EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 17

Results Generated From:
Embase <1980 to 2012 Week 25>
Embase (updates since 2012-06-15)

<1>
Accession Number
2012333302
Authors
Cheng J.W.M.
Institution
(Cheng) Massachusetts College of Pharmacy and Health Sciences, Brigham and
Women's Hospital, Boston, MA, United States
Title
Ticagrelor: Oral Reversible P2Y12 Receptor Antagonist for the Management
of Acute Coronary Syndromes.
Source
Clinical Therapeutics. 34 (6) (pp 1209-1220), 2012. Date of Publication:
June 2012.
Publisher
Excerpta Medica Inc. (105 Raider Blvd, Suite 101, Hillsborough NJ 08844,
United States)
Abstract
Background: The clinical benefits of dual antiplatelet treatment (aspirin
+ clopidogrel) in the management of acute coronary syndromes (ACS) are
well established. However, clopidogrel is a prodrug that requires hepatic
activation. Concerns regarding its delayed onset of action, variability in
antiplatelet effects, and prolonged recovery of platelet function after
discontinuation have prompted the development of P2Y₁₂ receptor
antagonists. Ticagrelor is the most recently developed P2Y₁₂
receptor antagonist available in the United States. Ticagrelor is a
nonthienopyridine antiplatelet agent and is the first reversible oral
antagonist of the P2Y₁₂ receptors. Objective: This article
reviews the pharmacology, clinical efficacy, and tolerability of
ticagrelor use in management of ACS. Methods: Peer-reviewed clinical
trials, review articles, and relevant treatment guidelines published from
1966 to March 15, 2012, were identified from the MEDLINE and Current
Content databases using the search terms ticagrelor, ACS,
pharmacokinetics, pharmacodynamics, pharmacoeconomics, and
cost-effectiveness. Citations from available articles were also reviewed
for additional references. Results: Nine pharmacokinetics/pharmacodynamics
studies in humans and 1 clinical study were identified. In addition, the
findings from 6 subanalyses based on the clinical study were included.
Compared with clopidogrel, ticagrelor was associated with a significantly
reduced composite rate of death from cardiovascular causes, myocardial
infarction, or stroke (ticagrelor, 9.8%; clopidogrel, 11.7%; hazard ratio
[HR] = 0.84; 95% CI, 0.77-0.92; P < 0.001). The difference in the rates of
major bleeding was not significant (ticagrelor, 11.6%; clopidogrel,
11.2%). Ticagrelor was associated with a higher rate of non-coronary
artery bypass graft surgery related major bleeding (4.5% vs 3.8%; P =
0.03), including fatal intracranial bleeding (0.1% vs 0.01%; P = 0.02),
and fewer cases of other types of fatal bleeding (0.1% vs 0.3%; P = 0.03).
Other adverse events reported with ticagrelor use included dyspnea
(13.8%), headache (6.5%), and bradyarrhythmia (5.8%). The effects of
ticagrelor have not been compared to those of other antiplatelet agents,
including prasugrel. Conclusions: Based on the findings from the present
review, ticagrelor provides reversible inhibition of adenosine
diphosphate-induced platelet aggregation, with a faster onset of action
than clopidogrel, and is effective in the treatment of patients with ACS.
More data are required to definitively position ticagrelor with respect to
other antiplatelet agents, including prasugrel. 2012 Elsevier HS
Journals, Inc.

<2>
Accession Number
2012328714
Authors
Kubica J. Kozinski M. Navarese E.P. Tantry U.S. Grzesk G. Fabiszak T.
Kubica A. Swiatkiewicz I. Bliden K.P. Gurbel P.A.
Institution
(Kubica, Kozinski, Navarese, Fabiszak, Swiatkiewicz) Department of
Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus
University, Bydgoszcz, Poland
(Tantry, Bliden, Gurbel) Sinai Center for Thrombosis Research, Sinai
Hospital of Baltimore, Baltimore, MD, United States
(Grzesk) Department of Pharmacology and Therapy, Collegium Medicum,
Nicolaus Copernicus University, Bydgoszcz, Poland
(Kubica) Department of Health Promotion, Collegium Medicum, Nicolaus
Copernicus University, Bydgoszcz, Poland
Title
Updated evidence on intracoronary abciximab in ST-elevation myocardial
infarction: A systematic review and meta-analysis of randomized clinical
trials.
Source
Cardiology Journal. 19 (3) (pp 230-242), 2012. Date of Publication: 2012.
Publisher
Grupa Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Intracoronary (IC) abciximab administration remains a
promising approach aimed to increase a drug concentration in the target
area and possibly improve clinical outcomes in the setting of ST-segment
elevation myocardial infarction (STEMI). The goal of this literature
review and meta-analysis is to update available knowledge comparing IC and
intravenous (IV) abciximab administration in STEMI patients. Methods: A
total of 7 randomized clinical trials (RCTs) with a median follow-up of 3
months were included in the meta-analysis (n = 3311). All-cause mortality
was selected as the primary end point while recurrent myocardial
infarction (re-MI), target vessel revascularization (TVR) and major
bleeding complications were the secondary end points. Results: IC
abciximab did not provide any benefits in terms of all-cause mortality as
compared with IV abciximab (odds ratio [OR] 0.67; 95% confidence interval
[CI] 0.34-1.34). However, this neutral effect was driven by the AIDA STEMI
trial. The IC route was associated with a reduced rate of re-MI when
compared with IV administration (OR 0.61; 95% CI 0.40-0.92) but the
difference disappeared after one of the RCTs was excluded from the
analysis. Both strategies were equal regarding TVR (OR 0.66; 95% CI
0.40-1.09) and major bleeding complications (OR 1.18; 95% CI 0.76-1.83).
Conclusions: Our updated meta-analysis shows that the clinical superiority
of IC over IV abciximab administration in STEMI patients is no longer
clear after the release of the AIDA STEMI trial results. Further research
in high-risk STEMI patients is warranted to finally determine clinical
advantages of IC vs IV abciximab administration. 2012 Via Medica.

