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<1>
Accession Number
2012050720
Authors
Tricoci P. Huang Z. Held C. Moliterno D.J. Armstrong P.W. Van De Werf F.
White H.D. Aylward P.E. Wallentin L. Chen E. Lokhnygina Y. Pei J. Leonardi
S. Rorick T.L. Kilian A.M. Jennings L.H.K. Ambrosio G. Bode C. Cequier A.
Cornel J.H. Diaz R. Erkan A. Huber K. Hudson M.P. Jiang L. Jukema J.W.
Lewis B.S. Lincoff A.M. Montalescot G. Nicolau J.C. Ogawa H. Pfisterer M.
Prieto J.C. Ruzyllo W. Sinnaeve P.R. Storey R.F. Valgimigli M. Whellan
D.J. Widimsky P. Strony J. Harrington R.A. Mahaffey K.W.
Institution
(Tricoci, Huang, Lokhnygina, Leonardi, Rorick, Harrington, Mahaffey) Duke
Clinical Research Institute, Duke University Medical Center, Durham, NC,
United States
(Held, Wallentin) Department of Medical Sciences, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Moliterno) University of Kentucky, Lexington, United States
(Armstrong) Canadian Virtual Coordinating Center for Global Collaborative
Cardiovascular Research, University of Alberta, Edmonton, Canada
(Van De Werf, Sinnaeve) University Hospital Gasthuisberg, Leuven
Coordinating Center, Leuven, Belgium
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Aylward) Flinders Medical Centre, Bedford Park, SA, Australia
(Chen, Pei, Kilian, Strony) Merck, Whitehouse Station, NJ, United States
(Jennings) CirQuest Labs., Department of Medicine, University of
Tennessee, Memphis, TN, United States
(Ambrosio) University of Perugia School of Medicine, Perugia, Italy
(Bode) Department of Internal Medicine III-Cardiology and Angiology,
University Hospital, Freiburg, Germany
(Cequier) Hospital Universitari de Bellvitge, Universitat de Barcelona,
Barcelona, Spain
(Cornel) Medisch Centrum Alkmaar, Alkmaar, Netherlands
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Erkan) Department of Cardiology, Ufuk University, Ankara, Turkey
(Huber) Department of Medicine, Cardiology, and Emergency Medicine,
Wilhelminen Hospital, Vienna, Austria
(Hudson) Henry Ford Hospital, Detroit, United States
(Jiang) Cardiovascular Institute and Fuwai Hospital, Chinese Academy of
Medical Sciences, Peking Union Medical College, Beijing, China
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Lincoff) Cleveland Clinic Coordinating Center for Clinical Research,
Cleveland, United States
(Montalescot) Institut de Cardiologie, Hopital Pitie-Salpetriere, Paris,
France
(Nicolau) Unidade de Coronariopatia Aguda, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Ogawa) Department of Cardiovascular Medicine, Kumamoto University
Graduate School of Medical Sciences, Kumamoto City, Japan
(Pfisterer) Division of Cardiology, University Hospital Basel, Basel,
Switzerland
(Prieto) Cardiovascular Department, Clinical Hospital, University of
Chile, Santiago, Chile
(Ruzyllo) Department of Coronary Artery Disease, Cardiac Catheterization
Laboratory, Institute of Cardiology, Warsaw, Poland
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
(Valgimigli) Universitaria di Ferrara, Unita Operativa di Cardiologia,
Ferrara, Italy
(Whellan) Division of Cardiology, Thomas Jefferson University,
Philadelphia, United States
(Widimsky) University Hospital Kralovske Vinohrady, Charles University,
Prague, Czech Republic
Title
Thrombin-receptor antagonist vorapaxar in acute coronary syndromes.
Source
New England Journal of Medicine. 366 (1) (pp 20-33), 2012. Date of
Publication: 05 Jan 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1)
antagonist that inhibits thrombin-induced platelet activation. METHODS: In
this multinational, double-blind, randomized trial, we compared vorapaxar
with placebo in 12,944 patients who had acute coronary syndromes without
ST-segment elevation. The primary end point was a composite of death from
cardiovascular causes, myocardial infarction, stroke, recurrent ischemia
with rehospitalization, or urgent coronary revascularization. RESULTS:
Follow-up in the trial was terminated early after a safety review. After a
median follow-up of 502 days (interquartile range, 349 to 667), the
primary end point occurred in 1031 of 6473 patients receiving vorapaxar
versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate,
18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to
1.01; P = 0.07). A composite of death from cardiovascular causes,
myocardial infarction, or stroke occurred in 822 patients in the vorapaxar
group versus 910 in the placebo group (14.7% and 16.4%, respectively;
hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P = 0.02). Rates of moderate and
severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo
group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial
hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95%
CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were
similar in the two groups. CONCLUSIONS: In patients with acute coronary
syndromes, the addition of vorapaxar to standard therapy did not
significantly reduce the primary composite end point but significantly
increased the risk of major bleeding, including intracranial hemorrhage.
