EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2012273396
Authors
Prochaska J.J. Hilton J.F.
Institution
(Prochaska) Department of Psychiatry, Center for Tobacco Control Research
and Education, University of California, San Francisco, CA 94143-0984,
United States
(Hilton) Department of Epidemiology and Biostatistics, University of
California, United States
Title
Risk of cardiovascular serious adverse events associated with varenicline
use for tobacco cessation: Systematic review and meta-analysis.
Source
BMJ (Online). 344 (7856) , 2012. Article Number: e2856. Date of
Publication: 12 May 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To examine the risk of treatment emergent, cardiovascular
serious adverse events associated with varenicline use for tobacco
cessation. Design: Meta-analysis comparing study effects using four
summary estimates. Data sources: Medline, Cochrane Library, online
clinical trials registries, and reference lists of identified articles.
Review methods: We included randomised controlled trials of current
tobacco users of adult age comparing use of varenicline with an inactive
control and reporting adverse events. We defined treatment emergent,
cardiovascular serious adverse events as occurring during drug treatment
or within 30 days of discontinuation, and included any ischaemic or
arrhythmic adverse cardiovascular event (myocardial infarction, unstable
angina, coronary revascularisation, coronary artery disease, arrhythmias,
transient ischaemic attacks, stroke, sudden death or cardiovascular
related death, or congestive heart failure). Results: We identified 22
trials; all were double blinded and placebo controlled; two included
participants with active cardiovascular disease and 11 enrolled
participants with a history of cardiovascular disease. Rates of treatment
emergent, cardiovascular serious adverse events were 0.63% (34/5431) in
the varenicline groups and 0.47% (18/3801) in the placebo groups. The
summary estimate for the risk difference, 0.27% (95% confidence interval
-0.10 to 0.63; P=0.15), based on all 22 trials, was neither clinically nor
statistically significant. For comparison, the relative risk (1.40, 0.82
to 2.39; P=0.22), Mantel-Haenszel odds ratio (1.41, 0.82 to 2.42; P=0.22),
and Peto odds ratio (1.58, 0.90 to 2.76; P=0.11), all based on 14 trials
with at least one event, also indicated a non-significant difference
between varenicline and placebo groups. Conclusions: This meta-analysis -
which included all trials published to date, focused on events occurring
during drug exposure, and analysed findings using four summary estimates -
found no significant increase in cardiovascular serious adverse events
associated with varenicline use. For rare outcomes, summary estimates
based on absolute effects are recommended and estimates based on the Peto
odds ratio should be avoided.

<2>
Accession Number
2012284911
Authors
Potena L. Prestinenzi P. Bianchi I.G. Masetti M. Romani P. Magnani G.
Fallani F. Coccolo F. Russo A. Ponticelli C. Rapezzi C. Grigioni F. Branzi
A.
Institution
(Potena, Prestinenzi, Bianchi, Masetti, Romani, Magnani, Fallani, Coccolo,
Russo, Rapezzi, Grigioni, Branzi) Cardiovascular Department, University of
Bologna, Bologna, Italy
(Ponticelli) Nephrology Department, Humanitas Hospital, Milan, Italy
Title
Cyclosporine lowering with everolimus versus mycophenolate mofetil in
heart transplant recipients: Long-term follow-up of the SHIRAKISS
randomized, prospective study.
Source
Journal of Heart and Lung Transplantation. 31 (6) (pp 565-570), 2012. Date
of Publication: June 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Cyclosporine nephrotoxicity negatively impacts long-term
outcome after heart transplantation (HT). We previously reported 1-year
results from a randomized study showing that cyclosporine-lowering
strategies based on everolimus or mycophenolate mofetil (MMF) are equally
effective for reducing progression of renal dysfunction. It is unknown
whether this efficacy could be maintained over the long term. Methods:
Thirty-four recipients 1 to 4 years after HT and with 25 to 60 ml/min of
creatinine clearance (CrCl) were randomized to everolimus with a very low
dose (C₀: 50 to 90 ng/ml, n = 17) or MMF with low dose of
cyclosporine (C₀: 100 to 150 ng/ml, n = 17). Follow-up was
prolonged up to 3 years, and calculated CrCl was the main efficacy
measure. Results: Cyclosporine was maintained at 70% and 30% lower than
baseline in the everolimus and MMF arms, respectively, throughout the
3-year study period. CrCl remained stable in the everolimus patients (+7%
from baseline; p = 0.7), but improved in the MMF patients (+20% from
baseline; p < 0.01), with a trend toward improved values compared with
everolimus patients (46 +/- 12 vs 56 +/- 15 ml/min; p = 0.06). Subgroup
analysis revealed that baseline proteinuria markedly influenced the renal
function response to everolimus: whereas in patients with baseline
proteinuria CrCl significantly worsened (-20%; p = 0.04), it improved in
those without (+15%; p = 0.03). Safety was comparable between the two
study arms. Conclusions: Cyclosporine nephrotoxicity improved after a
prolonged dose reduction in patients receiving MMF. The everolimus-based
strategy provided a similar benefit only to patients without baseline
proteinuria. While raising caution against the universal use of everolimus
for kidney protection, our long-term results support the need for
customized approaches in the management of drug toxicities in maintenance
HT recipients. 2012 International Society for Heart and Lung
Transplantation.

<3>
Accession Number
2012297284
Authors
Afilalo J. Rasti M. Ohayon S.M. Shimony A. Eisenberg M.J.
Institution
(Afilalo, Rasti, Ohayon, Shimony, Eisenberg) Department of Medicine,
SMBD-Jewish General Hospital, McGill University, 3755 Cote Ste Catherine,
Montreal, QC H3T 1E2, Canada
Title
Off-pump vs. on-pump coronary artery bypass surgery: An updated
meta-analysis and meta-regression of randomized trials.
Source
European Heart Journal. 33 (10) (pp 1257-1267), 2012. Date of Publication:
May 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims The benefits of off-pump coronary artery bypass (OPCAB) continue to
be debated, in part due to the fact that pooled effects fail to consider
differences in trial and patient characteristics. We sought to analyse the
contemporary evidence for OPCAB vs. conventional coronary artery bypass
(CCAB), incorporating recent larger trials, and adjusting for differences
in trials using a technique known as meta-regression. Methods and results
We systematically reviewed MEDLINE, EMBASE, and the Cochrane database for
published and unpublished randomized trials of OPCAB vs. CCAB in which
30-day or in-hospital clinical outcomes were reported. The outcomes of
interest were: all-cause mortality, stroke, and myocardial infarction. In
addition to measuring the pooled treatment effects using a random effects
meta-analysis model, we measured the effect of selected trial-level
factors on the effects observed using the meta-regression technique.
Fifty-nine trials were included, encompassing 8961 patients with a mean
age of 63.4 and 16 females. There was a significant 30 reduction in the
occurrence of post-operative stroke with OPCAB [risk ratio (RR) 0.70, 95
CI: 0.490.99]. There was no significant difference in mortality (RR: 0.90,
95 CI: 0.631.30) or myocardial infarction (pooled RR: 0.89, 95 CI:
0.691.13). In the meta-regression analysis, the effect of OPCAB on all of
the clinical outcomes was similar regardless of mean age, proportion of
females in the trial, number of grafts per patient, and trial publication
date. Conclusion Our meta-analysis incorporating recent trials suggests
that there appears to be a beneficial effect of OPCAB on stroke. Moreover,
our meta-regression does not support the hypothesis that differences in
study populations are responsible for the observed outcomes, although
pooled individual patient-data would be better suited to confirm these
findings. 2011 The Author.

