Total documents retrieved: 28
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<1>
Accession Number
2012388130
Authors
Cui W. Gong J. Wang Q. Wang K. Song T. Tian Z. Ren L.
Institution
(Cui, Wang, Wang, Song) Department of Anesthesiology, First Affiliated
Hospital, China Medical University, 155 Nanjing St, Shenyang, 110001,
China
(Gong) Department of Clinical Pharmacy, School of Life Science and
Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China
(Tian) Department of Anesthesiology, Yanbian Maternal and Child Healthcare
Hospital, Yanbian, China
(Ren) Department of Anesthesiology, Dalian Central Hospital, Dalian, China
Title
Myocardial protection with sevoflurane in coronary artery bypass grafting
surgery.
Source
Pakistan Journal of Medical Sciences. 28 (4) , 2012. Date of Publication:
July-September 2012.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Sevoflurane is a widely used volatile anesthetic agent, but the simple
efficacy of sevoflurane in cardio protection is unknown. This systematic
review assesses the effect of sevoflurane in myocardial protection during
coronary artery bypass graft surgery. An electronic search was undertaken,
without language restriction, from MEDLINE, EMBASE, and CENTRAL. All
relevant randomized controlled trials of adult cardiac patients undergoing
coronary artery bypass grafting surgery which involved in sevoflurane were
included. Exclusion criteria were duplicate publications and lack of
outcome data. The outcome measures were cardiac troponinI serum
concentration, myocardial infarction, and death. Statistical heterogeneity
and inconsistency of each outcome were detected. Publication bias was
measured through visual inspection of funnel plots of the outcomes. Twenty
eligible randomized clinical trials were identified, with 1,912 patients.
Thirteen studies, with 759 patients, reported 8a significant reduction in
cardiac troponin Iserum concentration (P <0.0001). There was no
significant difference between sevoflurane and control with respect to
myocardial infarction (P = 0.23, 14 studies, 1,395 patients) and mortality
(P = 0.36, 15 trials, 1,465 patients). This study has shown the evidence
of sevoflurane protection in coronary artery bypass graft surgery, with a
down regulation in troponin I.
<2>
Accession Number
2012387342
Authors
Jarral O.A. Saso S. Athanasiou T.
Institution
(Jarral, Saso, Athanasiou) Department of Biosurgery and Surgical
Technology, Imperial College London, St Mary's Hospital, London, United
Kingdom
Title
Does off-pump coronary artery bypass surgery have a beneficial effect on
mortality in patients with left ventricular dysfunction?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (6) (pp 856-864),
2012. Date of Publication: June 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether off-pump coronary artery bypass surgery
(OPCAB) offered any beneficial effect on mortality when compared with
on-pump coronary artery bypass surgery (ONCAB) in patients with left
ventricular dysfunction (LVD). A total of 491 papers were found using the
reported searches of which 17 represented the best evidence. The authors,
date, journal, study type, outcome measures and results are tabulated. The
17 studies (only containing patients with LVD) comprised of one
prospective randomized trial, one meta-analysis and 15 retrospective
studies. The prospective trial associated the OPCAB technique with
significantly lower in-hospital mortality. By comprising of seven studies
and 1512 patients, the meta-analysis showed no significant difference in
terms of operative mortality. Of the retrospective studies, all 15
compared short-term mortality (<30-day) of which four showed significantly
lower mortality in the OPCAB group. Nine of the studies compared mid-term
mortality (30 days to 5 years) with no significant difference detected and
three of the studies compared long-term mortality (>5 years) with no
significant difference detected. We conclude that there is limited
evidence to associate the OPCAB technique with improved short-term
mortality. The majority of the studies suffered from significant
limitations such as containing data from operations carried out prior to
the year 2000, a period when off-pump surgery was in its infancy. They
frequently contained major differences in baseline characteristics with no
specific inclusion/exclusion criteria, description of handling of patients
converted from off-pump to bypass or reporting of myocardial viability and
concomitant mitral regurgitation. Nine studies reported completeness of
revascularization of which eight associated the OPCAB group with a poorer
degree of revascularization making comparisons less valid. The lack of
high-quality data indicates that prospective randomized trials are needed.
The CRISP Trial ('Coronary artery grafting in highrisk patients randomized
to off-pump or on-pump surgery') has recently been halted due to
recruitment difficulties. The CORONARY ('Coronary artery bypass surgery
off- or on-pump revascularization study') trial is a large international
multicentre randomized study that is recruiting well and is likely to
provide valuable information in the near future. 2012 The Author.
<3>
Accession Number
2012387341
Authors
Abah U. Roberts P.G. Ishaq M. De Silva R.
Institution
(Abah, Roberts, De Silva) Department of Cardiothoracic Surgery, John
Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
(Ishaq) Department of Cardiac Surgery, Royal Infirmary of Edinburgh,
Edinburgh, United Kingdom
Title
Is cold or warm blood cardioplegia superior for myocardial protection?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (6) (pp 848-855),
2012. Date of Publication: June 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether the use of warm or
cold blood cardioplegia has superior myocardial protection. More than 192
papers were found using the reported search, of which 20 represented the
best evidence to answer the clinical question. The authors, journal, date,
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. A good breadth of
high-level evidence addressing this clinical dilemma is available,
including a recent meta-analysis and multiple large randomized clinical
trials. Yet despite this level of evidence, no clear significant clinical
benefit has been demonstrated by warm or cold blood cardioplegia. This
suggests that neither method is significantly superior and that both
provide similar efficacy of myocardial protection. The meta-analysis,
including 41 randomized control trials (5879 patients in total), concluded
that although a lower cardiac enzyme release and improved postoperative
cardiac index was demonstrated in the warm cardioplegia group, this
benefit was not reflected in clinical outcomes, which were similar in both
groups. This theme of benefit in biochemical markers, physiological
metrics and non-fatal postoperative events in the warm cardioplegia group
ran throughout the literature, in particular the 'Warm Heart
investigators' who conducted a randomized trial of 1732 patients,
demonstrated a reduction in postoperative low output syndrome (6.1 versus
9.3%, P = 0.01) in the warm cardioplegia group, but no significant drop in
30-day all-cause mortality (1.4 versus 2.5%, P = 0.12). However, their
later follow-up indicates non-fatal postoperative events predict reduced
late survival, independent of cardioplegia. A minority of studies
suggested a benefit of cold cardioplegia over warm in particular patient
subgroups: One group conducted a retrospective study of 520 patients who
required prolonged aortic cross-clamp times, results demonstrated less
myocardial damage and reduced postoperative cardiac mortality and
morbidity in the cold group. The clinical bottom line is that warm and
cold cardioplegia result in similar short-term mortality. However, large
studies have shown that warm cardioplegia reduces adverse post-operative
events; the significance of which is unclear. 2012 The Author.
<4>
Accession Number
2012387339
Authors
Chen Y. Maruthappu M. Nagendran M.
Institution
(Chen, Maruthappu, Nagendran) Green Templeton College, University of
Oxford, Woodstock Road, Oxford OX2 6HG, United Kingdom
Title
How effective is unipolar radiofrequency ablation for atrial fibrillation
during concomitant cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (6) (pp 843-847),
2012. Date of Publication: June 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether in patients
undergoing cardiac surgery, concomitant unipolar radiofrequency ablation
had a sufficiently acceptable success rate to justify the additional
procedure. A total of 256 papers were found using the reported search; of
which, 9 represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group
studied, study type, relevant outcomes and results of these papers were
tabulated. Major exclusion criteria included studies using bipolar
ablation, ambiguous or unspecified ablation techniques, other energy
modalities and studies with highly variable or undisclosed follow-up time.