(Funded by Merck; TRACER ClinicalTrials.gov number, NCT00527943.)
Copyright 2011 Massachusetts Medical Society.

<2>
Accession Number
2012360092
Authors
Ertmer C. Wulf H. Van Aken H. Friederich P. Mahl C. Bepperling F. Westphal
M. Gogarten W.
Institution
(Ertmer, Van Aken, Westphal, Gogarten) Department of Anesthesiology,
Intensive Care and Pain Therapy, University Hospital of Muenster,
Albert-Schweitzer-Campus, 48149 Muenster, Germany
(Wulf) Department of Anesthesiology and Intensive Care,
Phillips-University of Marburg, Marburg, Germany
(Friederich) Department of Anesthesiology, University Hospital of
Hamburg-Eppendorf, Hamburg, Germany
(Mahl, Bepperling, Westphal) Fresenius Kabi, Bad Homburg, Germany
Title
Efficacy and safety of 10% HES 130/0.4 versus 10% HES 200/0.5 for plasma
volume expansion in cardiac surgery patients.
Source
Minerva Medica. 103 (2) (pp 111-122), 2012. Date of Publication: April
2012.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. Hydroxyethyl starch (HES) solutions are frequently used for
perioperative volume replacement. Whereas older HES specimen tended to
accumulate in the plasma and to cause negative effects on hemostasis, more
recent products, e.g., HES 130/0.4, are characterised by improved
pharmacological properties. The present study was designed to compare the
efficacy and safety of 10% HES 130/0.4 and 10% HES 200/0.5. Methods. In
this post-hoc analysis of a prospective, randomised, double-blind,
multicenter therapeutic equivalence trial, 76 patients undergoing elective
on-pump cardiac surgery received perioperative volume replacement using
either 10% HES 130/0.4 (N.=37) or 10% HES 200/0.5 (N.=39) up to a maximum
dose of 20 mL kg ^-1. Results. Equivalent volumes of
investigational medication were infused until 24 hours after the first
administration (1577 vs. 1540 mL; treatment difference 37 [-150; 223] mL;
P<0.0001 for equivalence). Whereas standard laboratory tests of
coagulation were comparable between groups, von Willebrand factor activity
on the first postoperative morning tended to be higher following treatment
with 10% HES 130/0.4 as compared to 10% HES 200/0.5 (P=0.025) with this
difference being statistically significant only in the per-protocol
analysis (P=0.02). Treatment groups were comparable concerning other
safety parameters and the incidence of adverse drug reactions. In
particular, renal function was well preserved in both groups. Conclusion.
Ten percent HES 130/0.4 was equally effective and safe as compared to 10%
HES 200/0.5 for volume therapy in patients undergoing cardiovascular
surgery. Postoperative coagulation and renal function, as measured by
standard laboratory tests, were similar among groups.

<3>
Accession Number
2012356183
Authors
Tardif J.-C. Lee C.Y.W.
Institution
(Tardif, Lee) Montreal Heart Institute, Universite de Montreal, Montreal,
QC, Canada
Title
Angina and heart rate: What is new?.
Source
Dialogues in Cardiovascular Medicine. 16 (3) (pp 196-207), 2011. Date of
Publication: 2011.
Publisher
LES LABORATOIRES SERIVER (50 Rue Carnot, F-92284, Suresnes Cedex, France)
Abstract
Ivabradine, a novel antianginal drug that solely reduces heart rate (HR),
represents an important medical advance in the treatment of angina.
Selective I_f inhibition with ivabradine prolongs slow diastolic
depolarization in the sinus node, without affecting the action potential.
Ivabradine reduces HR in a dose-dependent manner, lowering the metabolic
demand of the heart and enhancing coronary perfusion during diastole,
without altering standard cardiac parameters. It is also safe and well
tolerated. Ivabradine has no significant effects on myocardial
contractility or other hemodynamic parameters, nor does it significantly
affect ventricular repolarization or other electrophysiological
parameters. Furthermore, neither glucose metabolism nor respiratory
function is impaired. This article reviews several key ivabradine studies
and the use of ivabradine, whether as monotherapy or in combination with
beta-blockers, in chronic stable angina. 2011 LLS SAS.

<4>
Accession Number
21943828
Authors
Guo P. East L. Arthur A.