<4>
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Accession Number
2012295499
Authors
Houlind K. Kjeldsen B.J. Madsen S.N. Rasmussen B.S. Holme S.J. Nielsen
P.H. Mortensen P.E.
Institution
(Houlind, Nielsen) Department of Cardiothoracic Surgery, Skejby Hospital,
Aarhus University Hospital, Aarhus, Denmark
(Houlind) Institute of Regional Health Services Research, Faculty of
Health Sciences, University of Southern Denmark, Odense, Denmark
(Kjeldsen, Mortensen) Department of Cardiothoracic Surgery, Odense
University Hospital, Odense, Denmark
(Madsen) Department of Cardiothoracic Surgery, Center for Cardiovascular
Research, Denmark
(Rasmussen) Department of Anesthesia, Aalborg Hospital, Aarhus University
Hospital, Aarhus, Denmark
(Holme) Department of Cardiothoracic Surgery, Gentofte Hospital, Hellerup,
Denmark
Title
On-pump versus off-pump coronary artery bypass surgery in elderly
patients: Results from the danish on-pump versus off-pump randomization
study.
Source
Circulation. 125 (20) (pp 2431-2439), 2012. Date of Publication: 22 May
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Conventional coronary artery bypass grafting performed with the
use of cardiopulmonary bypass is a well-validated treatment for patients
with ischemic heart disease. Off-pump coronary artery bypass grafting
(OPCAB) has been suggested to reduce the number of perioperative
complications, especially in elderly patients. Methods and Results-In a
multicenter, randomized trial, we assigned 900 patients >70 years of age
to conventional coronary artery bypass grafting or OPCAB surgery. After 30
days, a blinded end-point committee assessed whether a combined end point
of death, stroke, or myocardial infarction had occurred. At baseline and 6
months postoperatively, self-assessed quality of life was measured with
the Medical Outcomes Study Short Form-36 and EuroQol-5D questionnaires. A
6-month follow-up of mortality was performed through the Danish National
Registry. The proportion of patients experiencing the combined end point
within 30 days was 10.2% for conventional coronary artery bypass grafting
and 10.7% for OPCAB. Implied risk difference of 0.4% (with a 95%
confidence interval,-3.6 to 4.4) showed nonsignificance in a standard test
for equality (P=0.83) and for noninferiority with an inferiority margin of
0.5% (P=0.49). At the 6-month follow-up, mortality was 4.7% compared with
4.2% (P=0.75). Both groups showed significant improvement in self-assessed
health-related quality of life. Conclusions-Both conventional coronary
artery bypass grafting and OPCAB are safe procedures that improved the
quality of life when performed in elderly patients. No major differences
in intermediate-term outcomes were found. However, the noninferiority of
OPCAB with the prespecified margin could not be confirmed. Clinical Trial
Registration-URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00123981. 2012 American Heart Association, Inc.

<5>
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Accession Number
2012282817
Authors
Cholette J.M. Henrichs K.F. Alfieris G.M. Powers K.S. Phipps R. Spinelli
S.L. Swartz M. Gensini F. Daugherty L.E. Nazarian E. Rubenstein J.S.
Sweeney D. Eaton M. Lerner N.B. Blumberg N.
Institution
(Cholette, Powers, Daugherty, Nazarian, Rubenstein) Department of
Pediatrics, University of Rochester, Rochester, NY, United States
(Henrichs, Spinelli, Blumberg) Department of Pathology and Laboratory
Medicine, University of Rochester, Rochester, NY, United States
(Alfieris, Swartz, Gensini) Department of Cardiac Surgery, University of
Rochester, Rochester, NY, United States
(Phipps) Department of Environmental Medicine, University of Rochester,
Rochester, NY, United States
(Sweeney, Eaton) Department of Anesthesiology, University of Rochester,
Rochester, NY, United States
(Lerner) Department of Pediatrics, St. Christopher's Hospital for
Children, Philadelphia, PA, United States
Title
Washing red blood cells and platelets transfused in cardiac surgery
reduces postoperative inflammation and number of transfusions: Results of
a prospective, randomized, controlled clinical trial.
Source
Pediatric Critical Care Medicine. 13 (3) (pp 290-299), 2012. Date of
Publication: May 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVES: Children undergoing cardiac surgery with cardiopulmonary
bypass are susceptible to additional inflammatory and immunogenic insults
from blood transfusions. We hypothesize that washing red blood cells and
platelets transfused to these patients will reduce postoperative
transfusion-related immune modulation and inflammation. DESIGN:
Prospective, randomized, controlled clinical trial. SETTING: University
hospital pediatric cardiac intensive care unit. PATIENTS: Children from
birth to 17 yrs undergoing cardiac surgery with cardiopulmonary bypass.
INTERVENTIONS: Children were randomized to an unwashed or washed red blood
cells and platelet transfusion protocol for their surgery and
postoperative care. All blood was leuko-reduced, irradiated, and ABO
identical. Plasma was obtained for laboratory analysis preoperatively,
immediately, and 6 and 12 hrs after cardiopulmonary bypass. Primary
outcome was the 12-hr postcardiopulmonary bypass
interleukin-6-to-interleukin-10 ratio. Secondary measures were interleukin
levels, C-reactive protein, and clinical outcomes. MEASUREMENTS AND MAIN
RESULTS: One hundred sixty-two subjects were studied, 81 per group.
Thirty-four subjects (17 per group) did not receive any blood
transfusions. Storage duration of blood products was similar between
groups. Among transfused subjects, the 12-hr interleukin ratio was
significantly lower in the washed group (3.8 vs. 4.8; p = .04) secondary
to lower interleukin-6 levels (after cardiopulmonary bypass: 65 vs.100
pg/mL, p = .06; 6 hrs: 89 vs.152 pg/mL, p = .02; 12 hrs: 84 vs.122 pg/mL,
p = .09). Postoperative C-reactive protein was lower in subjects receiving
washed blood (38 vs. 43 mg/L; p = .03). There was a numerical, but not
statistically significant, decrease in total blood product transfusions
(203 vs. 260) and mortality (2 vs. 6 deaths) in the washed group compared
to the unwashed group. CONCLUSIONS: Washed blood transfusions in cardiac
surgery reduced inflammatory biomarkers, number of transfusions, donor
exposures, and were associated with a nonsignificant trend toward reduced
mortality. A larger study powered to test for clinical outcomes is needed
to determine whether these laboratory findings are clinically significant.
Copyright 2012 by the Society of Critical Care Medicine and the World
Federation of Pediatric Intensive and Critical Care Societies.

<6>
Accession Number
22345176
Authors
Litton E. Ho K.M.
Institution
(Litton) Department of Intensive Care Medicine, Royal Perth Hospital,
Perth, WA, Australia.
Title
The use of pre-operative brain natriuretic peptides as a predictor of
adverse outcomes after 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 (3) (pp 525-534),
2012. Date of Publication: Mar 2012.
Abstract
The objective of this systematic review was to assess whether
pre-operative brain natriuretic peptide (BNP) and N-terminal pro-B-type
natriuretic peptide (NT pro-BNP) are independent predictors of adverse
outcomes after cardiac surgery. MEDLINE, Embase and the Cochrane
Controlled Trials Register databases were searched. Eligible studies
included observational or randomized control trials measuring natriuretic
peptide concentrations before induction of anaesthesia for cardiac
surgery. Two investigators independently extracted the data and assessed
the validity of the included studies. The predictive ability of
pre-operative BNP or NT pro-BNP on mortality, post-operative atrial
fibrillation (AF) and intra-aortic balloon pump (IABP) requirement was
meta-analysed. The association between BNP or NT pro-BNP and other
outcomes was systematically summarized. A total of 4933 patients from 22
studies were considered in the systematic review. Ten studies with one or
more outcomes of interest were included in the meta-analyses. The strength
of association between pre-operative natriuretic peptide levels and
adverse outcomes after surgery was variable, as was the size and quality
of the included studies. The summary areas under the receiver operating
characteristic curve for mortality, post-operative AF and post-operative
IABP requirement were 0.61 (95% confidence interval [CI] 0.51-0.70), 0.61
(95% CI 0.58-0.64) and 0.81 (95% CI 0.73-0.89), respectively. With the
limited data available, the associations between pre-operative natriuretic
peptide levels and adverse outcomes after cardiac surgery were moderate.
Future studies should assess whether pre-operative natriuretic peptides
can provide additional independent predictive information to
well-validated prognostic scores of cardiac surgery.

