparoscopic cholecystectomy. Design: Prospective,
randomized, placebo-controlled, double-blinded study. Setting: Training
and research hospital. Patients: 90 adult, ASA physical status 1 and 2
patients. Interventions: Patients were randomly assigned to three groups
to receive orally one hour before surgery, a placebo (Group 1), pregabalin
150 mg (Group 2), or pregabalin 300 mg (Group 3). Patients were observed
for pregabalin side effects, somnolence via Ramsay Sedation Scale,
dizziness, confusion, and ataxia. Measurements: In the operating room,
heart rate and noninvasive systolic and diastolic blood pressures were
measured. Visual analog scale (VAS), Ramsay Sedation Scale, and Aldrete
scores were also recorded on arrival at the Postanesthesia Care Unit (time
0), 15, 30, 60, 120 minutes and 3, 4, 6, 8, 10, 12 and 24 hours after
surgery. Additional doses of drugs (fentanyl and/or metoclopramide) were
also recorded. Main Results: Preemptive pregabalin decreased pain scores
and postoperative fentanyl consumption in patients after laparoscopic
cholecystectomy in a dose-dependent manner. There were no differences
between the groups in side effects. Conclusion: Preoperative pregabalin
may be a useful analgesic for patients after laparoscopic cholecystectomy,
as it lowers pain intensity and opiod consumption, and does not increase
the frequency of side effects. 2012 Elsevier Inc.

<12>
Accession Number
2012241123
Authors
Kweon T.D. Jung C.-W. Park J.-W. Jeon Y.-S. Bahk J.-H.
Institution
(Kweon) Department of Anesthesiology and Pain Medicine, Yonsei University
College of Medicine, Seoul, South Korea
(Jung, Park, Jeon, Bahk) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
Title
Hemodynamic effect of full flexion of the hips and knees in the supine
position: A comparison with straight leg raising.
Source
Korean Journal of Anesthesiology. 62 (4) (pp 317-321), 2012. Date of
Publication: April 2012.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: Straight raising of the legs in the supine position or
Trendelenburg positioning has been used to treat hypotension or shock, but
the advantages of these positions are not clear and under debate. We
performed a crossover study to evaluate the circulatory effect of full
flexion of the hips and knees in the supine position (exaggerated
lithotomy), and compare it with straight leg raising. Methods: This study
was a prospective randomized crossover study from the tertiary care unit
at our university hospital. Twenty-two patients scheduled for off-pump
coronary artery bypass surgery were enrolled. Induction and maintenance of
anesthesia were standardized. Exaggerated lithotomy position or straight
leg raising were randomly selected in the supine position. Hemodynamic
variables were measured in the following sequence: 10 min after induction,
1, 5, and 10 min following the designated position, and 1 and 5 min after
returning to the supine position. Ten min later, the other position was
applied to measure the same hemodynamic variables. Results: During the
exaggerated lithotomy position, cerebral and coronary perfusion pressure
increased significantly (P < 0.01) without a change in cardiac output.
During straight leg raising, cardiac output increased at 5 min (P < 0.05)
and cerebral and coronary perfusion pressures did not increase except for
cerebral perfusion pressure at 1 min. However, the difference between the
two groups at each time point in terms of cerebral perfusion pressure was
clinically insignificant. Conclusions: Full flexion of the hips and knees
in the supine position did not increase cardiac output but may be more
beneficial than straight leg raising in terms of coronary perfusion
pressure. the Korean Society of Anesthesiologists, 2012.

<13>
Accession Number
2012231037
Authors
Perin E.C. Willerson J.T. Pepine C.J. Henry T.D. Ellis S.G. Zhao D.X.M.
Silva G.V. Lai D. Thomas J.D. Kronenberg M.W. Martin A.D. Anderson R.D.
Traverse J.H. Penn M.S. Anwaruddin S. Hatzopoulos A.K. Gee A.P. Taylor
D.A. Cogle C.R. Smith D. Westbrook L. Chen J. Handberg E. Olson R.E.
Geither C. Bowman S. Francescon J. Baraniuk S. Piller L.B. Simpson L.M.
Loghin C. Aguilar D. Richman S. Zierold C. Bettencourt J. Sayre S.L.
Vojvodic R.W. Skarlatos S.I. Gordon D.J. Ebert R.F. Kwak M. Moye L.A.