Institution
(Guo, East, Arthur) School of Nursing, Midwifery and Physiotherapy,
University of Nottingham, Nottingham, United Kingdom
(Guo) The First Affiliated Hospital of Henan University of Science and
Technology, Luoyang, Henan, China
Title
A preoperative education intervention to reduce anxiety and improve
recovery among Chinese cardiac patients: A randomized controlled trial.
Source
International Journal of Nursing Studies. 49 (2) (pp 129-137), 2012. Date
of Publication: February 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Patients awaiting cardiac surgery typically experience
significant physical and psychological stress. However, although there is
evidence that preoperative education interventions can lead to positive
postoperative outcomes for surgical patients in general, less is known
about the effectiveness among patients undergoing cardiac surgery,
especially Chinese cardiac patients. Objectives: To determine whether a
preoperative education intervention designed for Chinese cardiac patients
can reduce anxiety and improve recovery. Design: Randomized controlled
trial. Settings: Cardiac surgical wards of two public hospitals in
Luoyang, China. Methods: 153 adult patients undergoing cardiac surgery
were randomized into the trial, 77 to a usual care control group and 76 to
preoperative education group comprising usual care plus an information
leaflet and verbal advice. Measurement was conducted before randomization
and at seven days following surgery. The primary outcome was change in
anxiety measured by the Hospital Anxiety and Depression Scale (HADS).
Secondary outcomes were change in depression (HADS), change in pain as
measured by subscales of the Brief Pain Inventory-short form (BPI-sf),
length of Intensive Care Unit stay and postoperative hospital stay.
Results: Of 153 participants randomized, 135 (88.2%) completed the trial.
Participants who received preoperative education experienced a greater
decrease in anxiety score (mean difference -3.6 points, 95% confidence
interval -4.62 to -2.57; P< 0.001) and a greater decrease in depression
score (mean difference -2.1 points, 95% CI -3.19 to -0.92; P< 0.001)
compared with those who did not. There was no difference between groups in
average pain, current pain, and interference in general activity, mood and
walking ability. Patients randomized to the preoperative education group
reported less interference from pain in sleeping (mean difference -0.9
points, 95% CI -1.63 to -0.16; P= 0.02). There was some evidence to
suggest a reduced number of hours spent in the Intensive Care Unit among
preoperative education patients (P= 0.05) but no difference in length of
postoperative hospital stay (P= 0.17). Conclusions: This form of
preoperative education is effective in reducing anxiety and depression
among Chinese cardiac surgery patients. Based upon existing evidence and
international practice, preoperative education should be incorporated into
routine practice to prepare Chinese cardiac patients for surgery. 2011
Elsevier Ltd.

<5>
Accession Number
2012343313
Authors
Jovanovic M.M. Krstic A.Z. Stanojevic G. Stojanovic M. Smiljkovic I.D.
Damnjanovic Z.
Institution
(Jovanovic, Stanojevic, Stojanovic) Medical Faculty of Nis, Serbia
(Jovanovic, Smiljkovic, Damnjanovic) Vascular Surgery Clinic, Clinical
Centre of Nis, Serbia
(Krstic) Clinic for gastroenterology, Clinical Centre Serbia, Belgrade,
Serbia
(Stanojevic, Stojanovic) General Surgery Clinic, Clinical Centre of Nis,
Serbia
Title
Early detection of postoperative deep vein thrombosis after general
surgical procedures.
Source
HealthMED. 6 (3) (pp 1023-1032), 2012. Date of Publication: 2012.
Publisher
Drunpp-Sarajevo (Bolnicka bb, Sarajevo 71000, Bosnia and Herzegovina)
Abstract
Background: Diagnostic algorithm in patients with suspected deep vein
thrombosis (DVT) is well established: repeated ultrasound examinations,
ultrasound examination combined with determination of D-dimer (DD) serum
level, and evaluation of clinical probability of DVT combined with
ultrasound examination and/or D-dimer serum level estimation. Methods: We
have performed a prospective, randomized clinical study, evaluating 4802
operated patients with suspected DVT at University Surgical Clinic Nis,
during the period from 01.01.2003 to 31.12.2004. Patients were randomized
into two groups: DD and control group. Stratification of clinical
probability for DVT ("unlikely" and "likely") was performed using Wells's
clinical model. Results: Normal serum levels of DD excluded the presence
of DVT in 1156 (68.9%) patients with <<unlikely>> DVT and in 53.4% (1679)
of all patients in DD group regardless of the clinical probability.