<7>
Accession Number
22219412
Authors
Head S.J. Mack M.J. Holmes Jr. D.R. Mohr F.W. Morice M.C. Serruys P.W.
Kappetein A.P.
Institution
(Head) Department of Cardio-thoracic Surgery, Erasmus University Medical
Center, Rotterdam, The Netherlands.
Title
Incidence, predictors and outcomes of incomplete revascularization after
percutaneous coronary intervention and coronary artery bypass grafting: a
subgroup analysis of 3-year SYNTAX data.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 41 (3) (pp 535-541),
2012. Date of Publication: Mar 2012.
Abstract
To assess whether incomplete revascularization by percutaneous coronary
intervention (PCI) or coronary artery bypass grafting (CABG) has an effect
on long-term outcomes. During a heart team discussion to evaluate whether
patients were eligible for randomization in the SYNTAX trial, both the
cardiologist and surgeon agreed on which vessels needed revascularization.
This statement was compared with the actual revascularization after
treatment. Incomplete revascularization was defined as when a
preoperatively identified vessel with a lesion was not revascularized.
Outcomes were major adverse cardiac or cerebrovascular events (MACCE), the
composite safety endpoint of death/stroke/myocardial infarction (MI), and
individual MACCE components death, MI and repeat revascularization at 3
years. Predictors of incomplete revascularization were explored.
Incomplete revascularization was found in 43.3% (388/896) PCI and 36.8%
(320/870) CABG patients. Patients with complete revascularization by PCI
had lower rates of MACCE (66.5 versus 76.2%, P < 0.001), the composite
safety endpoint (83.4 versus 87.9%, P = 0.05) and repeat revascularization
(75.5 versus 83.9%, P < 0.001), but not death and MI. In the CABG group,
no difference in outcomes was seen between incomplete and complete
revascularization groups. Incomplete revascularization was identified as
independent predictor of MACCE in PCI (HR = 1.55, 95% CI 1.15-2.08, P =
0.004) but not CABG patients. Independent predictors of incomplete
revascularization by PCI were hyperlipidaemia (OR = 1.59, 95% CI
1.04-2.42, P = 0.031), a total occlusion (OR = 2.46, 95% CI 1.66-3.64, P <
0.001) and the number of vessels (OR = 1.58, 95% CI 1.41-1.77, P < 0.001).
Independent predictors of incomplete revascularization by CABG were
unstable angina (OR = 1.42, 95% CI 1.02-1.98, P = 0.038), diffuse disease
or narrowed ( < 2 mm) segment distal to the lesion (OR = 1.87, 95% CI
1.31-2.69, P = 0.001) and the number of vessels (OR = 1.70, 95% CI
1.53-1.89, P < 0.001). Despite the hypothesis-generating nature of this
data, this study demonstrates that incomplete revascularization is
associated with adverse events during follow-up after PCI but not CABG.

<8>
Accession Number
22219409
Authors
Pokushalov E. Romanov A. Corbucci G. Cherniavsky A. Karaskov A.
Institution
(Pokushalov) State Research Institute of Circulation Pathology,
Novosibirsk, Russia.
Title
Benefit of ablation of first diagnosed paroxysmal atrial fibrillation
during coronary artery bypass grafting: a pilot study.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 41 (3) (pp 556-560),
2012. Date of Publication: Mar 2012.
Abstract
Whether patients with recent onset of paroxysmal atrial fibrillation (PAF)
might benefit of epicardial atrial fibrillation (AF) ablation concomitant
to coronary artery bypass graft (CABG) is not known. The aim of this
prospective, randomized, single-centre pilot study is the comparison of
patients with first diagnosed AF submitted to CABG and treated with and
without epicardial pulmonary vein isolation (PVI). Patients with first
diagnosed PAF and indication for CABG were enrolled in this prospective
randomized pilot study. The primary endpoint was AF-free survival (AF
burden <0.5%) between the two groups at 18-month follow-up. The secondary
endpoints were the percentage of AF burden defined through continuous
monitoring using an implantable loop recorder, thromboembolic events and
procedural complications. All patients were implanted with a subcutaneous
cardiac monitor to track the cardiac rhythm and measure the AF burden.
This study enrolled 35 patients (mean age 59 +/- 7 years, 74% males),
followed up for 18 months after CABG. The patients were randomly allocated
to two groups, CABG alone (n = 17) and CABG with concomitant PVI (n = 18).
At 18-month follow-up after surgery, 16 (89%) patients in the CABG + PVI
group were AF-free (i.e. AF% < 0.5%) vs 8 (47%) in the CABG only group
(log-rank test, P = 0.007). At the end of follow-up, the mean AF burden in
the CABG and the CABG + PVI group was 7.8 +/- 5.1 and 1.6 +/- 1.8%,
respectively (P < 0.001). Two (18.2%) of the 11 patients with AF
recurrences were completely asymptomatic. Patients with recent-onset AF
submitted to CABG may benefit of concomitant ablation of the arrhythmia
for preventing recurrences.

<9>
Accession Number
22219405
Authors
Cardillo G. Carleo F. Carbone L. De Massimi A.R. Lococo A. Santini P.F.
Janni A. Gonfiotti A.
Institution
(Cardillo) Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda
Ospedaliera S. Camillo Forlanini, Rome, Italy.
Title
Adverse effects of fibrin sealants in thoracic surgery: the safety of a
new fibrin sealant: multicentre, randomized, controlled, clinical trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 41 (3) (pp 657-662),
2012. Date of Publication: Mar 2012.
Abstract
The safety of fibrin sealants (FS) has been questioned in the light of
recent reports of adverse effects. We evaluated the safety of a new FS in
a randomized controlled trial (RCT). Multicentre, open-label Phase II/III
RCT to evaluate the safety of the new FS. The trial was approved by the
Ethic Committee of each three participating Centre. FS includes two
components (component 1: fibrinogen; component 2: thrombin), each of them
subjected to two viral inactivation procedures. Out of 200 screened
patients, 185 eligible patients (49 females, 136 males), aged between 18
and 75 years, undergoing major thoracic surgery were randomized to receive
FS (#91 patients) as an adjuvant for air leak control or no treatment (#94
patients, control group). Safety variables were: percentage of subjects
with adverse events associated with the therapy; formation of antibodies
against bovine aprotinin; vital signs (blood pressure, body temperature,
heart and respiratory rate); laboratory parameters. Overall operative
mortality was 3.2% (6/185), 1.1% in the FS group and 5.3% in the control
group, respectively. Twenty patients (22%) had adverse events in the FS
group and 22 (23.4%) in the control group. Atrial fibrillation (five
patients in the FS group and four in the control group) and hyperpyrexia
(five and seven patients, respectively, in the two groups) were the most
common adverse events. No patient reported thromboembolic events
(pulmonary embolism or deep vein thrombosis) during the in hospital stay
or within 1 month from discharge. None of the adverse events was
considered as treatment related. The formation of bovine aprotinin
antibodies was reported in a total of 34 patients (37.4%) in the FS group
and was not related to any adverse effect. The present RCT did not show
any increased risk of adverse events, and of surgical complications,
related to the use of the new FS.

<10>
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Accession Number
2012295504
Authors
Parish S. Offer A. Clarke R. Hopewell J.C. Hill M.R. Otvos J.D. Armitage
J. Collins R.
Institution
(Parish, Offer, Clarke, Hopewell, Hill, Armitage, Collins) Clinical Trial
Service Unit, Epidemiological Studies Unit, University of Oxford, Old Road
Campus, Roosevelt Drive, Oxford OX3 7LF, United Kingdom
(Otvos) LipoScience Inc, Raleigh, NC, United States
Title
Lipids and lipoproteins and risk of different vascular events in the
MRC/BHF heart protection study.
Source
Circulation. 125 (20) (pp 2469-2478), 2012. Date of Publication: 22 May
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Low-density lipoprotein (LDL) cholesterol and high-density
lipoprotein (HDL) cholesterol are established risk factors for vascular
disease, but lipoprotein particle concentrations may be stronger
determinants of risk. Methods and Results-Associations between vascular
events and baseline concentrations of cholesterol fractions,
apolipoproteins B and A1, and lipoprotein particles assessed by nuclear
magnetic resonance were considered in the Heart Protection Study
randomized trial of simvastatin versus placebo (>5000 vascular events
during 5.3 years of follow-up among 20 000 participants). Major occlusive
coronary events were equally strongly associated with the cholesterol-and
particle-based total LDL measures; adjusted hazard ratios per 1-SD-higher
level were 1.25 (95% confidence interval [CI], 1.16-1.34) for LDL
cholesterol, 1.22 (95% CI, 1.14-1.32) for non-HDL cholesterol, 1.23 (95%
CI, 1.15-1.33) for apolipoprotein B, and 1.25 (95% CI, 1.16-1.35) for LDL
particle number. Given the total LDL particle number, the distribution
between small and large particles did not add predictive value.
Associations of these different LDL-related measures were similar with
arterial revascularization procedures but much weaker or nonexistent with
ischemic stroke and other cardiac events (mainly heart failure). After
adjustment for LDL particle number, the hazard ratios for major occlusive
coronary event per 1-SD-higher level were 0.91 (95% CI, 0.86-0.96) for HDL
cholesterol and 0.89 (95% CI, 0.85-0.93) for HDL particle number. Other
cardiac events were inversely associated with total (hazard ratio, 0.84;
95% CI, 0.79-0.90) and small (0.82; 95% CI, 0.76-0.89) HDL particle number
but only very weakly associated with HDL cholesterol (0.94; 95% CI,
0.88-1.00). Conclusions-In a population at 2% average coronary event risk
per year, cholesterol, apolipoprotein, and particle measures of LDL were
strongly correlated and had similar predictive values for incident major
occlusive vascular events. It is unclear whether the associations between
HDL particle numbers and other cardiac events represent a causal or
reverse-causal effect. Clinical Trial Registration-URL:
http://www.isrctn.org/. Unique identifier: ISRCTN48489393. 2012 American
Heart Association, Inc.