All of the studies showed concomitant unipolar ablation to have an
acceptable success rate in restoring patients to sinus rhythm (SR), with
follow-ups ranging from 12 months to 5 years. At 12-month follow-up, one
study showed that this rate was as high as 83%. Ablations were more likely
to be successful in patients with paroxysmal or persistent atrial
fibrillation (AF) as defined by ACC/AHA/ESC criteria. One paper showed
that paroxysmal/persistent AF at baseline was predictive of likely success
of ablation in patients with permanent AF (P = 0.0004). Restoration and
maintenance of SR after ablation was not significantly affected by the
type of cardiac surgery performed (P = 0.262). Unipolar ablation does have
limitations such as high tissue temperature and no predictable
transmurality. However, it appears to compare favourably in the long term
to energy modalities such as microwave. The lack of level I evidence was a
major drawback in the analysis, as was the lack of continuous
electrocardiogram monitoring in the methodology of the studies. Figures
quoted from the data could therefore be under-representations of the true
instances of AF recurrence. With the current evidence, concomitant
ablation to treat AF during cardiac surgery appears safe in terms of
adding no additional risks, and effective at restoring SR regardless of
the type of cardiac surgery. This is particularly true of younger patients
with paroxysmal or persistent AF and those with smaller atrial diameters.
2012 The Author.
<5>
Accession Number
2012387338
Authors
Okonta K.E. Agarwal V.
Institution
(Okonta) Division of Cardiothoracic Surgery, Department of Surgery,
University College Hospital, PMB 5116, Ibadan, Nigeria
(Agarwal) Department of Cardiac Surgery, Institute of Cardiovascular
Diseases, Madras Medical Mission, Chennai, India
Title
Does Warden's procedure reduce sinus node dysfunction after surgery for
partial anomalous pulmonary venous connection?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (6) (pp 839-842),
2012. Date of Publication: June 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was 'Does Warden's procedure
reduce sinus node dysfunction (SND) after surgery for partial anomalous
pulmonary venous connection?' Altogether 101 papers were found using the
reported search; of which 10 papers provided the best evidence to answer
the question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes, length of follow-up
and results of these studies were tabulated. There was a particular
reference to Warden's procedure, avoidance of incision across the
cavoatrial junction and the postoperative sinus node status. There was a
direct reference to the adoption of Warden's procedure in nine studies
while one study emphasized the careful use of incision across the
cavoatrial junction as a way of averting postoperative SND. The evidence
supports the notion that preservation of the sinus node and its blood
supply through the adoption of Warden's technique results in near-absent
SND during long-term follow-up. The incidence of SND ranged from 0 to 6.5%
when Warden's procedure was used, increasing to 18.1% when the atrial
incision was extended across the cavoatrial junction into the superior
vena cava and reaching as high as 55% in double-patch repair. The study
limitations include the lack of randomized controlled trial, absence of 24
h Holter monitoring in most of the patients and shorter periods of
follow-up. 2012 The Author.
<6>
Accession Number
2012387337
Authors
Sepehripour A.H. Farid S. Shah R.
Institution
(Sepehripour, Farid, Shah) Department of Cardiothoracic Surgery,
Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, United Kingdom
Title
Is routine chest radiography indicated following chest drain removal after
cardiothoracic surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (6) (pp 834-838),
2012. Date of Publication: June 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether routine chest radiography is indicated
following chest drain removal in patients undergoing cardiothoracic
surgery. A total of 356 papers were found using the reported searches; of
which, 6 represented the best evidence to answer the clinical question.
The authors, date, journal, study type, population, main outcome measures
and results are tabulated. Reported measures were mean duration of drains
left in situ, timing of drain removal, pathology detected on chest
radiographs (CXRs), interventions following imaging and clinical
assessment, complications in patients not undergoing routine CXRs and the
cost saving of omitting routine CXRs. One large cohort study reported the
detection of pathology in 79% of clinically indicated CXRs in comparison
to 40% of routine CXRs (P = 0.005). Ninety-five per cent of the nonroutine
CXR cohort remained asymptomatic and required no intervention. One large
observational study reported the detection of new pneumothoraces in 9.3%
of patients, 70.3% of which were barely perceptible. Intervention
following CXR was required in 0.25% and only one medium-sized pneumothorax
would have been potentially missed without CXR. Another large
observational study reported intervention following CXR in 1.9% and the
presence of relevant clinical signs and symptoms to be a significant
predictor of major intervention (P < 0.01). A smaller observational study
reported no pathology detected or intervention following CXR in 98% and
the cost saving of omitting a single CXR at 10 000 per annum. Another
small observational study reported only 7% of CXRs to be clinically
indicated with a false-positive rate of 100%, and a false-negative rate of
7% in CXRs not clinically indicated. The smallest study reported no
complications in the non-CXR cohort and only one patient undergoing
intervention in the routine CXR cohort. We conclude that there is evidence
that routine post drain removal CXR provides no diagnostic or therapeutic
advantage over clinically indicated CXR or simple clinical assessment. The
best evidence studies reported the detection of pathology on routine CXR
ranging from 2 to 40% compared with 79% in clinically indicated CXRs (P =
0.005). Whilst the rate of intervention following routine CXR was as high
as 4% in the smallest study, clinical signs and symptoms suggestive of
pathology were a significant predictor of major re-intervention (P <
0.01). 2012 The Author.
<7>
Accession Number
2012387333
Authors
De Zoysa M.K. Hamed D. Routledge T. Scarci M.
Institution
(De Zoysa, Scarci) Department of Thoracic Surgery, St Joseph's Healthcare,
McMaster University, Hamilton, Canada
(Hamed, Routledge) Department of Thoracic Surgery, Guy's Hospital, London,
United Kingdom
Title
Is limited pulmonary resection equivalent to lobectomy for surgical
management of stage i non-small-cell lung cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (6) (pp 816-820),
2012. Date of Publication: June 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: is limited pulmonary
resection equivalent to lobectomy in terms of morbidity, long-term
survival and locoregional recurrence in patients with stage I
non-small-cell lung cancer (NSCLC)? A total of 166 papers were found using
the reported search; of which, 16 papers, including one meta-analysis and
one randomized control trial (RCT), represented the best evidence to
answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. With regards to 5-year survival
rates, the evidence is conflicting: a 2005 meta-analysis and six other
retrospective or prospective nonrandomized analyses did not find any
statistically significant difference when comparing lobectomy with limited
resection. However, three studies found evidence of a decreased overall
survival with limited resection, including the only randomized control
trial, which showed a 50% increase in the cancer-related death rate (P =
0.09), and a 30% increase in the overall death rate in patients undergoing
limited resection (P = 0.08). Age, tumour size and specific type of
limited resection were also factors influencing the survival rates. Four
studies, including the RCT, found increased locoregional recurrence rates
with limited resection. There is also evidence that wedge resections,
compared with segmentectomies, lead to lower survival and higher
recurrence rates. In conclusion, lobectomy is still recommended for
younger patients with adequate cardiopulmonary function. Although limited
resection carries a decreased rate of complications and shorter hospital
stays, it may also carry a higher rate of loco-regional recurrences.
However, limited resection may be comparable for patients >71 years of
age, and those with small peripheral tumours. 2012 The Author.
<8>
Accession Number
2012360735
Authors
Thomas M.P. Mahaffey K.W. Chiswell K. Cohen M. Kontos M.C. Antman E.M.
Ferguson J.J. Califf R.M. Goodman S.G. Becker R.C.
Institution
(Thomas, Mahaffey, Chiswell, Becker) Duke Clinical Research Institute,
2400 Pratt Street, Durham, NC 27705, United States
(Cohen) Newark Beth Israel Medical Center, 201 Lyons Avenue at Osborne
Terrace, Newark, NJ 07112, United States
(Kontos) VCU Pauley Heart Center, Virginia Commonwealth University, VCU
Health System, PO Box 980036, Richmond, VA 23298, United States
(Antman) Brigham and Women's Hospital, 75 Francis Street, Boston, MA
02115, United States
(Ferguson) AstraZeneca LP, 1800 Concord Pike, Wilmington, DE 19801, United
States
(Califf) Duke Translational Medicine Institute, 200 Trent Drive, Durham,
NC 27710, United States
(Goodman) Canadian Heart Research Centre, St. Michael's Hospital,
University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada
(Thomas) Division of Cardiovascular Medicine, University of Michigan
Health System, Ann Arbor, MI 48109, United States
Title
Activated partial thromboplastin time measurement is not associated with
clinical outcomes in patients with high-risk non-ST-segment elevation
acute coronary syndromes treated with unfractionated heparin.