Negative values of DD also excluded DVT in 47.3% (193/408) of patients
with <<likely>> DVT, who had the negative first US examination. DVT was
definitely ruled out in 1990 patients in DD group and in 1943 patients in
control group. During the three months follow up period venous
thromboembolism (VTE) was registered in 10 patients (0.51%;
95%CI=0.19-0.83%) in the control group and in 3 patients (0.15%; 95%CI=
0.0-0.4%) in the DD group (chi2=3.95; p=0.047; p<0.05, 95% CI=0.01- 0.7%).
The DD diagnostic strategy reduced the need for US examination by 68%.
Conclusion: Proposed strategy significantly raises accuracy and
reliability of early detection of postoperative DVT in patients undergoing
general surgical procedures.

<6>
Accession Number
21995901
Authors
Straka F. Pirk J. Pindak M. Skalsky I. Vancura V. Cihak R. Marek T.
Lupinek P. Schornik D. Masin J. Zeman M. Skrobakova J. Dorazilova Z.
Skibova J.
Institution
(Straka, Pirk, Pindak, Skalsky, Vancura, Cihak, Marek, Lupinek, Schornik,
Masin, Skrobakova, Dorazilova) Heart Centre, Institute for Clinical and
Experimental Medicine, Prague, Czech Republic
(Skibova) Medical Statistics Unit, Institute for Clinical and Experimental
Medicine, Prague, Czech Republic
(Zeman) Medtronic Czechia, Prague, Czech Republic
Title
Biventricular pacing in the early postoperative period after cardiac
surgery.
Source
Physiological Research. 60 (6) (pp 877-885), 2011. Date of Publication:
2011.
Publisher
Czech Academy of Sciences (Videnska 1083, Prague 4 142 20, Czech Republic)
Abstract
Cardiac resynchronization therapy is not commonly used in the early
postoperative period in patients undergoing cardiac surgery who have left
ventricular (LV) dysfunction and a history of heart failure. We performed
a prospective randomized clinical trial to compare atrial synchronous
right ventricular (DDD RV) and biventricular (DDD BIV) pacing within 72
hours after cardiac surgery in patients with an EF <=35 %, a QRS interval
longer than 120 msec and who had LV dyssynchrony detected by real-time
three-dimensional echocardiography (RT3DE). Epicardial pacing was provided
by a modified Medtronic INSYNC III pacemaker. An LV epicardial pacing lead
was implanted on the latest activated segment of the LV based on RT3DE.
The study included 18 patients with ischemic heart disease, with or
without valvular heart disease (14 men, 4 women, average age 71 years).
Patients undergoing DDD BIV pacing had a statistically significant greater
CO and CI (CO 6.7+/-1.8 l/min, CI 3.4+/-0.7 l/min/m2) than patients
undergoing DDD RV pacing (CO 5.5+/-1.4 l/min, CI 2.8+/-0.7
l/min/m²), p<0.001. DDD BIV pacing in the early postoperative
period after cardiac surgery corrects LV dyssynchrony and has better
hemodynamic results than DDD RV pacing. 2011 Institute of Physiology.

<7>
Accession Number
2012353650
Authors
Navickis R.J. Haynes G.R. Wilkes M.M.
Institution
(Navickis, Wilkes) Hygeia Associates, 17988 Brewer Rd, Grass Valley, CA
95949, United States
(Haynes) Department of Anesthesiology and Critical Care, Saint Louis
University School of Medicine, St Louis, MO, United States
Title
Effect of hydroxyethyl starch on bleeding after cardiopulmonary bypass: A
meta-analysis of randomized trials.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (1) (pp 223-230.e5),
2012. Date of Publication: July 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The effects of hydroxyethyl starch on bleeding after
cardiopulmonary bypass were determined. Methods: A meta-analysis was
performed of postoperative blood loss in randomized clinical trials of
hydroxyethyl starch versus albumin for fluid management in adult
cardiopulmonary bypass surgery. Impacts of hydroxyethyl starch molecular
weight and molar substitution were assessed. Randomized trials directly
comparing different hydroxyethyl starch solutions were also included.
Results: Eighteen trials with 970 total patients were included. Compared
with albumin, hydroxyethyl starch increased postoperative blood loss by
33.3% of a pooled SD (95% confidence interval, 18.2%-48.3%; P < .001).