<11>
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Accession Number
2012294481
Authors
Petersen R.H. Hansen H.J. Dirksen A. Pedersen J.H.
Institution
(Petersen, Hansen, Pedersen) Department of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University, Blegdamsvej 9, Copenhagen, 2100,
Denmark
(Dirksen) Department of Respiratory Medicine, Gentofte University
Hospital, Copenhagen, Denmark
Title
Lung cancer screening and video-assisted thoracic surgery.
Source
Journal of Thoracic Oncology. 7 (6) (pp 1026-1031), 2012. Date of
Publication: June 2012.
Publisher
International Association for the Study of Lung Cancer (PO Box 6511, Mail
Stop 8111, Aurora, Colorado 80045-0511, United States)
Abstract
Introduction: The objective of this study is to report the impact of
computed tomography (CT) screening on the use of Video-Assisted Thoracic
Surgery (VATS) in a randomized screening trial. METHODS: The Danish Lung
Cancer Screening Trial is a randomized clinically controlled trial of 4104
smokers and previous smokers who were randomized to either screening with
five annual low-dose CT scans or no screening in Copenhagen from 2004 to
2006. The major end point is the effect of CT screening on lung cancer
mortality and treatment options. All diagnostic and treatment
interventions in both groups were monitored prospectively until 1 to 3
years after the last screening round. RESULTS: By February 1, 2011 68
cases of lung cancer were detected in the screening group. Furthermore,
seven patients with a benign nodule underwent surgical treatment because
of suspicion of malignancy (12%). Fifty-one of the 68 lung cancer patients
were eligible for surgical treatment. Eight patients had open thoracotomy.
Of the operations for lung cancer, 84% were performed by VATS in the
CT-screened arm, significantly higher than the control arm (p < 0.05).
Thirty-six patients had a VATS lobectomy. One patient had a VATS
segmentectomy, and four patients had a VATS wedge resection. The seven
benign nodules were all treated with VATS. CONCLUSIONS: CT screening seems
to facilitate the use of VATS in the treatment of lung cancer with an 84%
rate in our data. Furthermore, all benign nodules could be removed by
VATS. In our view, a basic requirement for a surgical institution to be
involved in lung cancer CT screening is a dedicated VATS program.
Copyright 2012 by the International Association for the Study of Lung
Cancer.

<12>
Accession Number
2012283494
Authors
Romero J. Xue X. Gonzalez W. Garcia M.J.
Institution
(Romero, Xue, Garcia) Division of Cardiology, Montefiore-Einstein Center
for Heart and Vascular Care, Albert Einstein College of Medicine, 111 East
210th Street, Silver Zone, Bronx, NY 10467-2400, United States
(Gonzalez) Division of Cardiology, St. Luke's Roosevelt Hospital, Columbia
University College of Physicians and Surgeons, New York, NY, United States
Title
CMR imaging assessing viability in patients with chronic ventricular
dysfunction due to coronary artery disease: A meta-analysis of prospective
trials.
Source
JACC: Cardiovascular Imaging. 5 (5) (pp 494-508), 2012. Date of
Publication: May 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: The purpose of this study was to compare the diagnostic
accuracy of cardiac magnetic resonance (CMR) assessing myocardial
viability in patients with chronic left ventricular (LV) dysfunction due
to coronary artery disease using 3 techniques: 1) end-diastolic wall
thickness (EDWT); 2) low-dose dobutamine (LDD); and 3) contrast delayed
enhancement (DE). Background: CMR has been proposed to assess myocardial
viability over the past decade. However, the best CMR strategy to evaluate
patients being contemplated for revascularization has not yet been
determined. Some centers advocate DE CMR due to its high sensitivity to
identify scar, whereas others favor the use of LDD CMR for its ability to
identify contractile reserve. Methods: A systematic review of MEDLINE,
Cochrane, and Embase for all the prospective trials assessing myocardial
viability in subjects with chronic LV dysfunction using CMR was performed
using a standard approach for meta-analysis for diagnostic tests and a
bivariate analysis of sensitivity, specificity, positive predictive value
(PPV), and negative predictive value (NPV). Results: A total of 24 studies
of CMR evaluating myocardial viability with 698 patients fulfilled the
inclusion criteria. Eleven studies used DE, 9 studies used LDD, and 4
studies used EDWT. Our meta-analysis indicates that among CMR methods, DE
CMR provides the highest sensitivity as well as the highest NPV (95% and
90%, respectively) for predicting improved segmental LV contractile
function after revascularization, followed by EDWT CMR, whereas LDD CMR
demonstrated the lowest sensitivity/NPV among all modalities. On the other
hand, LDD CMR offered the highest specificity and PPV (91% and 93%,
respectively), followed by DE CMR, whereas EDWT showed the lowest of these
parameters. Conclusions: DE CMR provides the highest sensitivity and NPV,
whereas LDD CMR provides the best specificity and PPV. In light of these
findings, integrating these 2 methods should provide increased accuracy in
evaluating patients with chronic LV dysfunction being considered for
revascularization. 2012 American College of Cardiology Foundation.

<13>
Accession Number
21988814
Authors
Slingsby L.S. Taylor P.M. Murrell J.C.
Institution
(Slingsby, Murrell) School of Clinical Veterinary Science, University of
Bristol, Bristol, United Kingdom
(Taylor) Gravel Head Farm, Downham Common, Little Downham, Nr Ely,
Cambridgeshire, United Kingdom
Title
A study to evaluate buprenorphine at 40mugkg-1 compared to 20mugkg-1 as a
post-operative analgesic in the dog.
Source
Veterinary Anaesthesia and Analgesia. 38 (6) (pp 584-593), 2011. Date of
Publication: November 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objective Comparison of the analgesic effect of buprenorphine at 20 or
40mugkg^-1. Study design An investigator 'blinded', randomised
study. Animals Twenty six dogs presented for ovariohysterectomy. Methods
Dogs were premedicated intramuscularly with acepromazine
0.03mgkg^-1 and buprenorphine at either 20 (B20, n=12) or
40mugkg^-1 (B40, n=14) followed by anaesthetic induction with
propofol and maintenance with isoflurane. During anaesthesia non invasive
blood pressure, heart rate, respiratory rate, blood oxygen saturation,
inspired and expired volatile agent, end-tidal carbon dioxide and ECG were
recorded. Pain and sedation were assessed using interactive VAS scores;
mechanical nociceptive thresholds were measured at the wound and hindlimb
- all were assessed before and up to 22hours after administration.
Carprofen was used for rescue analgesia. Results There were no significant
differences between the two groups for any of the parameters examined.
Rescue analgesia was required around 5hours after administration of
buprenorphine in a significant number of animals. Sedation was good
preoperatively and scores decreased over time postoperatively. Hock
thresholds did not change over time; wound thresholds decreased
significantly compared to the baseline value from 3hours onwards.
Conclusions Administration of buprenorphine at either 20 or
40mugkg^-1 IM with acepromazine provided good pre-operative
sedation. Cardiovascular and respiratory values remained within clinically
acceptable limits during anaesthesia. There was no evidence that
increasing dose increased adverse events that may be associated with
opioid administration (e.g. bradycardia and respiratory depression).
Clinical relevance Increasing the dose of buprenorphine from 20 to
40mugkg^-1 did not provide any benefits with respect to
analgesia after ovariohysterectomy as assessed using the VAS scoring
system. 2011 The Authors. Veterinary Anaesthesia and Analgesia. 2011
Association of Veterinary Anaesthetists and the American College of
Veterinary Anesthesiologists.