Source
Journal of Thrombosis and Thrombolysis. 34 (1) (pp 114-119), 2012. Date of
Publication: July 2012.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Our objective was to determine the association of activated partial
thromboplastin time (aPTT) with recurrent ischemic events and non-coronary
artery bypass surgery-related thrombolysis in myocardial infarction major
bleeding. We studied 4,985 patients with high-risk non-ST-segment
elevation acute coronary syndromes (NSTE ACS) participating in SYNERGY, a
prospective, randomized, international trial designed to emulate
contemporary practice wherein unfractionated heparin (UFH) is given
intravenously and titrated according to a weight-adjusted dosing nomogram
to a target aPTT of 1.5-2 times the upper limit of normal (approximately
50-70 s). Aspirin was administered to 95% of patients, clopidogrel to 63%,
and glycoprotein IIb/IIIa receptor inhibitors to 58%. More than 90% of
patients underwent early coronary angiography, and 69% were
revascularized. Used as a time-dependent covariate, aPTT was evaluated as
a predictor of time to ischemic or major hemorrhagic events in
proportional hazards regression models. Using discrete variable analysis,
aPTT was categorized as persistently below a lower threshold of
anticoagulation (<50 vs. >=50 s) for recurrent ischemic events and above
an upper threshold (>70 vs. <=70 s) for major hemorrhagic events. UFH
treatment lasted a median of 42 (30, 78) h. At >6-12 (n = 3,021), >12-24
(n = 3,406), and >24-48 (n = 2,497) h, 34, 41, and 46% of patients
achieved the target aPTT range, respectively. Both before and after
adjusting for baseline predictors of anticoagulant response and risk score
(age, hypertension, diabetes, smoking, ST depression, and renal function),
no significant relationship between aPTT values and recurrent ischemic
events or major bleeding was found. No relationship was observed between
clinical outcomes and aPTT values persistently above or below the
designated thresholds. Measurements of aPTT were not associated with
clinical outcomes among patients with NSTE ACS treated with UFH. The
required intensity of anticoagulation for benefit may be relatively modest
when UFH is administered concomitantly with dual or triple
platelet-directed therapy, particularly in patients undergoing early
coronary revascularization. 2012 Springer Science+Business Media, LLC.
<9>
Accession Number
2012369151
Authors
Deb S. Cohen E.A. Singh S.K. Une D. Laupacis A. Fremes S.E.
Institution
(Deb, Cohen, Une, Fremes) Division of Cardiac and Vascular Surgery,
Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview
Avenue, Toronto, ON M4N 3M5, Canada
(Singh) Division of Cardiac Surgery, Hamilton General Hospital, McMaster
University, Hamilton, ON, Canada
(Laupacis) Keenan Research Centre, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Laupacis) Departments of Medicine, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Laupacis, Fremes) Institute of Health Policy Management and Evaluation,
University of Toronto, Toronto, ON, Canada
Title
Radial artery and saphenous vein patency more than 5 years after coronary
artery bypass surgery: Results from RAPS (Radial Artery Patency Study).
Source
Journal of the American College of Cardiology. 60 (1) (pp 28-35), 2012.
Date of Publication: 03 Jul 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to present radial and saphenous
vein graft (SVG) occlusion results more than 5 years following coronary
artery bypass surgery. Background: In the RAPS (Radial Artery Patency
Study) study, complete graft occlusion was less frequent in radial artery
compared with SVG 1 year post-operatively while functional occlusion
(Thrombolysis In Myocardial Infarction flow grade 0, 1, 2) was similar.
Methods: A total of 510 patients <80 years of age undergoing primary
isolated nonemergent coronary artery bypass grafting with 3-vessel disease
were initially enrolled in 9 Canadian centers. Target vessels for the
radial artery and study SVG were the right and circumflex coronary
arteries, which had >70% proximal stenosis. Within-patient randomization
was performed; the radial artery was randomized to either the right or
circumflex territory and the study SVG was used for the other territory.
The primary endpoint was functional graft occlusion by invasive
angiography at least 5 years following surgery. Complete graft occlusion
by invasive angiography or computed tomography angiography was a secondary
endpoint. Results: A total of 269 patients underwent late angiography (234
invasive angiography, 35 computed tomography angiography) at a mean of 7.7
+/- 1.5 years after surgery. The frequency of functional graft occlusion
was lower in radial arteries compared with SVGs (28 of 234 [12.0%] vs. 46
of 234 [19.7%]; p = 0.03 by McNemar's test). The frequency of complete
graft occlusion was also significantly lower in radial compared with SVGs
(24 of 269 [8.9%] vs. 50 of 269 [18.6%]; p = 0.002). Conclusions: Radial
arteries are associated with reduced rates of functional and complete
graft occlusion compared with SVGs more than 5 years following surgery.
2012 American College of Cardiology Foundation.
<10>
Accession Number
2012392269
Authors
Meybohm P. Zacharowski K. Cremer J. Roesner J. Kletzin F. Schaelte G.
Felzen M. Strouhal U. Reyher C. Heringlake M. Schon J. Brandes I. Bauer M.
Knuefermann P. Wittmann M. Hachenberg T. Schilling T. Smul T. Maisch S.
Sander M. Moormann T. Boening A. Weigand M.A. Laufenberg R. Werner C.
Winterhalter M. Treschan T. Stehr S.N. Reinhart K. Hasenclever D.
Brosteanu O. Bein B.
Institution
(Meybohm, Zacharowski) Clinic of Anaesthesiology, Intensive Care Medicine
and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7,
60590 Frankfurt am Main, Germany
(Cremer) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Campus Kiel, Germany
(Roesner, Kletzin) Clinic of Anaesthesiology and Intensive Care Medicine,
University Hospital Rostock, Rostock, Germany
(Schaelte, Felzen) Department of Anaesthesiology, University Hospital
Aachen, Aachen, Germany
(Strouhal, Reyher) Department of Anaesthesiology, University Hospital
Luebeck, Luebeck, Germany
(Heringlake, Schon) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Brandes, Bauer) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Goettingen, Germany
(Knuefermann, Wittmann) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Duesseldorf, Germany
(Hachenberg, Schilling) Department of Anaesthesiology, University Hospital
Magdeburg, Germany
(Smul, Maisch) Department of Anaesthesiology, University Hospital
Wuerzburg, Wuerzburg, Germany
(Sander, Moormann) Department of Anaesthesiology and Intensive Care
Medicine, Charite-Universitatsmedizin Berlin, Campus Charite Mitte,
Berlin, Germany
(Boening, Weigand) Department of Cardiovascular Surgery, University of
Giessen, Germany
(Laufenberg, Werner) Department of Anesthesiology, Medical Center of
Johannes Gutenberg-University, Mainz, Germany
(Winterhalter, Treschan) Department of Anesthesiology, University
Dusseldorf, Germany
(Stehr, Reinhart) Department of Anesthesiology and Intensive Care
Medicine, Jena University Hospital, Jena, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology, University Leipzig, Germany
(Brosteanu) Clinical Trial Center, University Leipzig, Leipzig, Germany
(Meybohm, Bein) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Schleswig-Holstein, Campus Kiel, Germany
Title
Remote ischaemic preconditioning for heart surgery.
Source
European Heart Journal. 33 (12) (pp 1423-1425a), 2012. Date of
Publication: June 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Transient ischaemia of non-vital tissue has been shown to enhance the
tolerance of remote organs to cope with a subsequent prolonged ischaemic
event in a number of clinical conditions, a phenomenon known as remote
ischaemic preconditioning (RIPC). However, there remains uncertainty about
the efficacy of RIPC in patients undergoing cardiac surgery. The purpose
of this report is to describe the design and methods used in the 'Remote
Ischaemic Preconditioning for Heart Surgery (RIPHeart)-Study'. Methods We
are conducting a prospective, randomized, double-blind, multicentre,
controlled trial including 2070 adult cardiac surgical patients. All types
of surgery in which cardiopulmonary bypass is used will be included.
Patients will be randomized either to the RIPC group receiving four 5 min
cycles of transient upper limb ischaemia/reperfusion or to the control
group receiving four cycles of blood pressure cuff inflation/deflation at
a dummy arm. The primary endpoint is a composite outcome (all-cause
mortality, non-fatal myocardial infarction, any new stroke, and/or acute
renal failure) until hospital discharge. Conclusion The RIPHeart-Study is
a multicentre trial to determine whether RIPC may improve clinical outcome
in cardiac surgical patients. The Author 2011.