<3>
Accession Number
2012312676
Authors
Gopal R. Harikrishnan S. Sivasankaran S. Ajithkumar V.K. Titus T. Tharakan
J.M.
Institution
(Gopal, Harikrishnan, Sivasankaran, Ajithkumar, Titus, Tharakan)
Department of Cardiology, Sree Chitra Tirunal Institute for Medical
Sciences and Technology, Thiruvananthapuram, Kerala, India
Title
Once weekly azithromycin in secondary prevention of rheumatic fever.
Source
Indian Heart Journal. 64 (1) (pp 12-15), 2012. Date of Publication:
January-February 2012.
Publisher
Cardiology Society of India (Okhla Road, New Delhi 110 025, India)
Abstract
Rheumatic fever and rheumatic heart disease (RHD) are still important
problems in developing countries. Secondary prophylaxis which is the most
cost-effective method in preventing recurrences of rheumatic fever is
fraught with problems of drug compliance. The utility of 500 mg once
weekly azithromycin (AZT), an orally effective long-acting antibiotic was
evaluated against oral penicillin (phenoxy methyl penicillin 250 mg twice
daily) in this study. Forty-eight consecutive patients (44% males, mean
age 29.4 years) with established RHD were randomised into two groups-26
patients received AZT and 22 received oral penicillin. Patients were
evaluated at randomisation, at 1 month, 3 months, and 6 months,
clinically, serologically and by throat swab culture. End points were
absence of streptococcal colonisation, infection or fever at the end of 6
months. During the study, 4 patients (15.4%) in the AZT group developed
sore throat and fever, had positive throat culture and positive serology
indicating streptococcal infection. None satisfied the criteria for
rheumatic fever reactivation. None in the oral penicillin group developed
streptococcal infection. In conclusion, weekly 500 mg of AZT is not
effective in the prevention of streptococcal throat infection compared to
oral penicillin therapy in adult patients with established RHD. 2012.
Cardiological Society of India. All rights reserved.

<4>
[Use Link to view the full text]
Accession Number
2012332597
Authors
Hattler B. Messenger J.C. Shroyer A.L. Collins J.F. Haugen S.J. Garcia
J.A. Baltz J.H. Cleveland J.C. Novitzky D. Grover F.L.
Institution
(Hattler, Shroyer, Baltz, Cleveland, Grover) Department of Veterans
Affairs, Eastern Colorado Health Care System, Denver, United States
(Hattler, Messenger, Garcia) Department of Medicine, University of
Colorado Hospital at Denver, Health Sciences Center, Aurora, United States
(Shroyer) Northport Veterans Affairs Medical Center, Northport, NY, United
States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Haugen) Group Health Cooperative, Bellevue Medical Center, Bellevue, WA,
United States
(Cleveland, Grover) Department of Surgery, University of Colorado Hospital
at Denver, Health Sciences Center, Aurora, United States
(Novitzky) James A. Haley Veterans Hospital, Tampa, FL, United States
Title
Off-pump coronary artery bypass surgery is associated with worse arterial
and saphenous vein graft patency and less effective revascularization:
Results from the veterans affairs randomized on/off bypass (ROOBY) trial.
Source
Circulation. 125 (23) (pp 2827-2835), 2012. Date of Publication: 12 Jun
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-The Department of Veterans Affairs Randomized On/Off Bypass
(ROOBY) trial compared clinical and angiographic outcomes in off-pump
versus on-pump coronary artery bypass graft (CABG) surgery to ascertain
the relative efficacy of the 2 techniques. Methods and Results-From
February 2002 to May 2007, the ROOBY trial randomized 2203 patients to
off-pump versus on-pump CABG. Follow-up angiography was obtained in 685
off-pump (62%) and 685 on-pump (62%) patients. Angiograms were analyzed
(blinded to treatment) for FitzGibbon classification (A=widely patent,
B=flow limited, O=occluded) and effective revascularization. Effective
revascularization was defined as follows: All 3 major coronary territories
with significant disease were revascularized by a FitzGibbon A-quality
graft to the major diseased artery, and there were no new postanastomotic
lesions. Off-pump CABG resulted in lower FitzGibbon A patency rates than
on-pump CABG for arterial conduits (85.8% versus 91.4%; P=0.003) and
saphenous vein grafts (72.7% versus 80.4%; P<0.001). Fewer off-pump
patients were effectively revascularized (50.1% versus 63.9% on-pump;
P<0.001). Within each major coronary territory, effective
revascularization was worse off pump than on pump (all P<=0.001). The
1-year adverse cardiac event rate was 16.4% in patients with ineffective
revascularization versus 5.9% in patients with effective revascularization
(P<0.001). Conclusions-Off-pump CABG resulted in significantly lower
FitzGibbon A patency for arterial and saphenous vein graft conduits and
less effective revascularization than on-pump CABG. At 1 year, patients
with less effective revascularization had higher adverse event rates.
Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00032630. 2012 American Heart Association, Inc.