<14>
Accession Number
2012284546
Authors
Wisser W. Gabriel H. Machler H. Maier R. Maurer E. Muller L. Neunteufl T.
Institution
(Wisser, Gabriel, Machler, Maier, Maurer, Muller, Neunteufl) Task Force
Comprising the Austrian Society of Cardiology (OKG), Austrian Society of
Thoracic and Cardiovascular Society (OGTHC), Australia
Title
Terms of agreement between the Austrian Society of Cardiology and the
Austrian Society of Thoracic and Cardiovascular Surgery on transcatheter
heart valve interventions.
Source
European Surgery - Acta Chirurgica Austriaca. 44 (1) (pp 33-40), 2012.
Date of Publication: January 2012.
Publisher
Springer Wien (Sachsenplatz 4-6, P.O. Box 89, Vienna A-1201, Austria)
Abstract
Background: Due to the increasing volume of transcatheter heart valve
interventions, we place on record the terms of the agreement reached
between the Austrian Society of Cardiology (o KG) and the Austrian Society
of Thoracic and Cardiovascular Surgery (o GTHC) regarding these procedures
as follows. Methods: The paper is based on the guidelines of the European
societies, a review of the PubMed literature, as well as information from
the medical industry. Results: Currently, transcatheter-based aortic and
pulmonary implantation are performed as well as transcatheterbased
procedures for mitral valve insufficiency. In all cases the indication
should be decided jointly by the cardiologist and the cardiac surgeon.
Furthermore, these procedures should only be performed in centres where
both specialists are available on site. Only patients with either
congenital or acquired heart valve disease who are at very high risk of
morbidity and mortality with medical or standard surgical therapy should
undergo transcatheter heart valve intervention. Conclusions: According to
current literature, recommendations for transcatheter heart valve
interventions are only based on level of Evidence C (Consensus of Expert
Opinion). Springer-Verlag 2012.

<15>
Accession Number
2012286639
Authors
Knipp S.C. Scherag A. Beyersdorf F. Cremer J. Diener H.-C. Haverich J.A.
Jakob H.G. Mohr W. Ose C. Reichenspurner H. Walterbusch G. Welz A. Weimar
C.
Institution
(Knipp, Jakob) Department of Thoracic and Cardiovascular Surgery,
University of Duisburg-Essen, Essen, Germany
(Scherag, Ose) Centre for Clinical Trials Essen (ZKSE), Institute for
Medical Informatics, Biometry and Epidemiology, University of
Duisburg-Essen, Essen, Germany
(Beyersdorf) Department of Cardiac and Vascular Surgery, University of
Freiburg, Freiburg, Germany
(Cremer) Department of Cardiac and Vascular Surgery, University of Kiel,
Kiel, Germany
(Diener, Weimar) Department of Neurology, University of Duisburg-Essen,
Essen, Germany
(Haverich) Department of Heart, Thoracic, Transplantation and Vascular
Surgery, Medical School of Hannover, Hannover, Germany
(Mohr) Department of Cardiac Surgery, University of Leipzig, Leipzig,
Germany
(Reichenspurner) Department of Cardiac and Vascular Surgery, University of
Hamburg, Hamburg, Germany
(Walterbusch) Department of Cardiac, Thoracic and Vascular Surgery, St.
Johannes Hospital, Dortmund, Germany
(Welz) Department of Cardiac Surgery, University of Bonn, Bonn, Germany
Title
Randomized comparison of synchronous CABG and carotid endarterectomy vs.
isolated CABG in patients with asymptomatic carotid stenosis: The CABACS
trial.
Source
International Journal of Stroke. 7 (4) (pp 354-360), 2012. Date of
Publication: June 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Rationale: High-grade carotid artery stenosis is present in 6-8% of
patients undergoing coronary artery bypass graft surgery. Many
cardiovascular surgeons advocate staged or synchronous carotid
endarterectomy to reduce the high perioperative and long-term risk of
stroke associated with multivessel disease. However, no randomized trial
has assessed whether a combined synchronous or staged carotid
endarterectomy confers any benefit compared with isolated coronary artery
bypass grafting in these patients. Aims: The objective of this study is to
compare the safety and efficacy of isolated coronary artery bypass
grafting vs. synchronous coronary artery bypass grafting and carotid
endarterectomy in patients with asymptomatic high-grade carotid artery
stenosis. Design: Coronary Artery Bypass graft surgery in patients with
Asymptomatic Carotid Stenosis (CABACS) is a randomized, controlled, open,
multicenter, group sequential trial with two parallel arms and outcome
adjudication by blinded observers. Patients with asymptomatic high-grade
carotid stenosis scheduled for elective coronary artery bypass grafting
will be assigned to either isolated coronary artery bypass grafting or
synchronous coronary artery bypass grafting and carotid endarterectomy by
1:1 block-stratified randomization with three different stratification
factors (age, gender, modified Rankin scale). Study: The trial started in
December 2010 aiming at recruiting 1160 patients in 25 to 30 German
cardiovascular centers. The composite primary efficacy end point is the
number of strokes and deaths from any cause (whatever occurs first) within
30 days after operation. A 45% absolute difference (4% compared to 85%) in
the 30-day rate of the above end points can be detected with >80% power.
Outcomes: The results of this trial are expected to provide a basis for
defining an evidence-based standard and will have a wide impact on
managing this disease. 2011 The Authors. International Journal of Stroke
2011 World Stroke Organization.

<16>
[Use Link to view the full text]
Accession Number
2012282860
Authors
Kiaii B. Fox S. Swinamer S.A. Rayman R. Higgins J. Cleland A. Fernandes P.
MacDonald J. Dobkowski W.B. Stitt L.W. Novick R.J. Singh B. Bureau Y.
Summers K.
Institution
(Kiaii, Fox, Swinamer, Rayman, Higgins, Novick) Department of Surgery,
University of Western Ontario, University Hospital, 339 Windermere Road,
London, ON N6A 5A5, Canada
(Kiaii, Bureau, Summers) Lawson Health Research Institute, University of
Western Ontario, University Hospital, London, ON, Canada
(Cleland, Fernandes, MacDonald) Department of Clinical Perfusion Services
Medicine, University of Western Ontario, University Hospital, London, ON,
Canada
(Dobkowski) Department of Anesthesia and Perioperative, University of
Western Ontario, University Hospital, London, ON, Canada
(Stitt) Department of Epidemiology and Biostatistics, University of
Western Ontario, University Hospital, London, ON, Canada
(Singh, Summers) Department of Microbiology and Immunology, University of
Western Ontario, University Hospital, London, ON, Canada
Title
The early inflammatory response in a mini-cardiopulmonary bypass system: A
prospective randomized study.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 7 (1) (pp 23-32), 2012. Date of Publication: January-February
2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
OBJECTIVE: The aim of this study was to compare the early systemic
inflammatory response of the Resting Heart System (RHS; Medtronic,
Minneapolis, MN USA), a miniaturized cardiopulmonary bypass (CPB) system,
with two groups using a standard extracorporeal circulation system during
on-pump coronary artery bypass grafting (CABG) surgery. METHODS: A total
of 60 consecutive patients requiring CABG were prospectively randomized to
undergo on-pump CABG using conventional CPB without cardiotomy suction
(group A), conventional CPB with cardiotomy suction (group B), or the RHS
(group C). Blood samples were collected at five time points: immediately
before CPB, 30 minutes into CPB, immediately at the end of CPB, 30 minutes
post-CPB, and 1 hour post-CPB. Inflammation was analyzed by changes in (a)
levels of plasma proteins, including inflammatory cytokines (interleukin-6
[IL-6], IL-10, and tumor necrosis factor-alpha), chemokines (IL-8,
monokine induced by interferon-, monocyte chemotactic protein-1, regulated
on activation normal T cell expressed and secreted, and
interferon-inducible protein-10), and acute phase proteins (C-reactive
protein and complement protein 3); (b) biochemical variables (cardiac
troponin I, hematocrit, and immunoglobulin G); and (c) cell numbers
(leukocytes, neutrophils, and thrombocytes). RESULTS: The RHS showed more
delayed secretion of the cytokines tumor necrosis factor-alpha and IL-10,
chemokines monokine induced by interferon- (P < 0.001); IL-8, and
interferon-inducible protein-10; and complement protein 3 than
conventional CPB systems did. Median thrombocyte numbers were higher in
the RHS group. Levels of cardiac troponin I, monocyte chemotactic
protein-1, and IL-6 were lower in both the RHS and conventional CPB
without suction than with suction. Levels of C-reactive protein and
regulated on activation normal T cell expressed and secreted, plus
leukocyte and neutrophil numbers, were similar in all groups. CONCLUSIONS:
The Medtronic RHS may induce less systemic inflammation than conventional
CPB systems, particularly when cardiotomy suction was used, but it did not
result in improved clinical benefit. Copyright 2012 by the International
Society for Minimally Invasive Cardiothoracic Surgery.