<11>
Accession Number
2012392254
Authors
Head S.J. Mokhles M.M. Osnabrugge R.L.J. Pibarot P. MacK M.J. Takkenberg
J.J.M. Bogers A.J.J.C. Kappetein A.P.
Institution
(Head, Mokhles, Osnabrugge, Takkenberg, Bogers, Kappetein) Department of
Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam,
Netherlands
(Osnabrugge) Department of Epidemiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Pibarot) Institut Universitaire de Cardiologie, Pneumologie de Qubec, QC,
Canada
(MacK) Department of Cardiovascular Medicine, Heart Hospital Baylor,
Baylor Healthcare System, Plano, TX, United States
Title
The impact of prosthesispatient mismatch on long-term survival after
aortic valve replacement: A systematic review and meta-analysis of 34
observational studies comprising 27 186 patients with 133 141
patient-years.
Source
European Heart Journal. 33 (12) (pp 1518-1529), 2012. Date of Publication:
June 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Numerous studies have linked prosthesispatient mismatch (PPM) after
aortic valve replacement (AVR) to adverse outcomes. Its correlation with
long-term survival has been described but with contradicting results. This
systematic review and meta-analysis of observational studies aims to
determine the hazard of PPM after AVR. Methods and resultsThe Medline and
EMBase databases were searched for English-language original publications.
Two researchers independently screened studies and extracted data. Pooled
estimates were obtained by random effects model. Subgroup analyses were
performed to detect sources of heterogeneity. The search yielded 348
potentially relevant studies; 34 were included comprising 27 186 patients
and 133 141 patient-years. Defined by the universally accredited indexed
effective orifice area <0.85 cm <sup>2</sup>/m<sup>2</sup>, 44.2 of
patients were categorized as having PPM. In 34.2 and 9.8 of patients
moderate (0.650.85 cm<sup>2</sup>/m<sup>2</sup>) and severe (<0.65
cm<sup>2</sup>/m<sup>2</sup>) PPM was present, respectively.
Prosthesispatient mismatch was associated with a statistically significant
increase in all-cause mortality (HR 1.34, 95 CI: 1.181.51), but only a
trend to an increase in cardiac-related mortality (HR 1.51, 95 CI:
0.882.60) was recognized. Analysis by severity of PPM demonstrated that
both moderate and severe PPM increased all-cause mortality (HR 1.19, 95
CI: 1.071.33 and HR 1.84, 95 CI: 1.382.45) and cardiac-related mortality
(HR 1.32, 95 CI: 1.021.71 and HR 6.46, 95 CI: 2.7914.97). Further analyses
showed a consistent effect over separate time intervals during follow-up.
Conclusion Prosthesispatient mismatch is associated with an increase in
all-cause and cardiac-related mortality over long-term follow-up. We
recommend that current efforts to prevent PPM should receive more emphasis
and a widespread acceptance to improve long-term survival after AVR.
Published on behalf of the European Society of Cardiology. The Author
2011.
<12>
Accession Number
2012385886
Authors
Paparella D. Scrascia G. Rotunno C. Marraudino N. Guida P. De Palo M.
Rubino G. Cappabianca G.
Institution
(Paparella, Scrascia, Rotunno, Marraudino, Guida, De Palo, Cappabianca)
Division of Cardiac Surgery, Department of Emergency and Organ Transplant,
University of Bari, Bari, Italy
(Rubino) Division of Anesthesia, Policlinico Hospital of Bari, Bari, Italy
Title
A biocompatible cardiopulmonary bypass strategy to reduce hemostatic and
inflammatory alterations: A randomized controlled trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (4) (pp 557-562),
2012. Date of Publication: August 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: Cardiopulmonary bypass (CPB) systems without a venous reservoir
rarely are adopted clinically. The effects of a biocompatible CPB system
with a venous reservoir were evaluated on the activation of the
coagulation and inflammatory systems. Design: A prospective, randomized
controlled trial. Setting: A university hospital (single center).
Participants: Eighty-three coronary artery bypass graft (CABG) surgery
patients were assigned to the Physio group (closed venous reservoir,
phosphorylcholine coating, and no cardiotomy suction) or the Standard
group (open, noncoated, and cardiotomy suction used). Methods: Blood
samples were obtained at 6 different time points before, during, and after
surgery. Nuclear factor-kB (NF-B) was evaluated before surgery and 2 and
24 hours after surgery. Myocardial damage was evaluated measuring cardiac
troponin I. Measurements and Main Results: Interleukin (IL)-6 (a marker of
inflammation), prothrombin fragment 1-2 (PF-1.2, a marker of thrombin
generation), plasmin-antiplasmin complex (PAP, a marker of fibrinolysis),
and platelet factor 4 (PF4, a marker of platelet activation) were
measured. The DNA binding activity of proinflammatory transcription factor
NF-B was quantified in the isolated lymphomonocyte cells. Surgery caused
changes of all plasma biomarkers. This reaction was attenuated strongly in
the Physio group; PF-1.2, PAP, and PF4 all were decreased significantly.
In the Physio group, a significantly lower cardiac troponin I release was
observed postoperatively. After surgery, NF-B activity was reduced in the
Physio group although this difference was not statistically significant.
Conclusions: A multimodal strategy using a closed and
phosphorylcholine-coated CPB circuit together with the avoidance of
cardiotomy suction reduced activation of the coagulation and fibrinolytic
systems intraoperatively, although these changes did not persist
postoperatively. However, no difference in clinical outcome was
appreciated on a larger scale. 2012 Elsevier Inc.
<13>
Accession Number
2012385877
Authors
De Oliveira Jr. G.S. Knautz J.S. Sherwani S. McCarthy R.J.
Institution
(De Oliveira Jr., Knautz, Sherwani, McCarthy) Department of
Anesthesiology, Northwestern University, Feinberg School of Medicine,
Chicago, IL, United States
Title
Systemic magnesium to reduce postoperative arrhythmias after coronary
artery bypass graft surgery: A meta-analysis of randomized controlled
trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (4) (pp 643-650),
2012. Date of Publication: August 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To evaluate the effect of systemic magnesium on the prevention
of postoperative cardiac arrhythmias after coronary artery bypass graft
surgery. Design: A meta-analysis. Setting: Randomized controlled trials
evaluating the effect of systemic magnesium on the incidence of
postoperative arrhythmias. Participants: Patients undergoing coronary
artery bypass graft surgery. Interventions: Systemic perioperative
administration of magnesium sulfate. Measurements and Main Results: Twenty
studies evaluating 3,696 subjects were included. The combined effect
suggested that systemic magnesium reduced the incidence of
supraventricular arrhythmias compared with saline (odds ratio [OR] = 0.69;
95% confidence interval [CI], 0.53-0.90; number needed to treat [NNT] =
14). The effect was present for lower-quality studies (Jadad score <=3; OR
= 0.47; 95% CI, 0.28-0.81; NNT = 8), but it was not detected for
higher-quality studies (Jadad >3; OR = 0.85; 95% CI, 0.66-1.11). There was
no association between the total dose of magnesium administration and the
incidence of supraventricular arrhythmias (p = 0.19). There was no effect
of magnesium on the incidence of postoperative stroke, myocardial
infarction, and death. In addition, magnesium did not reduce the hospital
or intensive care unit lengths of stay (all p > 0.05). Conclusions: The
effect of magnesium sulfate in reducing postoperative supraventricular
arrhythmias was significant when examined by lower-quality studies but not
when examined by higher-quality studies. This fact probably is responsible
for controversial findings reported in the literature. Also, magnesium
sulfate did not reduce the incidence of complications associated with the
development of postoperative cardiac arrhythmias. More effective
strategies should be used to prevent complications caused by arrhythmias
in this patient population. 2012 Elsevier Inc.
<14>
Accession Number
2012385854
Authors
Ristikankare A. Poyhia R. Eriksson H. Valtonen M. Leino K. Salmenpera M.