Risk of reoperation for bleeding was more than doubled by hydroxyethyl
starch (relative risk, 2.24; 95% confidence interval, 1.14-4.40; P =
.020). Hydroxyethyl starch increased transfusion of red blood cells by
28.4% of a pooled SD (95% confidence interval, 12.2%-44.6%; P < .001), of
fresh-frozen plasma by 30.6% (95% confidence interval, 8.0%-53.1%; P =
.008), and of platelets by 29.8% (95% confidence interval, 3.4%-56.2%; P =
.027). None of these effects differed significantly between hydroxyethyl
starch 450/0.7 and 200/0.5. Insufficient data were available for
hydroxyethyl starch 130/0.4 versus albumin; however, no significant
differences were detected in head-to-head comparisons of hydroxyethyl
starch 130/0.4 with 200/0.5. Albumin improved hemodynamics. There were no
differences in fluid balance, ventilator time, intensive care unit stay,
or mortality. Conclusions: Hydroxyethyl starch increased blood loss,
reoperation for bleeding, and blood product transfusion after
cardiopulmonary bypass. There was no evidence that these risks could be
mitigated by lower molecular weight and substitution. Copyright 2012 by
The American Association for Thoracic Surgery.

<8>
Accession Number
2012353645
Authors
Deja M.A. Kargul T. Domaradzki W. Stacel T. Mazur W. Wojakowski W. Gocol
R. Gaszewska-Zurek E. Zurek P. Pytel A. Wos S.
Institution
(Deja, Kargul, Domaradzki, Stacel, Mazur, Gocol, Zurek, Wos) Second
Department of Cardiac Surgery, Medical University of Silesia, Ul. Ziolowa
47, 40-635 Katowice, Poland
(Wojakowski, Gaszewska-Zurek) Third Department of Cardiology, Medical
University of Silesia, Katowice, Poland
(Pytel) Academic Pharmacy, Katowice, Poland
Title
Effects of preoperative aspirin in coronary artery bypass grafting: A
double-blind, placebo-controlled, randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (1) (pp 204-209.e3),
2012. Date of Publication: July 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: This trial was undertaken to determine the safety and efficacy
of preoperative aspirin administration in a contemporary cardiac surgical
practice setting. Methods: This randomized, double-blind, parallel-group,
single-center trial involved patients with stable coronary artery disease
who were assigned to receive either 300 mg of aspirin or placebo the night
before coronary bypass surgery. Using a random digit table, patients were
allocated to receive the tablet from 1 of the 40 coded bottles containing
either aspirin or placebo. Patients, surgeons, anesthetists, and
investigators were all masked to treatment allocation. The primary safety
end points were as follows: more than 750 mL of bleeding during the first
postoperative 12 hours and more than 1000 mL of total discharge from the
chest drains. The secondary efficacy end point was a composite of
cardiovascular death, myocardial infarction, or repeat revascularization.
Results: A total of 390 patients were allocated to aspirin (387 analyzed)
and 399 to placebo (396 analyzed). The follow-up median was 53 months.
Fifty-four placebo recipients and 86 aspirin recipients bled more than 750
mL in the first 12 hours (odds ratio [OR], 1.81; 95% confidence interval
[CI], 1.25-2.63), while total chest drain discharge was above 1000 mL in
96 placebo and 131 aspirin recipients (OR, 1.60; 95% CI, 1.17-2.18).
Preoperative aspirin decreased the long-term hazard of nonfatal coronary
event (infarction or repeat revascularization) - hazard ratio (HR), 0.58
(95% CI, 0.33-0.99) - and tended to decrease the hazard of a major cardiac
event (cardiovascular death, infarction, or repeat revascularization - HR,
0.65 [95% CI, 0.41-1.03]). Conclusions: Performing coronary grafts on
aspirin is associated with increased postoperative bleeding but may
decrease the long-term hazard of coronary events. Copyright 2012 by The
American Association for Thoracic Surgery.

<9>
Accession Number
2012358160
Authors
Thomas-Rueddel D.O. Vlasakov V. Reinhart K. Jaeschke R. Rueddel H.
Hutagalung R. Stacke A. Hartog C.S.
Institution
(Thomas-Rueddel, Vlasakov, Reinhart, Rueddel, Hutagalung, Stacke, Hartog)
Department of Anesthesiology and Intensive Care Medicine, Jena University
Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, Jena
07747, Germany
(Thomas-Rueddel, Rueddel, Hartog) Center for Sepsis Control and Care (CSCC
Jena), Integrated Research and Treatment Center, Friedrich Schiller
University Jena, Erlanger Allee 101, Jena 07747, Germany
(Jaeschke) Department of Medicine, McMaster University, Hamilton, ON,
Canada
Title
Safety of gelatin for volume resuscitation-a systematic review and
meta-analysis.
Source
Intensive Care Medicine. 38 (7) (pp 1134-1142), 2012. Date of Publication:
July 2012.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: Gelatin is frequently used as a volume expander in critical care.
Our goal was to investigate its safety. Methods: Systematic review of
randomized controlled trials (RCT) in patients receiving gelatin for
resuscitation in comparison to albumin or crystalloids. Results: We
identified 40 RCTs published between 1976 and 2010 with 3,275 patients.