<5>
Accession Number
2012328124
Authors
Wohrle J. Merkle N. Kunze M. Cristea E. Mehran R. Rottbauer W. Stone G.W.
Institution
(Wohrle, Merkle, Kunze, Rottbauer) Clinic of Internal Medicine II,
University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
(Cristea, Mehran, Stone) Columbia University Medical Center,
Cardiovascular Research Foundation, New York, United States
Title
Effect of bivalirudin compared with unfractionated heparin plus abciximab
on infarct size and myocardial recovery after primary percutaneous
coronary intervention: The HORIZONS-AMI CMRI substudy.
Source
Catheterization and Cardiovascular Interventions. 79 (7) (pp 1083-1089),
2012. Date of Publication: 01 Jun 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background: Myocardial infarct size is a strong independent predictor of
mortality in patients with ST-elevation myocardial infarction (STEMI). In
the Harmonizing Outcomes with RevasculariZatiON and Stents in Acute
Myocardial Infarction (HORIZONS-AMI) trial, bivalirudin compared with
unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor reduced
cardiac mortality in STEMI patients, which was attributed to reduced major
bleeding. Whether a possible reduction in infarct size with bivalirudin
may have contributed to the enhanced survival with this agent is unknown.
Methods: Cardiac magnetic resonance imaging was performed within 7 days
and after 6 months in 51 randomized patients from a single center in
HORIZONS-AMI trial (N = 28 bivalirudin, N = 23 heparin plus abciximab).
Infarct size, microvascular obstruction (MVO), left ventricular ejection
fraction (LVEF), and LV end-diastolic and end-systolic volume indices were
evaluated. Results: Infarct size was not significantly different after
treatment with bivalirudin compared with heparin plus abciximab either
within 7 days (median 9.3% [interquartile range 4.9%, 26.6%] vs. 20.0%
[5.9%, 28.2%], P = 0.28) or at 6 months 6.7% [3.8%, 20.0%] vs. 8.2% [1.8%,
16.5%], P = 0.73). MVO was present in 28.6% versus 34.8% of patients
respectively (P = 0.63). LVEF and LV volume indices also did not
significantly differ between the two groups at either time period, nor
were differences in myocardial recovery evident. Conclusions: In
conclusion, in the HORIZONS-AMI Cardiac magnetic resonance imaging (CMRI)
substudy, cardiac magnetic resonance imaging within 7 days and at 6 months
after primary percutaneous coronary intervention (PCI) did not demonstrate
significant differences in infarct size, MVO, LVEF, or LV volume indices
in patients treated with bivalirudin compared with unfractionated heparin
plus abciximab. 2011 Wiley Periodicals, Inc.

<6>
Accession Number
22341193
Authors
Johnston C.C. Rennick J.E. Filion F. Campbell-Yeo M. Goulet C. Bell L.
Tucci M. Ranger M.
Institution
(Johnston, Filion, Ranger) McGill University, Montreal, QC, Canada
(Rennick) McGiIl University Health Centre, Montreal Children's campus,
Montreal QC, Canada
(Campbell-Yeo) IWK Health Centre, Halifax, Canada
(Filion, Goulet) Faculty of Nursing, University of Montreal, Quebec,
Canada
(Bell) University of Sherbrooke, Sherbrooke, QC, Canada
(Tucci) CHU Sainte-Justine, Montreal, QC, Canada
Title
Maternal Touch and Talk for Invasive Procedures in Infants and Toddlers in
the Pediatric Intensive Care Unit.
Source
Journal of Pediatric Nursing. 27 (2) (pp 144-153), 2012. Date of
Publication: April 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
The aim of this single-blind, randomized, crossover trial was to test the
effect of Touch & Talk (T&T) for infants and toddlers less than 36 months
of age (N = 65) in the pediatric intensive care unit on their
physiological stability and recovery to an invasive procedure. In the T&T
condition, mothers touched, sang, or told stories or rhymes to their child
during an invasive procedure. In the control condition, the mothers did
not have contact with their child. Physiological measures included heart
rate, heart rate variability, and oxygen saturation range during the
procedure and change from baseline. Time from the end of the procedure
until the heart rate returned to baseline levels gave the recovery time.
Analysis was conducted using repeated-measures analysis of covariance.
There were no significant differences on any of the physiological
parameters by condition during the procedure. However, when controlling
for severity of illness, recovery was faster with mothers. 2012 Elsevier
Inc.

<7>
Accession Number
22381987
Authors
Dumont C. Bourguignon C.
Institution
(Dumont) Winchester Medical Center, Winchester, VA, United States
(Bourguignon) Study of Complementary and Alternative Therapies, University
of Virginia, School of Nursing, Charlottesville, United States
Title
Effect of a computerized insulin dose calculator on the process of
glycemic control.
Source
American Journal of Critical Care. 21 (2) (pp 106-116), 2012. Date of
Publication: 01 Mar 2012.
Publisher
American Association of Critical Care Nurses (101 Columbia, Suite 100,
Aliso Viejo CA 92656-4109, United States)
Abstract
Background: Glycemic control is important to patients' outcomes. However,
the process of maintaining glycemic control is risk laden and labor
intensive for nurses. Objectives: To examine the effects of using a
computerized insulin dose calculator to facilitate management of glycemic
control for critically ill cardiac patients. Methods: A prospective
randomized controlled trial was conducted with a sample of 300 intensive
care patients, 141 randomized to the calculator group and 159 in the
control (paper protocol) group. A convenience sample of 44 intensive care
nurses responded to a nurse satisfaction survey. Results: A significantly
higher percentage of glucose measurements were in the target range in the
calculator group than in the control group (70.4% [SD, 15.2%] vs 61.6%
[SD, 17.9%], Z = -4.423, P <.001), and glucose variance was significantly
less in the calculator group (35.5 [SD, 18.3] mg/dL vs 42.3 [SD, 21.2]
mg/dL, Z = -3.845, P <.001). Fewer hypoglycemic events occurred in the
calculator group (7 vs 18), although this difference was not statistically
significant. Nurse satisfaction was higher for the calculator group than
for the control group (8.4 [SD, 1.4] vs 4.8 [SD, 2.4], Z = -5.055, P
<.001). Nurses' deviation from the protocol was also less in the
calculator group than in the control group. Conclusions: Management of
glycemic control and nurse satisfaction were improved with use of the dose
calculator. Improving nurses' processes of care may improve nurses' use of
time and patient care overall. Studies with larger sample sizes over time
are needed to determine these relationships. 2012 American Association of
Critical-Care Nurses.