Simari R.D.
Institution
(Perin, Willerson, Silva, Smith, Westbrook, Chen) Texas Heart Institute,
St. Luke's Episcopal Hospital, Houston, TX, United States
(Pepine, Anderson, Cogle, Handberg) School of Medicine, University of
Florida, Gainesville, FL, United States
(Martin) College of Public Health and Health Professions, University of
Florida, Gainesville, FL, United States
(Henry, Traverse, Olson) Minneapolis Heart Institute, Abbott Northwestern
Hospital, Minneapolis, MN, United States
(Henry, Traverse, Taylor, Zierold) School of Medicine, University of
Minnesota, Minneapolis, MN, United States
(Ellis, Thomas, Geither) Cleveland Clinic Foundation, Cleveland, OH,
United States
(Zhao, Kronenberg, Hatzopoulos, Bowman, Francescon) School of Medicine,
Vanderbilt University, Nashville, TN, United States
(Lai, Baraniuk, Piller, Simpson, Bettencourt, Sayre, Vojvodic, Moye)
School of Public Health, University of Texas, Houston, TX, United States
(Loghin) School of Medicine, University of Texas, Houston, TX, United
States
(Penn) Northeast Ohio Medical University, Akron, OH, United States
(Anwaruddin) Penn Heart and Vascular Hospital, University of Pennsylvania,
Philadelphia, PA, United States
(Gee, Aguilar, Richman) College of Medicine, Baylor University, Houston,
TX, United States
(Skarlatos, Gordon, Ebert, Kwak) National Heart, Lung, and Blood
Institute, Bethesda, MD, United States
(Simari) Mayo Clinic, Rochester, MN, United States
Title
Effect of transendocardial delivery of autologous bone marrow mononuclear
cells on functional capacity, left ventricular function, and perfusion in
chronic heart failure: The FOCUS-CCTRN trial.
Source
JAMA - Journal of the American Medical Association. 307 (16) (pp
1717-1726), 2012. Date of Publication: 25 Apr 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Previous studies using autologous bone marrow mononuclear cells
(BMCs) in patients with ischemic cardiomyopathy have demonstrated safety
and suggested efficacy. Objective: To determine if administration of BMCs
through transendocardial injections improves myocardial perfusion, reduces
left ventricular end-systolic volume (LVESV), or enhances maximal oxygen
consumption in patients with coronary artery disease or LV dysfunction,
and limiting heart failure or angina. Design, Setting, and Patients:
Aphase 2 randomized double-blind, placebo-controlled trial of symptomatic
patients (New York Heart Association classification II-III or Canadian
Cardiovascular Society classification II-IV) with a left ventricular
ejection fraction of 45% or less, a perfusion defect by single-photon
emission tomography (SPECT), and coronary artery diseasenotam enable to
revascularization who were receiving maximal medical therapy at 5 National
Heart, Lung, and Blood Institute-sponsored Cardiovascular Cell Therapy
Research Network (CCTRN) sites between April 29, 2009, and April 18, 2011.
Intervention: Bone marrow aspiration (isolation of BMCs using a
standardized automated system performed locally) and transendocardial
injection of 100 million BMCs or placebo (ratio of 2 for BMC group to 1
for placebo group). Main Outcome Measures: Co-primary end points assessed
at 6 months: changes in LVESV assessed by echocardiography, maximal oxygen
consumption, and reversibility on SPECT. Phenotypic and functional
analyses of the cell product were performed by the CCTRN biorepository
core laboratory. Results: Of 153 patients who provided consent, a total of
92 (82 men; average age: 63 years) were randomized (n=61 in BMC group and
n=31 in placebo group). Changes in LVESV index (-0.9 mL/m2 [95% CI, -6.1
to 4.3]; P=.73), maximal oxygen consumption (1.0 [95% CI, -0.42 to 2.34];
P=.17), and reversible defect (-1.2 [95% CI, -12.50 to 10.12]; P=.84) were
not statistically significant. There were no differences found in any of
the secondary outcomes, including percent myocardial defect, total defect
size, fixed defect size, regional wall motion, and clinical improvement.
Conclusion: Among patients with chronic ischemic heart failure,
transendocardial injection of autologous BMCs compared with placebo did
not improve LVESV, maximal oxygen consumption, or reversibility on SPECT.