Median sample size in the gelatin groups was 15 patients (range 10-249).
Median gelatin dose was 17 ml/kg (range 6-57 ml/kg). In 32 RCTs (n =
1,946/3,275, 59 % of all patients), the study period was >= 24.0 h.
Twenty-nine RCTs (n = 2,001) investigated elective surgical patients,
mostly undergoing cardiac surgery (18 RCTs, n = 819). Three RCTs (n = 723)
investigated critically ill adults. Two RCTs (n = 59) were performed in
emergency room patients, and six RCTs (n = 492) were performed in neonates
or children. No study was adequately powered to investigate the frequency
of patient-important outcomes. Risks were not statistically significantly
different for mortality (RR 1.12, 95 % confidence interval, 0.87-1.44) and
exposure to allogeneic transfusion (RR 1.28, 0.89-1.83). On account of
only few included studies and the small number of patients, subgroup
analyses (high vs. low dose, >24 h vs. shorter periods, and critically ill
patients vs. others) were uninformative. Only three RCTs reported the
occurrence of acute renal failure. Conclusion: Despite over 60 years of
clinical practice, the safety and efficacy of gelatin cannot be reliably
assessed in at least some settings in which it is currently used. We
suggest the need to investigate and establish such safety. 2012 Copyright
jointly held by Springer and ESICM.

<10>
Accession Number
2012353600
Authors
Pavione M.A. Carmona F. De Castro M. Carlotti A.P.C.P.
Institution
(Pavione, Carmona, Carlotti) Department of Pediatrics, Hospital Das
Clinicas, University of Sao Paulo, Avenida dos Bandeirantes, 3900,
14049-900, Ribeirao Preto SP, Brazil
(De Castro) Department of Internal Medicine, Hospital Das Clinicas,
University of Sao Paulo, Ribeirao Preto, Brazil
Title
Late remote ischemic preconditioning in children undergoing
cardiopulmonary bypass: A randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (1) (pp 178-183.e1),
2012. Date of Publication: July 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Cardiopulmonary bypass is associated with ischemia-reperfusion
injury to multiple organs. We aimed to evaluate whether remote ischemic
preconditioning performed the day before surgery for congenital heart
disease with cardiopulmonary bypass attenuates the postoperative
inflammatory response and myocardial dysfunction. Methods: This was a
prospective, randomized, single-blind, controlled trial. Children
allocated to remote ischemic preconditioning underwent 4 periods of 5
minutes of lower limb ischemia by a blood pressure cuff intercalated with
5 minutes of reperfusion. Blood samples were collected 4, 12, 24, and 48
hours after cardiopulmonary bypass to evaluate nuclear factor kappa B
activation in leukocytes by quantification of mRNA of I kappa B alpha by
real-time quantitative polymerase chain reaction and for interleukin-8 and
10 plasma concentration measurements by enzyme-linked immunosorbent assay.
Myocardial dysfunction was assessed by N-terminal pro-B-type natriuretic
peptide and cardiac troponin I plasma concentrations, measured by
chemiluminescence, and clinical parameters of low cardiac output syndrome.
Results: Twelve children were allocated to remote ischemic
preconditioning, and 10 children were allocated to the control group.
Demographic data and Risk Adjustment for Congenital Heart Surgery 1
classification were comparable in both groups. Remote ischemic
preconditioning group had lower postoperative values of N-terminal
pro-B-type natriuretic peptide, but cardiac troponin I levels were not
significantly different between groups. Interleukin-8 and 10
concentrations and I kappa B alpha gene expression were similar in both
groups. Postoperative morbidity was similar in both groups; there were no
postoperative deaths in either group. Conclusions: Late remote ischemic
preconditioning did not provide clinically relevant cardioprotection to
children undergoing cardiopulmonary bypass. Copyright 2012 by The
American Association for Thoracic Surgery.

<11>
Accession Number
2012354485
Authors
Bassareo P.P. Fanos V. Iacovidou N. Mercuro G.
Institution
(Bassareo, Mercuro) Department of Cardiovascular and Neurological
Sciences, University of Cagliari, Policlinico Universitario, S.S. 554,
bivio di Sestu, 09042 Monserrato (Cagliari), Italy
(Fanos) Department of Pediatrics and Clinical Medicine, Section of
Neonatal Intensive Care Unit, University of Cagliari, Cagliari, Italy
(Iacovidou) National and Kapodistrian University of Athens, Medical
School, Athens, Greece
Title
Antiplatelet Therapy in Children: Why So Different from Adults'?.