<8>
Accession Number
22086523
Authors
Armaganijan L. Lopes R.D. Healey J.S. Piccini J.P. Nair G.M. Morillo C.A.
Institution
(Armaganijan) Electrophysiology and Cardiac Arrhythmias, Dante Pazzanese
Institute of Cardiology, Sao Paulo/SP, Brazil
(Armaganijan, Healey, Nair, Morillo) Department of Medicine, Cardiology
Division, Population Health Research Institute, Arrhythmia Service,
McMaster University, Hamilton, ON, Canada
(Lopes, Piccini) Department of Medicine, Division of Cardiology, Duke
Clinical Research Institute, Duke University, Durham, NC, United States
Title
Do omega-3 fatty acids prevent atrial fibrillation after open heart
surgery? A meta-analysis of randomized controlled trials.
Source
Clinics. 66 (11) (pp 1923-1928), 2011. Date of Publication: 2011.
Publisher
Universidade de Sao Paulo (Av.Dr.Arnaldo 455-Cerqueira Cesar, Sao Paulo
01246903, Brazil)
Abstract
OBJECTIVES: N-3 polyunsaturated fatty acids have been proposed as a novel
treatment for preventing postoperative atrial fibrillation due to their
potential anti-inflammatory and anti-arrhythmic effects. However,
randomized studies have yielded conflicting results. The objective of this
study is to review randomized trials of N-3 polyunsaturated fatty acid use
for postoperative atrial fibrillation. METHODS: Using the CENTRAL, PUBMED,
EMBASE, and LILACS databases, a literature search was conducted to
identify all of the studies in human subjects that reported the effects of
N-3 polyunsaturated fatty acids on the prevention of postoperative atrial
fibrillation in cardiac surgery patients. The final search was performed
on January 30, 2011. There was no language restriction, and the search
strategy only involved terms for N-3 polyunsaturated fatty acids (or fish
oil), atrial fibrillation, and cardiac surgery. To be included, the
studies had to be randomized (open or blinded), and the enrolled patients
had to be $18 years of age. RESULTS: Four randomized studies (three
double-blind, one open-label) that enrolled 538 patients were identified.
The patients were predominantly male, the mean age was 62.3 years, and
most of the patients exhibited a normal left atrial size and ejection
fraction. N-3 polyunsaturated fatty acid use was not associated with a
reduction in postoperative atrial fibrillation. Similar results were
observed when the open-label study was excluded. CONCLUSIONS: There is
insufficient evidence to suggest that treatment with N-3 polyunsaturated
fatty acids reduces postoperative atrial fibrillation. Therefore, their
routine use in patients undergoing cardiac surgery is not recommended.
2011 CLINICS.

<9>
Accession Number
2012326923
Authors
Meng Q.-T. Xia Z.-Y. Luo T. Wu Y. Tang L.-H. Zhao B. Chen J.-H. Chen X.
Institution
(Meng, Xia, Luo, Wu, Tang, Zhao, Chen) Department of Anesthesiology,
Renmin Hospital of Wuhan University, Wuhan 430060, China
(Chen) Department of Otorhinolaryngology, Renmin Hospital of Wuhan
University, Wuhan 430060, China
Title
Dexmedetomidine reduces emergence agitation after tonsillectomy in
children by sevoflurane anesthesia: A case-control study.
Source
International Journal of Pediatric Otorhinolaryngology. 76 (7) (pp
1036-1041), 2012. Date of Publication: July 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: To evaluate the efficacy and safety of dexmedetomidine for
emergence agitation after tonsillectomy in children. Methods: 120 ASA
physical status I and II children, aged 5-14 years, undergoing anesthesia
for tonsillectomy, were randomly divided into 3 groups: Placebo group, the
low dexmedetomidine concentration group and the high dexmedetomidine
concentration group. Before the entrance of the operating room (OR), all
of the children received intravenous injection 40mugkg^-1
midazolam to reduce anxiety at first, and then dexmedetomidine was given
intravenously at an initial loading dose of 0.5mugkg^-1 or
1mug/kg over a 10-min period via a computer controlled infusion pump
followed by a maintenance infusion of 0.2mugkg^-1h^-1
or 0.4mugkg^-1h^-1over the surgery. The heart rate,
SpO₂ and mean arterial blood pressure were recorded for each
patient in both operation room and PACU. The designated time points: at
the start of the anesthetic induction, at the discontinuation of
inhalational agents, at first opening of eyes, at time to remove
endotracheal tube were recorded. After patient arrival at the PACU, VAS
score, RSS, the occurrence of emergence agitation were recorded every 5min
for the first 30min and every 10min for the next 30min after endotracheal
tube was removed. Results: There was significant difference in the
incidence of emergence agitation between Placebo group and the high
concentration group when endotracheal tube was removed (P<0.05). There was
significant difference in the VAS pain scores and in the RSS between three
groups at the time of extubation, as well as 5. min and 10. min after
extubation (P<0.05). Conclusions: Dexmedetomidine appears to be safe and
effective to reduce the incidence of early emergence agitation in children
after tonsillectomy. Initial loading dose of 1.0mugkg^-1
followed by a maintenance infusion of 0.4mugkg^-1h^-1
is better choice for children received tonsillectomy. 2012 Elsevier
Ireland Ltd.