Trial Registration: clinicaltrials.gov Identifier: NCT00824005. 2012
American Medical Association. All rights reserved.

<14>
Accession Number
2012237670
Authors
Foltran F. Ballali S. Passali F.M. Kern E. Morra B. Passali G.C.
Berchialla P. Lauriello M. Gregori D.
Institution
(Foltran, Gregori) Laboratory of Epidemiological Methods and
Biostatistics, Department of Environmental Medicine and Public Health,
University of Padova, Padova, Italy
(Ballali) Prochild ONLUS, Trieste, Italy
(Passali) Ear, Nose, and Throat Clinic, University Tor Vergata, Rome,
Italy
(Kern) ENT Department Mayo Clinic, Rochester, NY, United States
(Morra) ENT Department, San Giovanni Battista Molinette Hospital, Turin,
Italy
(Passali) ENT Department, Catholic University The Sacred Heart, Rome,
Italy
(Berchialla) Department of Public Health and Microbiology, University of
Torino, Italy
(Lauriello) Department of Experimental Medicine, University of L'Aquila,
Italy
Title
Foreign bodies in the airways: A meta-analysis of published papers.
Source
International Journal of Pediatric Otorhinolaryngology. 76 (SUPPL. 1) (pp
S12-S19), 2012. Date of Publication: 14 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Very recently, some attempts have been made to start a
systematic collection of foreign bodies (FB) in view of using them to
characterize the risk of chocking in terms of size, shape and consistency
of the FB. However, most of the epidemiologic evidence on foreign bodies
in children comes from single-center retrospective studies, without any
systematic geographical and temporal coverage. This paper is aimed at
providing an estimate of the distribution of foreign body's injuries in
children according to gender, age, type of FB, site of obstruction,
clinical presentation, diagnostic/therapeutic procedures, complications,
as emerging from a meta-analytic review of published papers. Methods: A
free text search on PubMed database ((foreign bodies) OR (foreign body))
AND ((aspiration) OR (airways) OR (tracheobronchial) OR (nasal) OR
(inhalation) OR (obstruction) OR (choking) OR (inhaled) OR (aspirations)
OR (nose) OR (throat) OR (asphyxiation)) AND ((children) OR (child))
finalized to identify all English written articles referring to foreign
body inhalation over a 30. years period (1978-2008) was performed. The
target of the analysis has been defined as the proportion of injuries as
reported in the studies, stratified according to children demographic
characteristics, type of FB, site of obstruction. The pooled proportions
of FB were calculated using the DerSimonian and Laird approach. Results:
1699 papers were retrieved and 1063 were judged pertinent; 214 English
written case series were identified, among them 174 articles were
available and have been included in the analysis. Airway foreign body most
commonly occurs in young children, almost 20% of children who have inhaled
foreign bodies being between 0 and 3. years of age. Organic FB,
particularly nuts, are the most documented objects while, among inorganic
FBs, the greatest pooled proportion has been recorded for magnets, which
can be particularly destructive in each location. Non specific symptoms or
a complete absence of symptoms are not unusual, justifying mistaken or
delayed diagnosis. Acute and chronic complications seem to occur in almost
15% of patients. Conclusions: Even if an enormous heterogeneity among
primary studies seems to exist and even if the absence of variables
standardized definitions across case series, including class age
definition and symptoms and signs descriptions, seriously impairs studies
comparability, our results testify the relevant morbidity associated with
foreign body inhalation in children, stressing the importance of
preventive measures. 2012 Elsevier Ireland Ltd.

<15>
Accession Number
2012236258
Authors
Hao Z. Zhi-Wei W. Zhen Z. Xiao-Ping H. Hong-Bing W. Yi G.
Institution
(Hao, Zhi-Wei, Zhen, Xiao-Ping, Hong-Bing, Yi) Department of
Cardiothoracic Surgery, Renmin Hospital of Wuhan University, 99 Ziyang
Road, Wuhan, Hubei Province 430060, China
Title
Endovascular stent-graft placement or open surgery for the treatment of
acute type B aortic dissection: A meta-analysis.