Institution
(Ristikankare, Poyhia, Eriksson, Salmenpera) Department of Anaesthesiology
and Intensive Care, Helsinki University Central Hospital, PO Box 340,
00029 Helsinki, Finland
(Valtonen, Leino) Department of Anaesthesiology, Turku University
Hospital, Turku, Finland
Title
Effects of levosimendan on renal function in patients undergoing coronary
artery surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (4) (pp 591-595),
2012. Date of Publication: August 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To evaluate the effect of levosimendan on postoperative renal
function in patients with compromised heart function undergoing on-pump
coronary artery bypass graft surgery. Design: A prospective, randomized,
placebo-controlled, double-blind substudy. Setting: Cardiothoracic
surgery, anesthesiology, and intensive care units at 2 university
hospitals. Participants: Sixty patients with left ventricular ejection
fraction <=50% were randomized into 2 parallel treatment groups.
Interventions: Levosimendan or placebo was started after the induction of
anesthesia with a 12-mug/kg bolus in 10 minutes followed by the infusion
of 0.2 mug/kg/min for the next 23 hours and 50 minutes. Measurements and
Results: Serum cystatin C and plasma creatinine were measured at baseline;
at 6 and 24 hours after declamping the aorta; and on the 1st, 2nd, and 5th
postoperative days. Urine N-acetyl-beta-glucosaminidase (U-NAG) was
measured at baseline and at 6 and 24 hours after declamping of the aorta.
Renal function was estimated with calculated glomerular filtration rate
(eGFR). The changes in plasma creatinine, serum cystatin C, and urine NAG
were not significant among the placebo and the levosimendan groups at any
of the measuring points. Conclusions: After coronary artery surgery,
levosimendan did not have a significant influence on the kidney function
measured with these specific kidney markers. 2012 Elsevier Inc.
<15>
Accession Number
2012386401
Authors
Butts R.J. Scheurer M.A. Atz A.M. Zyblewski S.C. Hulsey T.C. Bradley S.M.
Graham E.M.
Institution
(Butts, Scheurer, Atz, Zyblewski, Graham) Division of Cardiology,
Department of Pediatrics, Medical University of South Carolina,
Charleston, SC 29425, United States
(Hulsey) Division of Epidemiology, Medical University of South Carolina,
Charleston, SC 29425, United States
(Bradley) Division of Cardiothoracic Surgery, Department of Surgery,
Medical University of South Carolina, Charleston, SC 29425, United States
Title
Comparison of maximum vasoactive inotropic score and low cardiac output
syndrome as markers of early postoperative outcomes after neonatal cardiac
surgery.
Source
Pediatric Cardiology. 33 (4) (pp 633-638), 2012. Date of Publication:
April 2012.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Low cardiac output syndrome (LCOS) and maximum vasoactive inotropic score
(VIS) have been used as surrogate markers for early postoperative outcomes
in pediatric cardiac surgery. The objective of this study was to determine
the associations between LCOS and maximum VIS with clinical outcomes in
neonatal cardiac surgery. This was a secondary retrospective analysis of a
prospective randomized trial, and the setting was a pediatric cardiac
intensive care unit in a tertiary care children's hospital. Neonates (n =
76) undergoing corrective or palliative cardiac operations requiring
cardiopulmonary bypass were prospectively enrolled. LCOS was defined by a
standardized clinical criteria. VIS values were calculated by a standard
formula during the first 36 postoperative hours, and the maximum score was
recorded. Postoperative outcomes included hospital mortality, duration of
mechanical ventilation, intensive care unit (ICU) and hospital lengths of
stay (LOS), as well as total hospital charges. At surgery, the median age
was 7 days and weight was 3.2 kg. LCOS occurred in 32 of 76 (42%)
subjects. Median maximum VIS was 15 (range 5-33). LCOS was not associated
with duration of mechanical ventilation, ICU LOS, hospital LOS, and
hospital charges. Greater VIS was moderately associated with a longer
duration of mechanical ventilation (p = 0.001, r = 0.36), longer ICU LOS
(p = 0.02, r = 0.27), and greater total hospital costs (p = 0.05, r =
0.22) but not hospital LOS (p = 0.52). LCOS was not associated with early
postoperative outcomes. Maximum VIS has only modest correlation with
duration of mechanical ventilation, ICU LOS, and total hospital charges.
Springer Science+Business Media, LLC 2012.
<16>
Accession Number
2012387398
Authors
Doshia H. Venugopalb P. MacArthurc K.
Institution
(Doshia) Department of Cardio-thoracic Surgery, Golden Jubilee Hospital,
Glasgow G81 4HX, United Kingdom
(Venugopalb) Department of Cardio-thoracic Surgery, Alder Hey Children's
Hospital, Liverpool, United Kingdom
(MacArthurc) Department of Cardio-thoracic Surgery, Royal Hospital for
Sick Children, Glasgow, United Kingdom
Title
Does a balloon atrial septostomy performed before arterial switch surgery
increase adverse neurological outcomes?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (1) (pp 141-143),
2012. Date of Publication: July 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
This best evidence topic in congenital cardiac surgery was written
according to a structured protocol. The question addressed was whether the
use of balloon atrial septostomy (BAS) before the arterial switch surgery
for transposition of the great arteries (TGA) improved the final outcome.
Altogether more than 251 papers were found using the reported search, of
which 12 represented the best evidence to answer the clinical question.
The search was further limited to recent articles since the results have
improved compared with previous years, due to newer equipment and
techniques. This narrowed the search to five papers that have focused on
this issue since 2006 when a study of 29 term neonates identified BAS as
major risk factor for focal brain injury and reinvigorated the debate of
adverse neurological outcome especially in the context of the fact that
total correction by the arterial switch procedure is routine in neonates
now. Subsequently, a prospective study of 64 newborn infants followed by
another study of 26 neonates with TGA, have shown no association between
BAS and brain injury. Similarly, in a study of more than 2000 cases of
dTGA, no association has been found between BAS and increased risk of
clinical stroke either in the neonatal period or in follow-up
hospitalizations. On the other hand, another nationwide data analysis of
8681 patients with TGA, has shown increased risk of stroke in patients
undergoing BAS but it could only show association and not establish
causation of the complication. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. The Author 2012.
<17>
Accession Number
2012387395
Authors
Pucher P.H. Cummings I.G. Shipolini A.R. McCormack D.J.
Institution
(Pucher, Cummings, Shipolini, McCormack) Department of Cardiothoracic
Surgery, London Chest Hospital, Bonner Road, London E2 9JX, United Kingdom
Title
Is heparin needed for patients with an intra-aortic balloon pump?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (1) (pp 136-139),
2012. Date of Publication: July 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
We addressed the question of whether or not the currently available
evidence base supports heparinization in the context of a patient
requiring cardiovascular support with an intra-aortic balloon pump (IABP).
A best evidence topic was written according to a previously defined
structured protocol. A literature search returned 443 papers, 3 of which
were deemed relevant. Jiang et al. randomized 153 patients requiring IABP
to heparin or no heparin, matched for age, sex and comorbidities. There
was no significant difference in limb ischaemia; however, incidence of
bleeding was significantly increased in the heparinized group (14.1 vs
2.4%). One cohort study compared two management strategies of IABP in
which patients either received heparin universally or selectively with
heparin only given for certain pre-defined indications. They reported
increased bleeding with universal heparinization (39.2 vs 31.8%) but
similar other complication rates. Another cohort study in which patients
with IABP were initially treated with glycoprotein IIb/IIIa antagonists
only, reported bleeding and ischaemia rates within accepted ranges for
heparinized patients. The use of anticoagulation with IABP is intended to
reduce the risk of thrombus, thromboembolus or limb ischaemia whilst
generating an increased risk of bleeding as a side-effect. The
aforementioned studies demonstrate that omitting or implementing a
selective use strategy of heparinization during IABP counterpulsation can
significantly decrease the incidence of bleeding without an increase in
ischaemic events. One study also performed angiography prior to IABP
insertion on some of their patients, selecting the less diseased side to
insert the IABP. Current evidence on this topic is sparse, especially as
relates to patients in the context of cardiothoracic surgery. Just one
study specifically looked at surgical patients. However, the existing data
suggest that it is safe to omit heparinization when using IABP
counterpulsation. The decision to heparinize should be weighed in the
context of other indications or contraindications rather than being an
automatic response to the use of IABP. The Author 2012.