Source
Current Pharmaceutical Design. 18 (21) (pp 3019-3033), 2012. Date of
Publication: August 2012.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Antiplatelet agents are administered in the treatment of a large number of
adult diseases: coronary heart disease, ischemic stroke, peripheral
arterial disease, arrhythmias with their thromboembolic complications,
primary and secondary prevention. In childhood however, the situation is
substantially different. The lack of large interventional trials on the
use of antiplatelet drugs in children, has led to greater uncertainty, and
a less extensive use of these drugs, limited to fewer indications. The
purpose of this article was to review the studies conducted to date on the
use of antiplatelet agents in children. A concerted effort has been made
to identify which are the shared therapeutic indications of this class of
compounds, the recommended dose, the contraindications and the possible
side effects. In brief, an attempt has been made to ascertain the
interesting potential of these drugs which are so often neglected in
children. 2012 Bentham Science Publishers.

<12>
Accession Number
2012353681
Authors
Marcantoni C. Zanoli L. Rastelli S. Tripepi G. Matalone M. Mangiafico S.
Capodanno D. Scandura S. Di Landro D. Tamburino C. Zoccali C. Castellino
P.
Institution
(Marcantoni, Matalone, Di Landro) Division of Nephrology, Cannizzaro
Hospital, Via Messina, 829, 95126 Catania, Italy
(Zanoli, Rastelli, Castellino) Department of Internal Medicine, University
of Catania, Catania, Italy
(Tripepi, Zoccali) CNR-IBIM, Reggio Calabria, Italy
(Mangiafico, Capodanno, Scandura, Tamburino) Division of Cardiology,
University of Catania, Catania, Italy
Title
Effect of renal artery stenting on left ventricular mass: A randomized
clinical trial.
Source
American Journal of Kidney Diseases. 60 (1) (pp 39-46), 2012. Date of
Publication: July 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Background: Whether renal revascularization reduces left ventricular
hypertrophy in patients with coronary artery disease is uncertain. Study
Design: Randomized clinical trial testing the effect of renal artery
stenting versus medical therapy on left ventricular hypertrophy
progression in patients affected by ischemic heart disease and renal
artery stenosis. Setting & Participants: Incident patients with ischemic
heart disease undergoing cardiac catheterization with renal artery
stenosis >50%-<=80%. Intervention: Revascularization plus standard medical
therapy versus medical therapy alone. Outcomes: Primary end point was
change in echocardiographic left ventricular mass index (LVMI).
Measurements: Clinical and echocardiographic studies were performed at
baseline and after 1 year. Results: 84 patients were randomly assigned: 43
to revascularization plus standard medical therapy and 41 to medical
therapy alone. At baseline, clinical characteristics were similar in the 2
study groups. After 1 year, there was no statistically significant
difference between longitudinal change in the medical therapy group versus
that in the medical therapy plus revascularization group for LVMI (2.1;
95% CI, -6.1 to 10.3 g/m²), blood pressure (systolic, -0.2 [95%
CI, -9.1 to 8.8 mm Hg]; diastolic, -3.3 [95% CI, -8.4 to 1.8 mm Hg]), or
estimated glomerular filtration rate (1.5; 95% CI, -5.8 to 8.9 mL/min/1.73
m²). The number of major cardiovascular events was similar in
the 2 groups (revascularization plus standard medical therapy [fatal, n =
2; nonfatal, n = 11] and medical therapy alone [fatal, n = 2; nonfatal, n
= 11]). Limitations: Patients with very severe renal artery stenosis were
excluded from the study. Conclusions: Our study was unable to detect a
clinically significant benefit of renal revascularization on LVMI in
patients with coronary artery disease and renal artery stenosis of
50%-80%. 2012 National Kidney Foundation, Inc.

<13>
Accession Number
21978861
Authors
Parke R.L. McGuinness S.P. Dixon R. Jull A.
Institution
(Parke, McGuinness) Cardiothoracic and Vascular Intensive Care Unit,
Auckland City Hospital, Auckland, New Zealand
(Dixon) Centre for Child and Family Policy Research, University of
Auckland, Auckland, New Zealand
(Parke, Dixon, Jull) School of Nursing, University of Auckland, Auckland,
New Zealand
(Jull) Clinical Trials Research Unit, University of Auckland, Auckland,
New Zealand
Title
Protocol for a randomised controlled trial of nasal high flow oxygen
therapy compared to standard care in patients following cardiac surgery:
The HOT-AS study.
Source
International Journal of Nursing Studies. 49 (3) (pp 338-344), 2012. Date
of Publication: March 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Postoperative respiratory complications following cardiac
surgery may increase morbidity, mortality and length of stay. Non-invasive
respiratory support therapies can be used prophylactically or curatively
to reduce respiratory complications. One system, nasal high flow oxygen
therapy, is in use in many intensive care units (ICUs) however there is a
lack of information regarding its clinical utility and efficacy.