Source
Annals of Vascular Surgery. 26 (4) (pp 454-461), 2012. Date of
Publication: May 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: Acute type B aortic dissection (ATBAD) is a life-threatening
condition. Open chest surgical repair using a prosthetic graft has been a
conventional treatment for ATBAD. During the past decade, thoracic
endovascular aortic repair (TEVAR), which is considered as a less invasive
and potentially safer technique, has been increasingly used to treat this
condition. Evidence is needed to support the use of TEVAR for these
patients. The aim of this review was to assess the efficacy of TEVAR
versus conventional open surgery in patients with ATBAD. Methods: For this
review, we searched the Cochrane Central Register of Controlled Trials
(CENTRAL) in The Cochrane Library (last searched: 2010, issue 4), MEDLINE,
EMBASE, CINAHL, Web of Science, and the Chinese Biomedicine Database for
clinical trials until January 18, 2011. Controlled trials in which
patients with ATBAD were assigned to TEVAR or open surgical repair were
included. For each outcome, we evaluated the quality of the evidence with
reference to the Grading of Recommendations Assessments, Development, and
Evaluation criteria. At the end, we used RevMan 5.0 software to analyze
the datum. Results: Five trials (318 participants) are included in this
review. As determined by the Grading of Recommendations Assessments,
Development, and Evaluation approach, the result quality was low for
30-day mortality and very low for other variables. TEVAR can significantly
reduce the short-term mortality for ATBAD (Mantel-Haenszel fixed odds
ratio [95% confidence interval]: 0.19 [0.09-0.39], P < 0.001). TEVAR
cannot significantly improve postoperative complications or long-term
mortality. Conclusions: TEVAR can be weakly recommended as an alternative
for the selective treatment of ATBAD but cannot always be used in case of
surgery. Annals of Vascular Surgery Inc.

<16>
Accession Number
2012237799
Authors
Kawahara Y. Ninomiya I. Fujimura T. Funaki H. Nakagawara H. Takamura H.
Oyama K. Tajima H. Fushida S. Inaba H. Kayahara M.
Institution
(Kawahara, Ninomiya, Fujimura, Funaki, Nakagawara, Takamura, Oyama,
Tajima, Fushida, Kayahara) Gastroenterologic Surgery, Department of
Oncology, Division of Cancer Medicine, Graduate School of Medical Science,
Kanazawa University, Kanazawa, Japan
(Inaba) Department of Emergency and Critical Care Medicine, Kanazawa
University Hospital, Kanazawa, Japan
Title
Prospective randomized controlled study on the effects of perioperative
administration of a neutrophil elastase inhibitor to patients undergoing
video-assisted thoracoscopic surgery for thoracic esophageal cancer.
Source
Diseases of the Esophagus. 23 (4) (pp 329-339), 2010. Date of Publication:
May 2010.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Sivelestat sodium hydrate (Ono Pharmaceutical Co., Osaka, Japan) is a
selective inhibitor of neutrophil elastase (NE) and is effective in
reducing acute lung injury associated with systemic inflammatory response
syndrome (SIRS). We conducted a prospective randomized controlled study to
investigate the efficacy of perioperative administration of sivelestat
sodium hydrate to prevent postoperative acute lung injury in patients
undergoing thoracoscopic esophagectomy and radical lymphadenectomy.
Twenty-two patients with thoracic esophageal cancer underwent
video-assisted thoracoscopic esophagectomy with extended lymph node
dissection in our institution between April 2007 and November 2008. Using
a double-blinded method, these patients were randomly assigned to one of
two groups preoperatively. The active treatment group received sivelestat
sodium hydrate intravenously for 72 hours starting at the beginning of
surgery (sivelestat-treated group; n = 11), while the other group received
saline (control group; n = 11). All patients were given methylprednisolone
immediately before surgery. Postoperative clinical course was compared
between the two groups. Two patients (one in each group) were discontinued
from the study during the postoperative period because of surgery-related
complications. Of the remaining 20 patients, 2 patients who developed
pneumonia within a week after surgery were excluded from some laboratory
analyses, so data from 18 patients (9 patients in each group) were
analyzed based on the arterial oxygen pressure/fraction of inspired oxygen
ratio, white blood cell count, serum C-reactive protein level, plasma
cytokine levels, plasma NE level, and markers of alveolar type II
epithelial cells. In the current study, the incidence of postoperative
morbidity did not differ between the two groups. The median duration of
SIRS in the sivelestattreated group was significantly shorter than that in
the control group: 17 (range 9-36) hours versus 49 (15-60) hours,
respectively (P = 0.009). Concerning the parameters used for the diagnosis
of SIRS, the median heart rates on postoperative day (POD) 2 were
significantly lower in the sivelestat-treated group than in the control
group (P = 0.007). The median arterial oxygen pressure/fraction of
inspired oxygen ratio of the sivelestat-treated group were significantly
higher than those of the control group on POD 1 and POD 7 (POD 1: 372.0
[range 284.0-475.0] vs 322.5 [243.5-380.0], respectively, P = 0.040; POD
7: 377.2 [339.5-430.0] vs 357.6 [240.0-392.8], P = 0.031). Postoperative
white blood cell counts, serum C-reactive protein levels, plasma
interleukin-1beta, tumor necrosis factor-alpha levels, and plasma NE
levels did not differ significantly between the two groups at any point
during the postoperative course, nor did serum Krebs von den Lungen 6,
surfactant protein-A, or surfactant protein-D levels, which were used as
markers of alveolar type II epithelial cells to evaluate the severity of
lung injury. Plasma interleukin-8 levels were significantly lower in the
sivelestat-treated group than in the control group on POD 3 (P = 0.040).