<10>
Accession Number
2012323558
Authors
Hayes K. Leet A.S. Bradley S.J. Holland A.E.
Institution
(Hayes, Bradley, Holland) Alfred Hospital, Department of Physiotherapy, 55
Commercial Rd, Melbourne, VIC 3181, Australia
(Leet) Heart Transplant Unit, Alfred Hospital, Melbourne, VIC, Australia
(Leet) Baker Heart Institute, Melbourne, VIC, Australia
(Holland) La Trobe University, Melbourne, VIC, Australia
Title
Effects of exercise training on exercise capacity and quality of life in
patients with a left ventricular assist device: A preliminary randomized
controlled trial.
Source
Journal of Heart and Lung Transplantation. 31 (7) (pp 729-734), 2012. Date
of Publication: July 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
BACKGROUND: A paucity of studies has examined the effect of exercise
training after left ventricular assist device (LVAD) implantation.
Previous research has demonstrated that insertion of the LVAD alone
improves exercise capacity and quality of life (QOL). This study
investigated whether supervised exercise training results in a further
improvement. METHODS: This prospective, randomized controlled trial with
concealed allocation, assessor blinding, and intention-to-treat analysis
investigated the effect of exercise training on exercise capacity and QOL
in 14 patients who underwent LVAD insertion as a bridge to heart
transplantation. Exercise training consisted of 8 weeks of gym-based
aerobic and strengthening exercises 3 times a week, with a progressive
mobilization program, compared with the control group that completed
mobilization alone. Exercise capacity was measured before and after the
intervention using maximal cardiopulmonary exercise testing and 6-minute
walk distance (6MWD). QOL was measured using the Short Form 36-item
assessment. RESULTS: No adverse events were reported. There was a trend
toward greater improvement in peak oxygen consumption (Vo₂),
6MWD, and QOL in the exercise group (n = 7) compared with the control
group (n = 7); however, no significant between-group difference was
detected for improvements in peak Vo₂ [mean difference
(exercise - control)] of 2.96 ml/kg/min (95% confidence interval, -1.04 to
6.97), 6MWD at 54 meters (-51 to 159 meters), and QOL scores over time (p
> 0.05). CONCLUSION: Exercise training is feasible and safe in patients
with a LVAD. Trends toward greater improvement in exercise capacity and
QOL after exercise training warrant further investigation in a larger
trial. Crown Copyright 2012 Published by Elsevier Inc. on behalf of the
International Society for Heart and Lung Transplantation. All rights
reserved.

<11>
Accession Number
70779829
Authors
Slozowski P. Listewnik M. Brykczynski M.
Institution
(Slozowski, Listewnik, Brykczynski) Pomeranian Medical University,
Szczecin, Poland
Title
The influence of carbon dioxide field flooding in mitral valve procedures
using extracorporeal circulation on S100B marker in blood plasma.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 27th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists Amsterdam
Netherlands. Conference Start: 20120523 Conference End: 20120525.
Conference Publication: (var.pagings). 16 (pp 269), 2012. Date of
Publication: 2012.
Publisher
Pabst Science Publishers
Abstract
Introduction: Neurocognitive deficits after cardiac surgery are described
in 4 to 33% of patients in the first 7 days. Postulated explanations are
microembolization of small brain arterioles with air or solid particles
and use of the extracorporeal circulation (ECC). Despite de-airing in
valve surgery, some air always remains captured in pulmonary veins and
evacuates only after weaning from ECC. Field flooding is a technique which
aims to replace air in the surgical wound cavity with carbon dioxide,
which should pose less danger of microemboli because of its greater
solubility. Conducted research studies have shown various results, but the
matter remains unresolved. S100B is a small astroglial protein and is
released to blood plasma after brain injury. Its increase after cardiac
surgery has been connected with neurocognitive dysfunction. Method: We
conducted a randomized controlled clinical trial on mitral valve
procedures in a study group of 49 patients and 51 in a control group.
Exclusion criteria were: minimal invasive operations, concomitant aortic
valve and aorta procedures or brain damage incidents in the past. All the
operations were performed by classic access and most of them were combined
cardiac procedures. Carbon dioxide insufflation at 6 litres per minute was
administered by a multiperforated drain with closed end in the study
group, starting 60 seconds before opening the left atrium. Blood samples
for S100B measurement were taken before the operation, 2 h after
cross-clamp release and 24 h postoperatively. Results: There were no
statistically valid differences between groups in S100B increase at 2 h
and 24 h postoperatively, despite a 13% higher short term marker increase
in the control group. Increase of S100B at 2 h was statistically greater
in patients after mitral valve replacement (MVR) compared to plasty (MVP)
group and correlated with concomitant tricuspid valve plasty (TVP),
although the TVP group had greater bypass times. Conclusion: Lack of
strong evidence makes routine use of CO2 slightly unjustified, but the
matter requires further studies. MVP patients may have better neurologic
outcome than MVR, but have different organic valve disease.