<17>
Accession Number
22108937
Authors
Ahlsson A. Sobrosa C. Kaijser L. Jansson E. Bomfim V.
Institution
(Ahlsson) Department of Thoracic and Cardiovascular Surgery, Orebro
University Hospital, Orebro, Sweden.
Title
Adenosine in cold blood cardioplegia--a placebo-controlled study.
Source
Interactive cardiovascular and thoracic surgery. 14 (1) (pp 48-55), 2012.
Date of Publication: Jan 2012.
Abstract
OBJECTIVE Adenosine as an additive in blood cardioplegia is
cardioprotective in animal studies, but its clinical role in myocardial
protection remains controversial. The aim of this study was to investigate
whether the addition of adenosine in continuous cold blood cardioplegia
would enhance myocardial protection. METHODS In a prospective double-blind
study comparing adenosine 400 mumol l(-1) to placebo in continuous cold
blood cardioplegia, 80 patients undergoing isolated aortic valve
replacement were randomized into four groups: antegrade cardioplegia with
adenosine (n = 19), antegrade cardioplegia with placebo (n = 21),
retrograde cardioplegia with adenosine (n = 21) and retrograde
cardioplegia with placebo (n = 19). Myocardial arteriovenous differences
in oxygen and lactate were measured before, during and after aortic
occlusion. Myocardial concentrations of adenine nucleotides and lactate
were determined from left ventricular biopsies obtained before aortic
occlusion, after bolus cardioplegia, at 60 min of aortic occlusion and at
20 min after aortic occlusion. Plasma creatine kinase (CK-MB) and troponin
T were measured at 1, 3, 6, 9, 12 and 24 h after aortic occlusion.
Haemodynamic profiles were obtained before surgery and 1, 8 and 24 h after
cardiopulmonary bypass. Repeated-measures analysis of variance was used
for significance testing. RESULTS Adenosine had no effects on myocardial
metabolism of oxygen, lactate and adenine nucleotides, postoperative
enzyme release or haemodynamic performance. When compared with the
antegrade groups, the retrograde groups showed higher myocardial oxygen
uptake (17.3 +/- 11.4 versus 2.5 +/- 3.6 ml l(-1) at 60 min of aortic
occlusion, P < 0.001) and lactate accumulation (43.1 +/- 20.7 versus 36.3
+/- 23.0 mumol g(-1) at 60 min of aortic occlusion, P = 0.052) in the
myocardium during aortic occlusion, and lower postoperative left
ventricular stroke work index (27.2 +/- 8.4 versus 30.1 +/- 7.9 g m m(-2),
P = 0.034). CONCLUSIONS Adenosine 400 mumol l(-1) in cold blood
cardioplegia showed no cardioprotective effects on the parameters studied.
Myocardial ischaemia was more pronounced in patients receiving retrograde
cardioplegia.

<18>
Accession Number
22108921
Authors
El Zayat H. Puskas J.D. Hwang S. Thourani V.H. Lattouf O.M. Kilgo P.
Halkos M.E.
Institution
(El Zayat) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Clinical Research Unit, Atlanta, GA, USA.
Title
Avoiding the clamp during off-pump coronary artery bypass reduces cerebral
embolic events: results of a prospective randomized trial.
Source
Interactive cardiovascular and thoracic surgery. 14 (1) (pp 12-16), 2012.
Date of Publication: Jan 2012.
Abstract
The purpose of this study was to determine whether a clampless
facilitating device (CFD) to perform proximal aortocoronary anastomoses
would result in a lower incidence of cerebral embolic events compared with
a partial clamping strategy during off-pump coronary artery bypass
(OPCAB). After epiaortic ultrasound confirmed the mild aortic disease
(Grades I and II), 57 patients were randomly assigned to have proximal
anastomoses using a partial-occluding clamp (CL, n = 28) or a CFD
[Heartstring (HS), n = 29] (Maquet Cardiovascular LLC, San Jose, CA).
Solid and gaseous emboli in the middle cerebral arteries were detected
using transcranial Doppler ultrasonography. The mean number of proximal
anastomoses was similar between groups 1.93 +/- 0.72 (CL) and 1.72 +/-
0.70 (HS) (P = 0.28). The mean number of gaseous plus solid emboli was
greater in the CL group than the HS group (90.0 +/- 64.0 vs. 50.8 +/-
36.6, P = 0.01). Emboli were fewest in patients undergoing HS anastomoses
using the suction device. The number of intraoperative cerebral emboli was
proportional to the number of proximal anastomoses in the HS groups, but
independent of the number of proximal anastomoses in the CL groups. Among
patients with a low burden of aortic atherosclerosis, partial clamping of
the ascending aorta during OPCAB was associated with more cerebral embolic
events compared with an anastomosis with a CFD.

<19>
Accession Number
2012279532
Authors
Zangrillo A. Biondi-Zoccai G.G.L. Frati E. Covello R.D. Cabrini L.
Guarracino F. Ruggeri L. Bove T. Bignami E. Landoni G.
Institution
(Zangrillo, Frati, Covello, Cabrini, Ruggeri, Bove, Bignami, Landoni)
Department of Anesthesia, Intensive Care, Universita Vita-Salute San
Raffaele, Milan, Italy
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy
(Guarracino) Cardiothoracic Anaesthesia and Intensive Care Medicine,
Cardiothoracic Department, University Hospital of Pisa, Pisa, Italy
Title
Fenoldopam and acute renal failure in cardiac surgery: A meta-analysis of
randomized placebo-controlled trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (3) (pp 407-413),
2012. Date of Publication: June 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: Because at present no pharmacologic prevention or treatment of
acute kidney injury seems to be available, the authors updated a
meta-analysis to investigate the effects of fenoldopam in reducing acute
kidney injury in patients undergoing cardiac surgery, focusing on
randomized placebo-controlled studies only. Design: A meta-analysis of
randomized, placebo-controlled trials. Setting: Hospitals. Participants: A
total of 440 patients from 6 studies were included in the analysis.
Interventions: None. The ability of fenoldopam to reduce acute kidney
injury in the perioperative period when compared with placebo was
investigated. Measurements and Main Results: Google Scholar and PubMed
were searched (updated January 1, 2012). Authors and external experts were
contacted. Pooled estimates showed that fenoldopam consistently and
significantly reduced the risk of acute kidney injury (odds ratio [OR] =
0.41; 95% confidence interval [CI], 0.23-0.74; p = 0.003), with a higher
rate of hypotensive episodes and/or use of vasopressors (30/109 [27.5%] v
21/112 [18.8%]; OR = 2.09; 95% CI, 0.98-4.47; p = 0.06) and no effect on
renal replacement therapy, survival, and length of intensive care unit or
hospital stay. Conclusions: This analysis suggests that fenoldopam reduces
acute kidney injury in patients undergoing cardiac surgery. Because the
number of the enrolled patients was small and there was no effect on renal
replacement therapy or survival, a large, multicenter, and appropriately
powered trial is needed to confirm these promising results. 2012 Elsevier
Inc. All rights reserved.

<20>
Accession Number
2012279510
Authors
Pipanmekaporn T. Bunchungmongkol N. Pin On P. Punjasawadwong Y.
Institution
(Pipanmekaporn, Bunchungmongkol, Pin On, Punjasawadwong) Department of
Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai
50200, Thailand
Title
Impact of patients' positions on the incidence of arrhythmias during
pulmonary artery catheterization.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (3) (pp 391-394),
2012. Date of Publication: June 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The complication of cardiac arrhythmias during pulmonary artery
catheterization (PAC) may be related to the position of the patient.
Therefore, the purpose of this study was to determine the effects of
patients' positions on incidence of arrhythmias and the time required to
place the pulmonary artery catheter. Design: A prospective, double-blind,
randomized, controlled study. Setting: A tertiary university hospital.
Participants: One hundred forty patients undergoing elective coronary
artery bypass graft surgery. Interventions: Patients were divided into 2
groups. In the study group (n = 70), patients were positioned with their
head down at 10degree first and then 10degree up and tilted right
laterally when the PACs were passed from the right atrium to the right
ventricle and then the right ventricle to the pulmonary capillary wedge
position, respectively. In the control group (n = 70), patients remained
in a supine position during pulmonary artery catheterization. Measurement
and Main Result: During the catheterization, arrhythmias were recorded and
classified into benign (1-3 premature ventricular contractions) and severe
(more than 3 premature ventricular contractions or nonsustained
ventricular tachycardia). The time for PACs to pass from the right atrium
to the right ventricle and the right ventricle to the pulmonary capillary
wedge position was measured as T1 and T2, respectively. The incidence of
benign arrhythmias between groups was not significantly different (49% for
study and 34% for control group, p = 0.196), whereas the incidence of
severe arrhythmias was significantly higher in the control group (20% v
5.8%, p = 0.036). The time used for each technique (T1 and T2) in both
groups was not significantly different (p = 0.362 and 0.468,
respectively). One patient in the study group was excluded because of
difficulty in passing the catheter from the right atrium to the right
ventricle. Conclusions: Adjusting patients in the head-up and right
lateral position while passing the PAC can reduce the incidence of severe
arrhythmias, but not in the time taken to place it. This position may have
clinical implications, particularly in high-risk patients. 2012 Elsevier
Inc. All rights reserved.