In conclusion, perioperative administration of sivelestat sodium hydrate
(starting at the beginning of surgery) mitigated postoperative hypoxia,
partially suppressed postoperative hypercytokinemia, shortened the
duration of SIRS, and stabilized postoperative circulatory status after
thoracoscopic esophagectomy. 2009 Copyright the Authors Journal
compilation 2010, Wiley Periodicals, Inc.

<17>
Accession Number
70728079
Authors
Lee J.K. Pearce-Smith B. Wei L. Chelly J.
Institution
(Lee, Pearce-Smith, Chelly) University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
(Wei) University of Pittsburgh, Pittsburgh, PA, United States
Title
Continuous paravertebral catheters in patients who underwent minimally
invasive cardiac surgery: A case series.
Source
Regional Anesthesia and Pain Medicine. Conference: 36th Annual Regional
Anesthesia Meeting and Workshops, ASRA 2011 Las Vegas, NV United States.
Conference Start: 20110505 Conference End: 20110508. Conference
Publication: (var.pagings). 36 (5) , 2011. Date of Publication:
September-October 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Minimally invasive surgery is a relatively new approach to
cardiac procedures done through several small thoractomy incisions. This
is done in an effort to reduce the morbidity associated with cardiac
procedures approached with a full sternotomy. In combination with the
physiolgical benefits of regional anesthesia techniques during recovery,
fast tracking surgical strategies may provide a benefit on surgical
outcome (Carli, 2011). Paravertebral nerve block techniques have gained a
recent resurgence in popularity as an effective mode of analgesia post
thoracotomy. Paravertebrals may be just as effective as thoracic epidural
analgesia and associated with fewer side effects and less incidence of
devastating neurological complications (Davies, 2006). Recent
meta-analyses demonstrated that thoracic paravertebrals may decrease
pulmonary complications and facilitate earlier extubation (Joshi, 2008),
(Lynch, 2010). We aim to describe a novel modality of postoperative pain
control after minimally invasive cardiac surgery. Methods: Following IRB
approval, we performed a retrospective review of 11 patients who received
continuous paravertebral catheters for postoperative analgesia undergoing
minimally invasive maze, mitral valve replacement, or LIMA to LAD CABG
procedures. All surgeries were performed by a single surgeon. Depending on
the type of surgery, patients received preoperative bilateral or
unilateral paravertebral continuous catheters at levels T3 or T4. Patients
were given ropivacaine 0.5% bolus during the initial placement of the
block. Infusate consisted of either lidocaine 0.25% or bupivacaine
0.0625%. Inclusion criteria include age greater than 18 - 85 years old,
ASA physical status I-IV, who underwent a minimally invasive cardiac
surgery (coronary artery bypass, mitroplasty, mitral valve repair, or maze
procedure) under the care a single cardiothoracic surgeon, from the dates
9/1/2008 to 12/15/2010. Exclusion criteria included patients who have
psychological disease, history of narcotic or substance abuse, on chronic
anticoagulation, antiplatelet therapy within one week of the procedure, or
had a contraindication to the surgery, paravertebral block, allergy or
intolerance to local anesthetic, or women who were pregnant or post
partum. Results: Eleven patients were retrospectively studied (2 F/9 M).