<18>
Accession Number
2012387394
Authors
Khorsandia M. Banerjeeb A. Singhb H. Srivastava A.R.
Institution
(Khorsandia) Department of Cardiothoracic Surgery, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom
(Banerjeeb, Singhb) Department of Cardiothoracic and Vascular Surgery, G B
Pant Hospital, New Delhi, India
(Srivastava) Department of Cardiothoracic Surgery, University of
Pittsburgh, Medical Center, Pittsburgh, United States
Title
Is a tricuspid annuloplasty ring significantly better than a de Vega's
annuloplasty stitch when repairing severe tricuspid regurgitation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (1) (pp 129-135),
2012. Date of Publication: July 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether tricuspid valve
(TV) repair with an annuloplasty ring leads to an improved outcome over a
conventional suture annuloplasty for patients with severe tricuspid
incompetence. Altogether, 306 papers were found using the reported search,
of which 14 presented the best evidence to answer the clinical question.
The author, journal, date and country of publication, patient group
studied, study type, relevant outcomes, results and study weaknesses of
these papers are tabulated. We found seven studies supporting the use of
ring annuloplasty over De Vega's suture annuloplasty. Five studies found
no significant difference in outcome between the two techniques. We found
only two studies supporting the use of De Vega's suture annuloplasty over
ring annuloplasty. Therefore, most of the tabulated studies show good
evidence in support of ring annuloplasty compared with De Vega's suture
repair for treatment of moderate to severe TV regurgitation. One cohort
study identified a 20.4% postoperative failure rate for tricuspid
regurgitation (TR) repair and concluded non-application of ring as a
predictor for reoperation. One cohort study with a mean follow-up of 17
months reported success rates as high as 97% with ring annuloplasty for TV
regurgitation. One large cohort study of 2277 patients with TR who had
undergone repair reported a sustained reduction in TR and the rate of
recurrence in a 5-year echocardiographic follow-up. One cohort study of
129 patients concluded that ring annuloplasty has the lowest rate of
recurrence compared with De Vega's suture repair. An old randomized
controlled trial (RCT) on the subject also reported a similar result to
the mentioned studies. In contrast, we reviewed one recent study and four
older studies and found no significant difference between the two
techniques. We reviewed one study that reported De Vega's suture repair as
a superior technique to ring annuloplasty. We conclude that there is good
evidence supporting ring annuloplasty over conventional De Vega's suture
annuloplasty. The Author 2012.
<19>
Accession Number
2012387392
Authors
MacDonald D.R.W. Maruthappu M. Nagendran M.
Institution
(MacDonald, Maruthappu, Nagendran) Green Templeton College, University of
Oxford, Woodstock Road, Oxford OX2 6HG, United Kingdom
Title
How effective is microwave ablation for atrial fibrillation during
concomitant cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (1) (pp 122-127),
2012. Date of Publication: July 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether performing
microwave ablative procedures during concomitant cardiac surgical
procedures is effective for the treatment of atrial fibrillation (AF). In
total, 200 papers were found using the reported search, of which 12
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
Major exclusion criteria included studies exclusively using bipolar
ablation, ambiguous or unspecified ablation technique, other energy
modalities and studies with highly variable or undisclosed follow-up time.
One study reported that 66% of patients were in sinus rhythm (SR) with
follow-ups ranging from 1 to 14 months and suggested that the risk of AF
recurrence was significantly increased with a larger left atrial diameter
(OR = 1.21, P = 0.02) and an increased duration of preoperative AF (OR =
2.14, P = 0.03). A separate study found no significant difference in the
success rate on the basis of the concomitant procedure (coronary artery
bypass grafting or mitral valve surgery, P > 0.5). In the only randomized
trial identified, microwave ablation delivered significantly inferior SR
restoration rates to radiofrequency (RF) ablation at all time points from
discharge to 24 months. There is a large degree of heterogeneity in the
studies, with patients' characteristics, for example type of AF, and
patient management postoperatively, for example administration of
anti-arrhythmias, being inconsistent. Of the 12 studies, nine assessed SR
at a mean of 6-12 months and found postoperative success rates between 62
and 87%. One study looked at the medium range follow-up of 24 months with
SR restoration at 71%. Two studies looked at the long-term follow-up (5
and 5.37 years) with SR restoration at 39 and 61%, respectively. We
conclude that microwave ablation, as an intervention for the treatment of
AF during concomitant surgery, is not currently recommended on the limited
available evidence. This is because the success rates in the longer term
are less clear and the only randomized study to date has found inferior
outcomes compared with RF-based ablation. The Author 2012.
<20>
Accession Number
2012387391
Authors
Rossi M. Serraino G.F. Spadafora A. Renzulli A.
Institution
(Rossi, Serraino, Spadafora, Renzulli) Department of Cardiac Surgery,
Magna Graecia University, Viale Europa, Germaneto 88100. Catanzaro, Italy
Title
What do you do with the antiplatelet agents in patients with drug eluting
stents who then receive a mechanical valve?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (1) (pp 115-121),
2012. Date of Publication: July 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is a
cornerstone of treatment during and after percutaneous coronary
interventions with drug-eluting stent (DES) implantation. Oral
anticoagulation (OAC) is the recommended treatment for patients with
mechanical heart valves. When patients with DES need a mechanical heart
valve or vice versa, we face the difficult choice of their antithrombotic
therapy. Different institutions empirically follow a combination of OAC
and single or DAT, the so-called triple antithrombotic therapy (TT) aiming
to find the best balance between the thrombotic and bleeding risk for this
subset of patients. A best evidence topic in cardiac surgery was written
according to a structured protocol. The question addressed was whether
there is an optimal antithrombotic management for patients with DES
undergoing mechanical heart valve or vice versa. Altogether, more than 148
papers were found using the reported search, of which 16 represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. We conclude that DES
implantation in patients who could potentially need valve surgery in the
future should be discouraged and bare-metal stent or an aortic
bioprosthesis preferred. However, in high-risk patients with DES, the
recommendation is to postpone elective surgery for 1 year and, if surgery
cannot be deferred, continue aspirin during the perioperative period.
Moreover, when OAC is given in combination with clopidogrel and/or
low-dose aspirin, the target INR should be 2.0-2.5 (Class IIb, level of
evidence C). As per the longterm management, antithrombotic management
with DAT alone in mechanical aortic valve replacement might be possible,
but there is not enough evidence to support it. The available evidence
suggests that triple anticoagulation (OAC + DAT) is associated with the
best clinical outcome compared with all the other possible strategies. The
duration of TT should be 3 months after sirolimus DES implantation, and 6
months after paclitaxel DES implantation, followed by long-term therapy
with OAC plus clopidogrel or aspirin with either PPIs, or H2-receptor
antagonists (Class IIa Level of Evidence C). The Author 2012.
<21>
Accession Number
2012387390
Authors
Mydina M.I. Dimitrakakisb G. Younisa J. Nowella J. Athanasiouc T.
Kourliourosa A.
Institution
(Mydina, Younisa, Nowella, Kourliourosa) Department of Cardiac Surgery, St
Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom
(Dimitrakakisb) Department of Cardiothoracic Surgery, University Hospital
of Wales, Cardiff, United Kingdom
(Athanasiouc) Department of Cardiothoracic Surgery, Imperial College
Healthcare, Hammersmith Hospital, London, United Kingdom
Title
Optimal thromboprophylaxis following bioprosthetic aortic valve
replacement: Still a matter of debate?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (1) (pp 109-114),
2012. Date of Publication: July 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Optimal thromboprophylaxis following bioprosthetic aortic valve
replacement (AVR) remains controversial. The main objective, which is the
effective prevention of central nervous or peripheral embolic events,
especially in the early postoperative period, will have to be weighed
against the haemorrhagic risk that is associated with the utilization of
different antithrombotic regimes. Most governing bodies in cardiovascular
medicine have issued recommendations on thromboprophylaxis after the
surgical implantation of aortic bioprostheses. However, the level of
evidence to support these recommendations remains low, largely due to the
inherent limitations of conducting appropriately randomized and adequately
powered clinical research in this area. It is apparent from the recent
surveys and large registries that there is a great variability in
antithrombotic practice at an institutional or individual-clinician level
reflecting this controversy and the lack of robust evidence. While
organizational, financial or conceptual limitations could hinder the
conduct and availability of conclusive research on optimal
thromboprophylaxis after aortic bioprosthesis, it is imperative that all
evidence is presented in a systematic way in order to assist the
decision-making for the modern clinician. In this review, we provide an
outline of the current recommendations for thromboprophylaxis, followed by
a comprehensive and analytical presentation of all comparative studies
examining anticoagulation vs. antiplatelet therapy after bioprosthetic
AVR. The Author 2012.