<21>
Accession Number
2012279509
Authors
Chaudhary V. Chauhan S. Choudhury M. Kiran U. Vasdev S. Talwar S.
Institution
(Chaudhary, Chauhan, Choudhury, Kiran, Vasdev) Department of Cardiac
Anesthesia, CN Center, All India Institute of Medical Sciences, New Delhi,
India
(Talwar) Department of CTVS, All India Institute of Medical Sciences, New
Delhi, India
Title
Parasternal intercostal block with ropivacaine for postoperative analgesia
in pediatric patients undergoing cardiac surgery: A double-blind,
randomized, controlled study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (3) (pp 439-442),
2012. Date of Publication: June 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The objective of this study was to assess the effectiveness of
0.5% ropivacaine used for parasternal intercostal blocks for postoperative
analgesia in pediatric patients undergoing cardiac surgery. Design: A
randomized, controlled, prospective, double-blind study. Setting: A
tertiary care teaching hospital. Participants: Thirty children scheduled
for cardiac surgery with a median sternotomy. Interventions: A 0.5%
ropivacaine injection with 5 doses of 0.5 to 2.0 mL on each side in the
2nd to 6th parasternal intercostal space with a total dose of ropivacaine
below 5 mg/kg or the same volume of saline before sternal wound closure.
Measurements and Main Results: The time to extubation was significantly
lower in patients administered the parasternal blocks with ropivacaine
than in the control group; the mean values were 2.66 hours and 5.31 hours,
respectively (p < 0.001). The pain scores were lower in the ropivacaine
group compared with the saline group; mean values were 2.20 for the
ropivacaine group and 4.83 for the saline group on a scale of 10. The
cumulative fentanyl dose requirement over a 24-hour period was higher in
the saline group than the ropivacaine group (p < 0.001). Conclusions:
Parasternal blocks with ropivacaine appear to be a simple, safe, and
useful technique of supplementation of postoperative analgesia in
pediatric patients undergoing cardiac surgery with a median sternotomy.
2012 Elsevier Inc. All rights reserved.

<22>
Accession Number
2012280065
Authors
Hernandez M.B. Asher C.R. Hernandez A.V. Novaro G.M.
Institution
(Hernandez) Department of Internal Medicine, Cleveland Clinic Florida,
Weston, FL 33331, United States
(Asher, Novaro) Department of Cardiology, Cleveland Clinic Florida, 2950
Cleveland Clinic Blvd, Weston, FL 33331, United States
(Hernandez) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH 44195, United States
(Hernandez) Quantitative Research Division, BioEstadistica, S.C.,
Monterrey NL 66260, Mexico
Title
African American race and prevalence of atrial fibrillation: A
meta-analysis.
Source
Cardiology Research and Practice. 1 (1) , 2012. Article Number: 275624.
Date of Publication: 2012.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. It has been observed that African American race is associated
with a lower prevalence of atrial fibrillation (AF) compared to Caucasian
race. To better quantify the association between African American race and
AF, we performed a meta-analysis of published studies among different
patient populations which reported the presence of AF by race. Methods. A
literature search was conducted using electronic databases between January
1999 and January 2011. The search was limited to published studies in
English conducted in the United States, which clearly defined the presence
of AF in African American and Caucasian subjects. A meta-analysis was
performed with prevalence of AF as the primary endpoint. Results. In
total, 10 studies involving 1,031,351 subjects were included. According to
a random effects analysis, African American race was associated with a
protective effect with regard to AF as compared to Caucasian race (odds
ratio 0.51, 95% CI 0.44 to 0.59, P<0.001). In subgroup analyses, African
American race was significantly associated with a lower prevalence of AF
in the general population, those hospitalized or greater than 60 years
old, postcoronary artery bypass surgery patients, and subjects with heart
failure. Conclusions. In a broad sweep of subjects in the general
population and hospitalized patients, the prevalence of AF in African
Americans is consistently lower than in Caucasians. 2012 Marlow B.
Hernandez et al.

<23>
[Use Link to view the full text]
Accession Number
2012270944
Authors
Matamis D. Pampori S. Papathanasiou A. Papakonstantinou P. Tsagourias M.
Galiatsou E. Koulouras V. Nakos G.
Institution
(Matamis, Pampori, Papathanasiou, Papakonstantinou, Tsagourias, Galiatsou,
Koulouras, Nakos) Intensive Care Unit, Papageorgiou General Hospital,
Thessalonica, Greece
(Papathanasiou, Galiatsou, Koulouras, Nakos) Intensive Care Unit,
University Hospital of Ioannina, 45500 Ioannina, 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:
January 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-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. Methods and Results-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
PaO₂/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 PaO₂/inspired fraction of oxygen returned to
values near baseline. Conclusion-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. 2011 American Heart Association, Inc.

<24>
Accession Number
70747166
Authors
Wever-Pinzon O. Romero J. Manrique C. Alharethi R. Bader F. Drakos S.G.
Kfoury A.G. Stehlik J.
Institution
(Wever-Pinzon, Alharethi, Bader, Drakos, Kfoury, Stehlik) UTAH Cardiac
Transplant Program, Salt Lake City, UT, United States
(Romero, Manrique) Albert Einstein College of Medicine, Montefiore Medical
Center, New York, NY, United States
Title
Coronary computed tomography angiography for the detection of cardiac
allograft vasculopathy a metanalysis of prospective studies.
Source
American Journal of Transplantation. Conference: 2012 American Transplant
Congress Boston, MA United States. Conference Start: 20120602 Conference
End: 20120606. Conference Publication: (var.pagings). 12 (pp 381), 2012.
Date of Publication: May 2012.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiac allograft vasculopathy (CAV) limits long-term survival
after heart transplantation (HTx). Its detection impacts patient's
management as certain immunosuppressive agents (e.g. proliferation signal
inhibitors) can reduce vasculopathy progression. A noninvasive test with
high accuracy would be desirable for the routine follow-up after HTx.
Coronary Computed Tomography Angiography (CCTA) is currently not
recommended for CAV screening in HTx recipients, however technological
advances might have resulted in improved accuracy of this test. We aimed
to evaluate the accuracy of CCTA for detecting CAV. Methods: A systematic
review of Medline, Cochrane, and Embase for all the prospective trials
assessing CAV after HTx using CCTA was performed using a hierarchical
meta-analytical model. Results: A total of 9 studies including 198
patients (mean age 48 years, 83% males) and 2995 segments fulfilled the
inclusion criteria. Five studies used 64-slice CCTA and 4 used 16-slice
CCTA compared either with conventional coronary angiography (CCAG) alone
or with intravascular ultrasound (IVUS). Using CCAG, CAV was defined as
stenosis >50% in 4 studies, >70% in 1 study and >luminal irregularities in
other. Compared with CCAG, 16-slice CCTA had a mean sensitivity and
specificity of 75% and 94%, whereas the positive (PPV) and negative
predictive value (NPV) were 78% and 91%. In studies evaluating 64-slice
CCTA vs. CCAG the mean sensitivity and specificity were 90% and 92%,
whereas the PPV and NPV were 59% and 99%. Using IVUS, early CAV was
defined by intimal thickening >0.5 mm. Comparing 64-slice CCTA vs. IVUS
the mean sensitivity and specificity were 78% and 88%, whereas the PPV AND
NPV were 83% and 84%. Conclusion: The newer 64-slice CCTA provides an
improved sensitivity and NPV, albeit lower for early detection of CAV as
assessed by IVUS. Routine use of CCTA as a screening tool for CAV should
be considered as an alternative to CCAG in the long-term follow-up of HTx
recipients (Figure Presented) .