Median postoperative pain scores at 6, 12, 24, and 48 hrs were 3 (range
0-8, n= 9), 2.25 (0-6, n = 10), 2.5 (0-4, n = 8), and 2 (0-6, n=5),
respectively. 5 of 9 patients were extubated in the OR. Median length of
ICU stay was 1 day (1-7, n= 9). Conclusions: Continuous paravertebral
nerve blocks may be an effective and beneficial modality of postoperative
pain control for minimally invasive cardiac surgery.

<18>
Accession Number
2012230784
Authors
Gu W.-J. Wu Z.-J. Wang P.-F. Htet Aung L.H. Yin R.-X.
Institution
(Gu, Htet Aung, Yin) Department of Cardiology, Institute of Cardiovascular
Diseases, The First Affiliated Hospital, Guangxi Medical University, 22
Shuangyong Road, Nanning 530021, Guangxi, China
(Wu) Department of Colorectal and Anal Surgery, The First Affiliated
Hospital, Guangxi Medical University, Nanning, Guangxi, China
(Wang) Department of Orthopaedics, China-Japan Union Hospital, Jilin
University, Changchun, Jilin, China
Title
N-acetylcysteine supplementation for the prevention of atrial fibrillation
after cardiac surgery: A meta-analysis of eight randomized controlled
trials.
Source
BMC Cardiovascular Disorders. 12 , 2012. Article Number: 10. Date of
Publication: 24 Feb 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Atrial fibrillation is the most common type of arrhythmia
after cardiac surgery. An increasing body of evidence demonstrates that
oxidative stress plays a pivotal role in the pathophysiology of atrial
fibrillation. N-acetylcysteine (NAC) is a free radical scavenger, and may
attenuate this pathophysiologic response and reduce the incidence of
postoperative AF (POAF). However, it is unclear whether NAC could
effectively prevent POAF. Therefore, this meta-analysis aims to assess the
efficacy of NAC supplementation on the prevention of POAF.Methods: Medline
and Embase were systematically reviewed for studies published up to
November 2011, in which NAC was compared with controls for adult patients
undergoing cardiac surgery. Outcome measures comprised the incidence of
POAF and hospital length of stay (LOS). The meta-analysis was performed
with the fixed-effect model or random-effect model according to the
heterogeneity.Results: Eight randomized trials incorporating 578 patients
provided the best evidence and were included in this meta-analysis. NAC
supplementation significantly reduced the incidence of POAF (OR 0.62, 95%
CI 0.41 to 0.93; P = 0.021) compared with controls, but had no effect on
LOS (WMD -0.07, 95% CI -0.42 to 0.28; P = 0.703).Conclusions: The
prophylactic NAC supplementation may effectively reduce the incidence of
POAF. However, the overall quality of current studies is poor and further
research should focus on adequately powered randomized controlled trials
with POAF incidence as a primary outcome measure. 2012 Gu et al; licensee
BioMed Central Ltd.

<19>
Accession Number
21684171
Authors
Mukherjee D. Ashrafian H. Kourliouros A. Ahmed K. Darzi A. Athanasiou T.
Institution
(Mukherjee) Department of Surgery and Cancer, Imperial College London,
London, UK.
Title
Intra-operative conversion is a cause of masked mortality in off-pump
coronary artery bypass: a meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 41 (2) (pp 291-299),
2012. Date of Publication: Feb 2012.
Abstract
Coronary artery bypass surgery can offer excellent results when performed
with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass
(off pump). The debate as to which technique is superior remains
unanswered. Intra-operative conversion from off- to on-pump coronary
surgery is a relatively unexplored phenomenon, which cannot be assessed
within randomised controlled trial design. We aimed to assess the effect
of off-pump conversion on patient mortality. Medline, Embase, Cochrane and
Google Scholar databases were systematically reviewed for studies
published between 1980 and 2010 that compared the incidence of mortality
between converted and non-converted off-pump patients. Publication bias
and heterogeneity were assessed and data were extracted independently by
multiple observers. We undertook a meta-analysis of these studies using
random effects modelling. A total of 17 studies fulfilled our inclusion
criteria, containing data for 18,870 off-pump coronary artery bypass
operations spanning a decade (1998-2008), involving 920 cases of
conversion. Overall, conversion increased mortality by an odds ratio of
6.18 (95% confidence interval 4.65-8.20), whereas emergency conversion
further raised the odds ratio of mortality to 6.99 (95% confidence
interval 5.18-9.45). The conversion from off- to on-pump cardiac surgery
may significantly increase the chance of an adverse outcome, whereas
emergency conversion confers a significant rise in mortality. The risk of
conversion should be discussed when obtaining the patient's informed
consent and its prevention warrants serious consideration by cardiac
surgeons and cardiac surgical training programmes.