<22>
Accession Number
2012387372
Authors
Mansouria M. Attarya M. Bagheria K. Massoumia G. Ghavamib B.
Institution
(Mansouria, Attarya, Bagheria, Massoumia) Anaesthesiology and Critical
Care Research Centre, Isfahan University of Medical Sciences, Chamran
Heart Hospital, PO Box 8166173414, Isfahan, Iran, Islamic Republic of
(Ghavamib) Department of Cardiac Anesthesiology, Chamran Heart Hospital,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Title
Comparative evaluation of the effects of tranexamic acid and low-dose
aprotinin on post-valvular heart surgery bleeding and allogenic
transfusion.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (1) (pp 23-27), 2012.
Date of Publication: July 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Bleeding diathesis and allogenic transfusion after complex heart surgery,
such as heart valve surgery, may result in complications such as
transfusion reaction, viral infection, postoperative infection,
haemodynamic disturbance, prolonged stay in the intensive care unit and
hospital, renal and respiratory failure and mortality. In this
prospective, double-blind, randomized, placebo-controlled clinical trial,
90 patients were randomly divided into three groups: aprotinin, tranexamic
acid and control. Chest-tube drainage, transfusion requirements and renal
and neurological complications were evaluated. We found that chest-tube
drainage during the first (P < 0.0001) and second 24 h (P = 0.001) after
admission to the intensive care unit were significantly lower in the
aprotinin group. The amounts of transfused packed red blood cells (P <
0.0001) and platelets (P = 0.02) were significantly lower in the aprotinin
and tranexamic acid groups. The quantity of transfused fresh frozen plasma
(P = 0.034) was significantly lower in the aprotinin group only. We did
not find any neurological complications or renal failure in the three
groups. Our data suggest that in valvular heart surgery, low-dose
aprotinin is significantly better than tranexamic acid or a placebo for
reduction of postoperative bleeding and allogenic transfusion, without
increasing adverse outcomes. The Author 2012.
<23>
Accession Number
2012387371
Authors
Lomivorotov V.V. Shmyrev V.A. Nepomnyaschih V.A. Ponomarev D.N. Knyazkova
L.G. Lomivorotov V.N. Karaskov A.M.
Institution
(Lomivorotov, Shmyrev, Nepomnyaschih, Ponomarev, Knyazkova, Lomivorotov,
Karaskov) Department of Anesthesiology and Intensive Care, Academician
E.N. Meshalkin Novosibirsk State Research, Institute of Circulation
Pathology, Rechkunovskaya str, 15., 630055 Novosibirsk, Russian Federation
Title
Remote ischaemic preconditioning does not protect the heart in patients
undergoing coronary artery bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (1) (pp 18-22), 2012.
Date of Publication: July 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Remote ischaemic preconditioning (RIPC) gained attention as a possibility
to reduce myocardial injury after a subsequent sustained episode of
myocardial ischaemia. This prospective randomized study was carried out to
assess whether RIPC reduces myocardial injury in coronary artery bypass
grafting patients. Eighty patients were assigned to remote preconditioning
or control treatment. Ischaemic preconditioning was induced by three 5-min
cycles of upper limb ischaemia and reperfusion after anaesthesia
induction. Haemodynamic and markers of myocardial damage were analysed
preoperatively and over 48 h postoperatively. The cardiac index was higher
immediately after remote preconditioning in the main group. There were no
differences in other haemodynamic, troponin I and creatine kinase-MB
concentrations at any time point between groups. Thus, short-term remote
preconditioning improves haemodynamics and does not reduce myocardial
injury after coronary artery bypass surgery. Further study of high-risk
patients may be needed to fully evaluate the clinical effect of RIPC. The
Author 2012.
<24>
Accession Number
2012381614
Authors
Batcho C.S. Thonnard J.-L. Nielens H.
Institution
(Batcho, Thonnard, Nielens) Institute of Neuroscience, Universite
Catholique de Louvain, Brussels, Belgium
(Thonnard, Nielens) Department of Physical Medicine and Rehabilitation,
Cliniques Universitaires St-Luc, Universite Catholique de Louvain,
Brussels, Belgium
Title
PWC75%/kg, a fitness index not linked to resting heart rate: Testing
procedure and reference values.
Source
Archives of Physical Medicine and Rehabilitation. 93 (7) (pp 1196-1200),
2012. Date of Publication: July 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To develop a fitness index unlinked to resting heart rate and
suitable for clinical use, and to obtain reference values of this new
index for healthy subjects. Design: Cross-sectional study. Setting:
Research laboratory. Participants: A volunteer sample of healthy subjects
(N=100; 50 men; age range, 20-70y) randomly recruited from the general
community. Interventions: Not applicable. Main Outcome Measures:
Participants performed a submaximal, multistage cycle ergometer test. A
new fitness index, the physical working capacity at 75% of the predicted
maximal heart rate per kilogram of body weight (PWC<sub>75%</sub>/kg), was
calculated. Its concordance with a previously described fitness index and
its relationship with age were examined, as well as differences
attributable to sex and lifestyle. Reference values of the PWC
<sub>75%</sub>/kg (mean +/- SD and 95% confidence interval) were
calculated and categorized by age classes of 10 years and by sex. Results:
The intraclass correlation coefficient (ICC) between PWC<sub>75%</sub>/kg
and the working capacity index at 65% of the heart rate reserve per
kilogram of body weight (WCI<sub>65%HRreserve</sub>/kg) was very high
(ICC=.96, P<.001), indicating that the fitness index can be estimated
without measuring the resting heart rate. PWC<sub>75%</sub>/kg decreased
as age increased. The average PWC <sub>75%</sub>/kg was significantly
higher in men than in women (P<.001), and in active than in inactive
subjects (P<.01). Conclusions: This study presents a new fitness index,
the PWC<sub>75%</sub>/kg, which is suitable for measuring fitness in
active and sedentary people aged 20 to 70 years. It may also be a suitable
fitness index for selected chronically ill individuals. This study also
provides reference values of the PWC<sub>75%</sub>/kg obtained from
healthy men and women. 2012 American Congress of Rehabilitation Medicine.
<25>
Accession Number
2012387724
Authors
Yu J.-B. Gong L.-R. Wang J. Wang M. Zhang L.-F. Li L.
Institution
(Yu, Gong, Wang, Wang, Zhang, Li) Department of Anesthesiology, TianJin
NanKai Hospital, TianJin Medical University, Tianjin, China
Title
Effect of sevoflurane combination with epidural anesthesia on myocardial
injury in patients with coronary artery disease undergoing non-cardiac
surgery.
Source
Saudi Medical Journal. 32 (10) (pp 1009-1016), 2011. Date of Publication:
2011.
Publisher
Saudi Arabian Armed Forces Hospital (P.O. Box 7897, Riyadh 11159, Saudi
Arabia)
Abstract
Objectives: To determine the effect of sevoflurane combination with
epidural anesthesia on myocardial injury in patients with coronary artery
disease (CAD) undergoing non-cardiac surgery. Methods: The investigation
was performed in TianJin NanKai Hospital, TianJin, China from November
2009 to March 2010. Eighty patients with CAD undergoing elective abdominal
surgery were randomized into 4 groups: group S1- combined sevoflurane
general and epidural anesthesia; group S2 - standard sevoflurane general
anesthesia; group P1 - combined propofol general and epidural anesthesia;
and group P2 - standard propofol general anesthesia. Mean arterial
pressure, central venous pressure, electrocardiogram, and bispectral index
was monitored throughout the surgery. The serum levels of interleukin-6
(IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha),
cardiac troponin I (cTnI), and glycogen phosphorylase BB (GP-BB) was
measured at different time points during surgery. Results: The ST
depression in group P1 and S2 was significantly higher than that in group
S1 (p=0.000) and lower than that in group P2 (p=0.00). The serum levels of
IL-6, IL-8, TNF-alpha, cTnI, and GP-BB in group P1 and S2 were
dramatically greater than that in group S1 (p=0.00), and lower than that
in group P2 (p=0.00). Conclusion: Sevoflurane in combination with
continuous epidural anesthesia could protect against myocardial damage in
patients with CAD, downregulation of IL-6, IL-8, and TNF-alpha might
contribute to this protection.