<12>
Accession Number
70779827
Authors
Covotta M. Vaccaro P. Barchetta R. Riitano G. Gargano F. Falco M. Turani
F.
Institution
(Covotta, Vaccaro, Barchetta, Riitano, Gargano, Falco, Turani) Cardiac
Anaesthesia, European Hospital, Rome, Italy
Title
Evaluation of a new software version (Version 3.02) of the FloTrac during
OPCAB.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 27th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists Amsterdam
Netherlands. Conference Start: 20120523 Conference End: 20120525.
Conference Publication: (var.pagings). 16 (pp 267-268), 2012. Date of
Publication: 2012.
Publisher
Pabst Science Publishers
Abstract
Introduction: Off-pump coronary artery bypass is frequently used in
cardiac surgery and may be useful in some clinical situations. During
OPCAB, rotating and compressing the beating heart may result in acute
deterioration of haemodynamics and monitoring of CO in continuous mode
(CCO) is clinically useful. The FloTrac/Vigileo is a minimally invasive
system to monitor CCO without calibration. The aim of this study on OPCAB
patients was 1) to assess the accuracy of the new third generation
(version 3.02) FloTrac/Vigileo software; 2) to compare the new version
with the previous one (version 1.10). Method: Twenty patients submitted to
OPCAB were included in this study. The CO was measured simultaneously with
FloTrac/Vigileo (version 3.02) and by single-bolus thermodilution (in
triplicate) at 5 time points: T1, after anaesthesia induction; T2, left
anterior descending anastomosis; T3, obtuse marginal anastomosis; T4,
posterior descending anastomosis; T5, sternal closure. Bland Altman
analysis was used to compare Trac / Vigileo and Thermodilution
measurements. Percentage Error (PE), concordance rate, and correlation
coefficient were also evaluated. Results: Table 1 shows the main results
of the study. CCO FloTrac well correlated with ther- (Table presented)
modilution measurements although PE was little higher then 30 %.
Conclusions: The new version of software shows a good correlation with
thermodilution but accuracy and precision is little below the current
benchmark. The new algorithm provides improvement over the previous
version. In the light of the recent meta-analysis on minimal invasive CO
[1] and of data of this study, FloTrac Vigileo may be a valuable tool
during OPCAB.

<13>
Accession Number
70779793
Authors
Buse G.A.L.L. Seeberger E. Schumacher P. Schumann R.M. Filipovic M.
Bolliger D. Seeberger M.D.
Institution
(Buse, Seeberger, Schumann, Bolliger, Seeberger) University Hospital
Basel, Basel, Switzerland
(Filipovic) Kantonsspital St. Gallen, St. Gallen, Switzerland
(Schumacher) Burgerspital Solothurn, Solothurn, Switzerland
Title
Impact of sevoflurane vs. propofol on side-effects after noncardiac
surgery: A randomized controlled trial.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 27th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists Amsterdam
Netherlands. Conference Start: 20120523 Conference End: 20120525.
Conference Publication: (var.pagings). 16 (pp 239-240), 2012. Date of
Publication: 2012.
Publisher
Pabst Science Publishers
Abstract
Introduction: The aim was to evaluate the effect of sevoflurane compared
to propofol on the incidence of postoperative nausea and vomiting (PONV),
headache, and vertigo after major non-cardiac surgery. Method: This is a
secondary analysis of a randomized, controlled, multi-centre trial of
sevoflurane vs. propofol to reduce myocardial ischaemia. PONV, headache
and vertigo were pre-specified, systematically collected tertiary
endpoints. PONV was defined as nausea or vomiting or postoperative use of
antiemetics. Patients were induced with etomidate and maintained with
sevoflurane or propofol as allocated. Side effects were assessed by visits
on postoperative days 1, 2 and 7 or discharge day whichever occurred
first. We tested for differences across treatment groups by chi-squared or
Fisher's exact test as appropriate. Results: We enrolled 385 patients.
Five patients dropped out (3 patients in the sevoflurane group), leaving
181 patients in the sevoflurane and 199 patients in the propofol groups.
Side-effect data were missing in 1% on days 1 and 2, and in 11% on day 7.
Sex (P=0.547), smoking (P=0.561), surgery duration (P=0.489), and choice
of opioids (fentanyl P=0.508, alfentanil P=0.950, sufentanil P=0.596,
remifentanil P=0.507, methadon P=0.573) did not differ between groups.
None of the patients underwent procedures typically associated with PONV
[1].The table (Table presented) reports the results (percentages refer to
patients with available data). Conclusion: Compared to propofol,
anaesthesia maintenance with sevoflurane was associated with increased
PONV on postoperative day 1 but without persistence thereafter. In
contrast, the type of anaesthesia did not affect the incidences of
headache or vertigo.