<20>
Accession Number
21640602
Authors
Biancari F. Mikkola R. Heikkinen J. Lahtinen J. Airaksinen K.E. Juvonen T.
Institution
(Biancari) Department of Surgery, Oulu University Hospital, Oulu, Finland.
Title
Estimating the risk of complications related to re-exploration for
bleeding after adult cardiac surgery: a systematic review and
meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 41 (1) (pp 50-55), 2012.
Date of Publication: Jan 2012.
Abstract
The aim of this study was to evaluate the impact of re-exploration for
bleeding after cardiac surgery on the immediate postoperative outcome.
Systematic review of the literature and meta-analysis of data on
re-exploration for bleeding after adult cardiac surgery were performed.
The literature search yielded eight observational studies reporting on
557,923 patients and were included in the present analysis. Patients
requiring re-exploration were significantly older, more frequently males,
had a higher prevalence of peripheral vascular disease and preoperative
exposure to aspirin, and more frequently underwent urgent/emergency
surgery. Re-exploration was associated with significantly increased risk
ratio (RR) of immediate postoperative mortality (RR 3.27, 95% confidence
interval (CI) 2.44-4.37), stroke, need of intra-aortic balloon pump, acute
renal failure, sternal wound infection, and prolonged mechanical
ventilation. The pooled analysis of four studies (two being propensity
score-matched pairs analysis) reporting adjusted risk for mortality led to
an RR of 2.56 (95%CI 1.46-4.50). Studies published during the last decade
tended to report a higher risk of re-exploration-related mortality (RR
4.30, 95%CI 3.09-5.97) than those published in the 1990s (RR 2.75, 95%CI
2.06-3.66). This study suggests that re-exploration for bleeding after
cardiac surgery carries a significantly increased risk of postoperative
mortality and morbidity.

<21>
Accession Number
22314630
Authors
Cutshall S.A. Anderson P.G. Prinsen S.K. Wentworth L.J. Olney T.J. Messner
P.K. Brekke K.M. Li Z. Sundt 3rd. T.M. Kelly R.F. Bauer B.A.
Institution
(Bauer) Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Title
Effect of the combination of music and nature sounds on pain and anxiety
in cardiac surgical patients: a randomized study.
Source
Alternative therapies in health and medicine. 17 (4) (pp 16-23), 2011.
Date of Publication: 2011 Jul-Aug.
Abstract
Postoperative pain and anxiety are common in cardiac surgery patients.
Studies have suggested that music can decrease anxiety in hospitalized
patients. Primary Study Objective This study focused on the efficacy and
feasibility of special music, which included nature sounds, for pain and
anxiety. In this randomized controlled trial, postoperative cardiovascular
surgery patients were randomly assigned to a music group to receive 20
minutes of standard postoperative care and music twice daily on
postoperative days 2 through 4 or to a control group to receive 20 minutes
of standard care with a quiet resting period twice daily on postoperative
days 2 through 4. Cardiovascular surgical unit of Saint Marys Hospital,
Rochester, Minnesota. One hundred patients completed the study (music
group, n = 49; control group, n = 51). Intervention The music was
delivered through CD players in the patients' rooms. Pain, anxiety,
satisfaction, and relaxation were evaluated from visual analog scales.
Data showed a significant decrease in mean (SD) pain scores after the
second session of day 2 for the music group (change, ?1.4 [1.4]) compared
with the control group (change, ?0.4 [1.4]) (P = .001). Mean relaxation
scores improved more at the first session of day 2 for the music group
(change, 1.9 [2.7]) compared with the control group (change, 0.3 [2.9]) (P
= .03). The music group also showed lower anxiety and increased
satisfaction overall, but these differences were not statistically
significant. No major barriers to using the therapy were identified.
Recorded music and nature sounds can be integrated into the postoperative
care of cardiovascular surgery patients. The recordings may provide an
additional means for addressing common symptoms of pain and anxiety while
providing a means of relaxation for these patients.