<25>
Accession Number
70746816
Authors
Khatri P. Roedder S. Kimura N. Morgan A. Vitalone M. Gong Y. Fischbein M.
Robbins R. Butte A. Sarwal M.
Institution
(Khatri, Roedder, Kimura, Morgan, Vitalone, Gong, Fischbein, Robbins,
Butte, Sarwal) Stanford University, United States
Title
A common immune response module for acute rejection across multiple organs
can reposition novel therapeutics for organ transplantation.
Source
American Journal of Transplantation. Conference: 2012 American Transplant
Congress Boston, MA United States. Conference Start: 20120602 Conference
End: 20120606. Conference Publication: (var.pagings). 12 (pp 282), 2012.
Date of Publication: May 2012.
Publisher
Blackwell Publishing Ltd
Abstract
Background: We hypothesized that although the prompts for tissue-specific
injury may be different, there is a common mechanism of acute rejection
across all solid organ transplants. Method: We downloaded 8 microarray
gene expression data sets from 4 transplanted organs consisting of 236
human biopsy samples with and without histological diagnosis of acute
rejection. We applied a novel meta-analysis method that combines
measurements from all data sets to compute overall change in expression
for each gene in acute rejection biopsies compared to stable biopsies. For
each gene, our method assigns different weights in each study that are
used in the meta-analysis, where weights are inversely proportional to the
variance of a gene in a given study. Results: We identified a common
immune response module (CIRM) of 12 genes, ubiquitously over-expressed
during acute rejection irrespective of the type of organ transplanted.
Network analysis of the CIRM gene set showed that it is regulated by a
single transcription factor, STAT1. We validated over-expression of the
CIRM in an independent cohort of 109 human renal transplant biopsies using
microarrays and Q-PCR. Six out of the 12 genes in the CIRM are targets of
7 FDA-approved drugs, of which 2 are currently used as immunosuppressives
in transplantation. Based on over-expression of the CIRM in all
transplanted organs and enrichment of known FDA-approved drug targets in
the CIRM, we hypothesized that pharmacological modulation of a gene in the
CIRM module will reduce the number of graft infiltrating cells. To test
this hypothesis, we treated cardiac transplants in HLA-mismatched mice
using Dasatinib and Atorvastatin, which target LCK and CXCL10,
respectively, from the CIRM. We compared them against Cyclosporine, the
drug used as current standard of care. Both drugs reduced the number of
infiltrating cells in the graft significantly, and as much as
Cyclosporine. In addition, they also significantly reduced macrophages,
dendritic cells and natural killer cells, which Cyclosporine did not. Most
notably, Atrovastatin and Dasatinib increased graft survival by 7 days
(p=0.0007) and 14.5 days (p=0.002), respectively. Our results support our
hypothesis that the CIRM genes identified using our novel meta-analysis
approach are indeed causal in transplants and their pharmacological
modulation can reduce graft-infiltrating cells.

<26>
Accession Number
70746016
Authors
De Geest S. Burkhalter H. Bogert L. Berben L. Glass T. Denhaerynck K.
Institution
(De Geest, Burkhalter, Bogert, Berben, Glass, Denhaerynck) University of
Basel, Psychosocial Interest Group of the Swiss Transplant Cohort Study,
Switzerland
Title
Medication non-adherence pre-transplant predicts post-transplant
non-adherence with immunosuppressive drugs in liver, renal lung and heart
transplant recipients.
Source
American Journal of Transplantation. Conference: 2012 American Transplant
Congress Boston, MA United States. Conference Start: 20120602 Conference
End: 20120606. Conference Publication: (var.pagings). 12 (pp 47), 2012.
Date of Publication: May 2012.
Publisher
Blackwell Publishing Ltd
Abstract
Medication non-adherence (NA) is a major behavioral risk factor for poor
outcome in solid organ transplant (Tx) recipients. We assessed the
magnitude and evolution of NA at time of listing until 2 years post-Tx in
liver, renal, lung and heart Tx recipients and determined if pre-Tx
medication NA predict for post-Tx NA to immunosuppressives. Methods: All
adult patients included in the Swiss Transplant Cohort Study with a single
1st Tx, an assessment at time of listing, 1 assessment in the 1st 2 y.
post-Tx, and taking medications at time of listing, were included in this
analysis. NA was assessed at time of listing, 6 m. post-Tx and 1 & 2 y.
post-Tx with a 2 items (self-report): (1) missed dose of medications in
past 4 w. (1x / m.; 1x /every 2 w.; > 1x/w.; Every day) and (2)
consecutive doses missed (yes/no). NA was defined as any deviation from
dosing schedule. Descriptive statistics and graphics show size and
evolution of NA overall and per Tx group. Analysis of NA over time
occurred by Generalized Estimation equations-adjusted logistic regression
analyses using time, NA at time of listing, organ, age, gender and the
length of waiting list period as covariables. Results: A total of 888
patients (age: 52 13.1 y.; 34% fem.; 544 renal; 165 liver, 105 lung, 74
heart) was included. NA at time of listing was 34% and variable among Tx
groups (40% renal; 26% liver, 34% lung, 12% heart). NA decreased
significantly post-Tx (p<.0001) and increased again until 2 years post-Tx
(p=0.008). (Figure Presented) ]NA was highest in liver Tx post-Tx,
compared to lung (p=.05) and heart Tx (p=.03). NA at time of listing was
predictive of post-Tx NA: those non-adherent at time of listing had a 2.06
higher odds to be non-adherent after Tx (95%CI: 1.43-2.94; p<.0001).
Conclusion: We observed pre-Tx variability in NA. In contrast to a
published metaanalysis, liver Tx patients had a higher magnitude of NA
post-Tx. NA at time of listing is predictive for post-Tx NA. NA needs to
be assessed during pre-Tx evaluation and be targeted for intervention.

<27>
Accession Number
70745963
Authors
Paoletti E. Marsano L. Bellino D. Cassottana P. Rolla D. Di Maio G.
Institution
(Paoletti, Marsano, Bellino, Rolla, Di Maio) Nephrology, Dialysis, and
Transplantation, IRCCS Azienda Ospedaliera Universitaria San Martino -
IST, Genova, Italy
(Cassottana) Cardiology, IRCCS Azienda Ospedaliera Universitaria San
Martino - IST, Genova, Italy
Title
Everolimus for regression of left ventricular hypertrophy of renal
transplant recipients: A randomized controlled trial.
Source
American Journal of Transplantation. Conference: 2012 American Transplant
Congress Boston, MA United States. Conference Start: 20120602 Conference
End: 20120606. Conference Publication: (var.pagings). 12 (pp 31), 2012.
Date of Publication: May 2012.
Publisher
Blackwell Publishing Ltd
Abstract
Background Interventional studies have shown significant regression of
left ventricular hypertrophy (LVH) in both renal and cardiac transplant
recipients after conversion from CNI to mTOR inhibitors. However, there
are currently no reports of randomized trials on this issue involving de
novo renal transplant recipients (RTRs). This is the first randomized
controlled trial to evaluate the impact of EVL plus reduced exposure
cyclosporine (CsA) on the left ventricular mass index (LVMi) of RTRs.
Methods Thirty non diabetic RTRs (21 men; age 28-65 years) were randomly
allocated in a 1:2 ratio to EVL plus reduced exposure CsA or standard
exposure CsA plus mycophenolate mofetil. All patients were also
administered steroids. LVMi was assessed by echocardiography both at
baseline and one year later. Blood pressure, hemoglobin, serum creatinine,
lipids, immunosuppressive drugs trough levels, and daily proteinuria were
also evaluated twice monthly. Antihypertensive therapy which did not
include renin-angiotensin system blockers was administered to achieve BP
<= 130/80 mmHg. Results Changes in BP were similar in the two groups
(between group difference 1.2+/-5.7 mmHg, P=0.84 for systolic, and
-1.5+/-3.7, P=0.69, for diastolic BP), whereas LVMi significantly
decreased in the EVL group alone (between group difference 8.2+/-3.1
g/m^2.7, P=0.012), due to a reduction in both the
interventricular septum (-1.1+/- 1.0 mm, P=0.007) and the left ventricular
posterior wall thickness (-1.2+/-1.5 mm, P=0.037). EVL therapy together
with baseline LVMi were the only significant predictors of LVH regression
according to a multivariate model that explained 49% of the total LVMi
variance (P=0.0015). A slight increase in daily proteinuria occurred in
the EVL group (0.13+/-0.13 g/24 hr; P=0.015), whereas no between group
difference was observed in the 1-year acute rejection incidence (1 in the
EVL group, and 2 in the control group). Conclusions An immunosuppressive
regimen consisting of EVL plus reduced exposure CsA proved to be effective
in regressing LVH in RTRs regardless of BP, mainly by reducing left
ventricular wall thickness.