<14>
Accession Number
70779792
Authors
Lurati Buse G.A.L. Seeberger E. Kasper J. Schumann R.M. Filipovic M.
Bolliger D. Seeberger M.D.
Institution
(Lurati Buse, Seeberger, Kasper, Schumann, Bolliger, Seeberger) University
Hospital Basel, Basel, Switzerland
(Filipovic) Kantonspital St. Gallen, St. Gallen, Switzerland
Title
Impact of sevoflurane vs. propofol on patients' satisfaction after
non-cardiac surgery: A randomized controlled trial.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 27th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists Amsterdam
Netherlands. Conference Start: 20120523 Conference End: 20120525.
Conference Publication: (var.pagings). 16 (pp 238-239), 2012. Date of
Publication: 2012.
Publisher
Pabst Science Publishers
Abstract
Introduction: The aim was to evaluate the effect of sevoflurane compared
to propofol on patients' satisfaction after major non-cardiac surgery.
Method: This is a secondary analysis of a multicentre randomized
controlled trial of sevoflurane vs. propofol to reduce perioperative
ischaemia in patients at cardiovascular risk. Patients' satisfaction was a
prespecified tertiary endpoint and was collected systematically by visual
analogue scale in 2 study centres. The scale ranges from 0 to 10 with low
values indicating low satisfaction. Patients were induced by etomidate and
maintained by sevoflurane or propofol as randomized. Research staff
visited the patients on postoperative days 1, 2, and day 7 or discharge
day whichever occurred first, and assessed satisfaction. We tested for
differences in the VAS distribution across treatment groups by
Mann-Whitney U test. We tested for dichotomous variables by chi-squared or
Fisher's exact test, as appropriate. The big majority (97%) of the
patients was enrolled in one of the centres; therefore, we did not
stratify the satisfaction analysis by centre. Results: We analysed 284
patients, thereof 57.7% underwent major vascular surgery. Four patients
dropped out (2 patients in the sevoflurane group) leaving 137 patients in
the sevoflurane and 143 patients in the propofol groups. VAS data were
missing in 2% of the patients on day 1, 1% on day 2, and 15% on day 7.
Four percent (11/280), 5% (14/280) and 3% (9/280) of the patients were not
able to quantify their satisfaction by VAS on postoperative days 1, 2 and
7, respectively. These proportions did not differ across treatments. The
median VAS was 7 (interquartile range [IQR] 5-8) on days 1 and 2 in both
the sevoflurane and the propofol group. On day 7 the median VAS was 8 (IQR
6-9) in the sevoflurane and 7 (IQR 5-9) in the propofol group. The VAS
distribution did not differ across the two groups at any time-point (P=
0.173 on day 1, P=0.734 on day 2, P=0.122 on day 7). Conclusion: The
choice of sevoflurane or propofol did not affect the patients'
satisfaction after major noncardiac surgery.

<15>
Accession Number
70779776
Authors
Brevoord D. Kranke P. Kuijpers M. Weber N. Hollmann M. Preckel B.
Institution
(Brevoord, Kuijpers, Weber, Hollmann, Preckel) Academic Medical Centre,
University of Amsterdam, Amsterdam, Netherlands
(Kranke) University Hospital Wurzburg, Wurzburg, Germany
Title
Does remote ischaemic conditioning improve outcome? A systematic review.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 27th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists Amsterdam
Netherlands. Conference Start: 20120523 Conference End: 20120525.
Conference Publication: (var.pagings). 16 (pp 226-227), 2012. Date of
Publication: 2012.
Publisher
Pabst Science Publishers
Abstract
Introduction: Remote ischaemic conditioning (RIC) is an intriguing method
to induce resistance against ischaemia reperfusion injury and can be used
in a variety of clinical settings. Available studies mostly focus on
surrogate endpoints, such as biomarker release. We performed a systematic
review and metaanalysis to investigate whether RIC reduces mortality,
major adverse cardiovascular events, length of stay in hospital and in the
intensive care unit, as well as biomarker release, in patients who suffer
from or are at risk for ischaemia reperfusion injury. Method: Medline,
EMBASE and Cochrane databases were searched for abstracts of randomized
clinical trials comparing RIC, regardless of timing, with no conditioning.
Abstracts were screened by two investigators, who independently selected
suitable trials, assessed trial quality and extracted data. Results: In
total, 23 studies were included on patients undergoing cardiac surgery (15
studies), percutaneous coronary intervention (four studies) and vascular
surgery (four studies), compromising 1878 patients. Compared to no
conditioning, RIC did not reduce mortality (odds ratio 1.22 [95%
confidence interval 0.48, 3.07]) or major adverse cardiovascular events
(0.65 [0.38, 1.14]). However, the incidence of myocardial infarction was
reduced with RIC (0.50 [0.31, 0.82], P<0.005), as was peak troponin
release (mean difference -0.28 [-0.47, -0.09], P<0.01). A subgroup
analysis of the different study populations was not performed, due to
insufficient number of trials. Conclusion: We found no evidence that RIC
reduces mortality or the incidence of associated major adverse
cardiovascular events after ischaemic injury. However, the data did show a
reduction in the incidence of peri-procedural myocardial infarction, as
well as reduced release of troponin after RIC.

<16>
Accession Number
70779764
Authors
Anderson J. Ang Y. Chen S. Choy K. Farhan-Alanie M. Kennedy E. Mackenzie
S. Moore D. Sykes R. Alston R.P.
Institution
(Anderson, Ang, Chen, Choy, Farhan-Alanie, Kennedy, Mackenzie, Moore,
Sykes) College of Medicine, University of Edinburgh, Edinburgh, United
Kingdom
(Alston) Department of Anaesthesia, Royal Infirmary of Edinburgh,
Edinburgh, United Kingdom
Title
Cognition after coronary artery bypass grafting surgery: A comparison of
on- and off-pump.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 27th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists Amsterdam
Netherlands. Conference Start: 20120523 Conference End: 20120525.
Conference Publication: (var.pagings). 16 (pp 215-216), 2012. Date of
Publication: 2012.
Publisher
Pabst Science Publishers
Abstract
Introduction: In the last two decades, coronary artery bypass grafting
(CABG) surgery has increasingly been performed without cardiopulmonary
bypass (CPB), that is 'offpump'. A strong motivation for performing CABG
surgery off-pump was to avoid CPB which has been believed to cause
cognitive decline. However, accumulating evidence from systematic reviews
and meta-analyses comparing on- and off-pump CABG surgery indicates that
CPB may not be the cause of cognitive decline [1]. Several additional
randomized controlled trials (RCTs) comparing cognition after on- and
off-pump CABG surgery have been published since the last metaanalyses. The
aim of this study was to undertake a systematic review of the literature
and meta-analysis to compare cognition following on- and off-pump CABG
surgery. Method: RCTs comparing continuous measures of cognitive outcome
after on- and offpump CABG surgery were identified by literature
searching. Data extraction enabled data from seven psychometric tests
(Auditory Verbal Learning Test, Grooved Pegboard, Trail-Making A and B,
Digit Symbol, Digit Span, and Stroop Colour Word Test) to be amalgamated.
Data was grouped into early (< six months) and late (>= six months)
postoperative periods and analysed using Revman 5. Results: A systematic
literature search conducted in Medline, Embase, PsychINFO and The Cochrane
Library yielded 13 studies totalling 2285 patients that could be included
in the meta-analysis. No significant differences were found between on-
and off-pump groups in any of the psychometric tests in either early or
late postoperative periods. Discussion: To-date, this is the largest
metaanalysis comparing cognition following onand off-pump CABG surgery and
the absence of difference is consistent with previous systematic reviews
and meta-analyses. The results are highly suggestive that CPB may not be
the cause of cognitive decline associated with CABG surgery.