<26>
Accession Number
2012380024
Authors
Claassen M. Sybrandy K.C. Appelman Y.E. Asselbergs F.W.
Institution
(Claassen, Sybrandy, Asselbergs) Department of Cardiology, Division Heart
and Lungs, University Medical Center Utrecht, 3508 GA Utrecht, Netherlands
(Appelman) VU University Medical Center, 1081 HV Amsterdam, Netherlands
Title
Gender gap in acute coronary heart disease: Myth or reality?.
Source
World Journal of Cardiology. 4 (2) (pp 36-47), 2012. Date of Publication:
2012.
Publisher
Baishideng Publishing Group Co (Room 1701, 17/F, Henan Bulding, No.90
Jaffe Road, Wanchai,Hong Kong, China, China)
Abstract
Aim: To investigate potential gender differences in the prevalence of
cardiovascular risk factors, cardiovascular disease (CVD) management, and
prognosis in acute coronary syndrome (ACS). Methods: A systematic
literature search was performed through Medline using pre-specified
keywords. An additional search was performed, focusing specifically on
randomized controlled clinical trials in relation to therapeutic
intervention and prognosis. In total, 92 relevant articles were found.
Results: Women with CVD tended to have more hypertension and diabetes at
the time of presentation, whereas men were more likely to smoke. Coronary
angiography and revascularization by percutaneous coronary intervention
were performed more often in men. Women were at a greater risk of
short-term mortality and complications after revascularization.
Interestingly, women under 40 years presenting with ACS were at highest
risk of cardiovascular death compared with men of the same age,
irrespective of risk factors. This disadvantage disappeared in older age.
The long-term mortality risk of ACS was similar in men and women, and even
in favor of women. Conclusion: Mortality rates are higher among young
women with ACS, but this difference tends to disappear with age, and
long-term prognosis is even better among older women. 2012 Baishideng.
<27>
Accession Number
22406977
Authors
Young P.J. Dalley P. Garden A. Horrocks C. La Flamme A. Mahon B. Miller J.
Pilcher J. Weatherall M. Williams J. Young W. Beasley R.
Institution
(Young) Wellington Hospital, Capital and Coast District Health Board,
Wellington, New Zealand.
Title
A pilot study investigating the effects of remote ischemic preconditioning
in high-risk cardiac surgery using a randomised controlled double-blind
protocol.
Source
Basic research in cardiology. 107 (3) (pp 256), 2012. Date of Publication:
2012.
Abstract
The efficacy of remote ischemic preconditioning (RIPC) in high-risk
cardiac surgery is uncertain. In this study, 96 adults undergoing
high-risk cardiac surgery were randomised to RIPC (3 cycles of 5 min of
upper-limb ischemia induced by inflating a blood pressure cuff to 200 mmHg
with 5 min of reperfusion) or control. Main endpoints were plasma
high-sensitivity troponin T (hsTNT) levels at 6 and 12 h, worst
post-operative acute kidney injury (AKI) based on RIFLE criteria, and
noradrenaline duration. hsTNT levels were log-normally distributed and
higher with RIPC than control at 6-h post cross-clamp removal [810 ng/ml
(IQR 527-1,724) vs. 634 ng/ml (429-1,012); ratio of means 1.41 (99.17% CI
0.92-2.17); P=0.04] and 12 h [742 ng/ml (IQR 427-1,700) vs. 514 ng/ml (IQR
356-833); ratio of means 1.56 (99.17% CI 0.97-2.53); P=0.01]. After
adjustment for baseline confounders, the ratio of means of hsTNT at 6 h
was 1.23 (99.17% CI 0.88-1.72; P=0.10) and at 12 h was 1.30 (99.17% CI
0.92-1.84; P=0.05). In the RIPC group, 35/48 (72.9%) had no AKI, 5/48
(10.4%) had AKI risk, and 8/48 (16.7%) had either renal injury or failure
compared to the control group where 34/48 (70.8%) had no AKI, 7/48 (14.6%)
had AKI risk, and 7/48 (14.6%) had renal injury or failure (Chi-squared
0.41; two degrees of freedom; P = 0.82). RIPC increased post-operative
duration of noradrenaline support [21 h (IQR 7-45) vs. 9 h (IQR 3-19);
ratio of means 1.70 (99.17% CI 0.86-3.34); P=0.04]. RIPC does not reduce
hsTNT, AKI, or ICU-support requirements in high-risk cardiac surgery.
<28>
Accession Number
2012371714
Authors
Russell S.J. Tan C. O'Keefe P. Ashraf S. Zaidi A. Fraser A.G. Yousef Z.R.
Institution
(Russell, Fraser, Yousef) Wales Heart Research Institute, Heath Park,
Cardiff. CF14 4XN., United Kingdom
(Tan, O'Keefe, Fraser, Yousef) University Hospital of Wales, Heath Park,
Cardiff. CF14 4XW., United Kingdom
(Ashraf, Zaidi) Morriston Hospital, Swansea. SA6 6NL., United Kingdom
Title
Temporary epicardial cardiac resynchronisation versus conventional right
ventricular pacing after cardiac surgery: Study protocol for a randomised
control trial.
Source
Trials. 13 , 2012. Article Number: 20. Date of Publication: 20 Feb 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Heart failure patients with stable angina, acute coronary
syndromes and valvular heart disease may benefit from revascularisation
and/or valve surgery. However, the mortality rate is increased- 5-30%.
Biventricular pacing using temporary epicardial wires after surgery is a
potential mechanism to improve cardiac function and clinical
endpoints.Method/design: A multi-centred, prospective, randomised,
single-blinded, intervention-control trial of temporary biventricular
pacing versus standard pacing. Patients with ischaemic cardiomyopathy,
valvular heart disease or both, an ejection fraction <= 35% and a
conventional indication for cardiac surgery will be recruited from 2
cardiac centres. Baseline investigations will include: an
electrocardiogram to confirm sinus rhythm and measure QRS duration;
echocardiogram to evaluate left ventricular function and markers of
mechanical dyssynchrony; dobutamine echocardiogram for viability and blood
tests for renal function and biomarkers of myocardial injury- troponin T
and brain naturetic peptide. Blood tests will be repeated at 18, 48 and 72
hours. The principal exclusions will be subjects with permanent atrial
arrhythmias, permanent pacemakers, infective endocarditis or end-stage
renal disease.After surgery, temporary pacing wires will be attached to
the postero-lateral wall of the left ventricle, the right atrium and right
ventricle and connected to a triple chamber temporary pacemaker. Subjects
will be randomised to receive either temporary biventricular pacing or
standard pacing (atrial inhibited pacing or atrial-synchronous right
ventricular pacing) for 48 hours.The primary endpoint will be the duration
of level 3 care. In brief, this is the requirement for invasive
ventilation, multi-organ support or more than one
inotrope/vasoconstrictor. Haemodynamic studies will be performed at
baseline, 6, 18 and 24 hours after surgery using a pulmonary arterial
catheter. Measurements will be taken in the following pacing modes: atrial
inhibited; right ventricular only; atrial synchronous-right ventricular;
atrial synchronous-left ventricular and biventricular pacing. Optimisation
of the atrioventricular and interventricular delay will be performed in
the biventricular pacing group at 18 hours. The effect of biventricular
pacing on myocardial injury, post operative arrhythmias and renal function
will also be quantified.Trial Registration: ClinicalTrials.gov:
NCT01027299. 2012 Russell et al; licensee BioMed Central Ltd.