<17>
Accession Number
70774737
Authors
Shehata N. Burns L.A. Nathan H. Hebert P. Hare G.T. Fergusson D. Mazer
C.D.
Institution
(Shehata) Division of Hematology, St. Michael's Hospital, Toronto, ON,
Canada
(Burns) Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
(Nathan) Anesthesia, University of Ottawa, Ottawa, ON, Canada
(Hebert) Medicine, Surgery, Anesthesiology and Epidemiology, University of
Ottawa, Ottawa, Canada
(Hare) Anesthesia, University of Toronto, Toronto, Canada
(Fergusson) Centre for Transfusion Research, University of Ottawa, Ottawa,
Canada
(Mazer) University of Toronto, Toronto, Canada
Title
Transfusion requirements in cariovascular surgery (TRICI).
Source
Blood. Conference: 52nd Annual Meeting of the American Society of
Hematology, ASH 2010 Orlando, FL United States. Conference Start: 20101204
Conference End: 20101207. Conference Publication: (var.pagings). 116 (21)
, 2010. Date of Publication: 19 Nov 2010.
Publisher
American Society of Hematology
Abstract
Background: Determination of the optimal hemoglobin concentration (Hb) for
red cell (RBCs) transfusion is essential for patients undergoing cardiac
surgery as mortality may be dependent on the severity of anemia and
administration of RBCs. As there is considerable variability in
transfusion practices, a pilot feasibility study is required to ensure
that adherence to proposed strategies can be achieved before conducting a
definitive study requiring thousands of patients. The primary objective of
this study was to assess overall adherence to two transfusion strategies.
Methods: We conducted a single centre parallel randomized controlled pilot
trial to assess adherence to two transfusion strategies. The randomization
sequence was created using block randomization by age and Cardiac
Anesthesia Risk Score in groups of 4. High risk patients were allocated to
a "restrictive" transfusion strategy (RBCs if their Hb was 70 g/L or less
intraoperatively during cardiopulmonary bypass (CPB) and 75 g/L or less
postoperatively following CPB); or a "liberal" transfusion strategy (RBCs
if their Hb was 95 g/L or less during CPB and less than 100 g/L
postoperatively). We defined adherence as adherence to the transfusion
strategies for each patient for more than 90% of their days in hospital.
We also assessed reasons for non-adherence and clinical outcomes. A total
sample size of 50 patients was estimated to produce a 97% confidence
interval equal to the sample adherence prevalence plus or minus 8% when
the true prevalence of adherence was hypothesized to be 90%. We estimated
our sample size using PASS 2002 software. The significance level was set
at p<0.05 for all statistical analyses. Results: Fifty patients were
randomized, 25 in the liberal group and 25 in the restrictive group.
Overall, 99 units of RBCs were transfused in the liberal group compared 50
units in the restrictive group (p<0.01). Forty eight units of RBCs were
administered intraoperatively for the liberal group compared to 14 RBC
units for the restrictive group (p< 0.01). Ninety eight units were
transfused in the liberal group according to the transfusion strategy
compared to 42 units in the restrictive group (p=0.01). The median number
of days of adherence to the transfusion strategy was 8 (interquartile
range 12) in the restrictive arm and 6 days (interquartile range 3) in the
liberal arm (Table, p<0.05). The proportion of patients with 100%
adherence was higher in the liberal group i.e., more patients in the
restrictive group received transfusions without meeting a transfusion
criterion. This was also reflected in the proportion of red cells
administered according to the transfusion strategy. The percent of adhered
transfusion thresholds was 70% in the restrictive arm and 65% in the
liberal arm. The adherence rate was highest in the operating room followed
by the cardiovascular intensive care unit then the ward (Table). Reasons
for non adherence included attending staff opinion that transfusion not
indicated, patient refusal, the use of hemoconcentration to increase the
hemoglobin concentration, hemorrhage, use of hematocrit instead Hb to
transfuse the patient, confusion whether the transfusion strategy was to
be applied on the ward, hyperkalemia, repetition of the complete blood
count before transfusing the patient, and the staff was too busy. (Table
Presented) Conclusions: This is the first randomized controlled trial that
has assessed adherence rates to transfusion strategies in high-risk
patients undergoing cardiac surgery. Determination of adherence rates to
transfusion strategies is essential as adherence rates can impact outcomes
if a considerable proportion of enrolled patients do not receive a
transfusion according to their transfusion strategy. Poor adherence may
impact outcomes despite the subsequent use of intention to treat analysis.
Restrictive strategies can reduce transfusion, but further studies will be
required to determine whether restrictive transfusions confer risk.