Objectives: This paper outlines the study protocol and methodology for a
study designed to determine if the prophylactic use of nasal high flow
oxygen therapy can improve pulmonary function in patients following
cardiac surgery. Methods/design: A prospective randomised controlled trial
will be conducted of adult patients scheduled for cardiac surgery and
admitted to the Cardiothoracic Intensive Care Unit of a tertiary hospital.
Study participants will be assigned to receive either nasal high flow or
standard oxygen therapy (oxygen therapy at 2-4L/min via either simple
facemask or nasal cannulae) at extubation. The primary outcome measure is
improved pulmonary function demonstrated by
SpO₂/FiO₂ ratio >445 on post-operative day 3.
Secondary outcome measures include atelectasis score on chest X-ray;
spirometry; readmission to ICU for respiratory causes; ICU and hospital
length of stay; mortality and incidence of respiratory complications at
day 28; oxygenation variables; use of adjunctive respiratory support
therapies; escalation of respiratory support; adverse events and patient
comfort during administration of oxygen therapy. Sample size: It was
calculated that 340 patients will be required - 170 per arm of study - to
give a 90% power to detect a 15% treatment effect. Results: This study
started recruiting in March 2011. It is anticipated that enrolment will be
complete in April 2012 and results available towards the end of 2012.
Conclusion: This study will provide evidence of any benefits in the use of
prophylactic nasal high flow therapy in post-operative cardiac surgical
patients. Trial registration: This trial is registered with the Australian
New Zealand Clinical Trials Registry www.anzctr.org.au
(ACTRN12610000973011). 2011 Elsevier Ltd.

<14>
Accession Number
2012352122
Authors
Muller M.C.A. Porcelijn L. Vlaar A.P.J.
Institution
(Muller, Vlaar) Department of Intensive Care Medicine, Academic Medical
Center, Amsterdam, Netherlands
(Vlaar) Department of Internal Medicine, Academic Medical Center,
Amsterdam, Netherlands
(Muller, Vlaar) Laboratory of Experimental Intensive Care and
Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam,
Netherlands
(Porcelijn) Sanquin Diagnostic Services, Amsterdam, Netherlands
Title
Prevention of immune-mediated transfusion-related acute lung injury; from
bloodbank to patient.
Source
Current Pharmaceutical Design. 18 (22) (pp 3241-3248), 2012. Date of
Publication: July 2012.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Transfusion-related acute lung injury (TRALI) is the leading cause of
transfusion related morbidity and mortality. Immunemediated TRALI is
caused by leucocyte and neutrophil antibodies in the transfused blood
products that react with white blood cell antigens of the recipient,
hereby inducing endothelial damage and lung injury. About two thirds of
TRALI cases are thought to be immunemediated. Both Human Leucocyte
Antibodies (HLA Class I and II) and Human Neutrophil Antibodies (HNA) are
involved in TRALI. Most antibodies result from allo-exposure of the blood
donor, with multiparous donors having the highest incidence of antibodies.
Detection of anti-leucocyte and anti-neutrophil antibodies is complex and
many uncertainties still exist regarding the interpretation of the test
results. In this review we discuss the evidence and effectiveness of
measurements to prevent immune-mediated TRALI from a bloodbank and bedside
perspective. From a bloodbank perspective various preventive measures have
been implicated. In some countries bloodbanks have successfully
implemented donor selection strategies, ranging from testing of
allo-exposed donors for leucocyte antibodies to the exclusion of all
females from donating high plasma volume products. Another strategy
involves dilution of antibodies present by pooling of plasma donations of
multiple donors. From a bedside view, the most important measure to
prevent TRALI is to limit patients' exposure to allogenic bloodproducts.
Furthermore recognition and awareness of the syndrome need to be
heightened among clinicians. 2012 Bentham Science Publishers.

<15>
Accession Number
2012333392
Authors
Ross R.E. Sherrid M.V. Casey M.M. Swistel D.G. Balaram S.K.
Institution
(Ross) Department of Surgery, St Luke's-Roosevelt Hospital Center,
Columbia University College of Physicians and Surgeons, New York, NY,
United States
(Sherrid) Divsion of Cardiology, St Luke's-Roosevelt Hospital Center,
Columbia University College of Physicians and Surgeons, New York, NY,
United States
(Casey, Swistel, Balaram) Division of Cardiothoracic Surgery, St
Luke's-Roosevelt Hospital Center, Columbia University College of
Physicians and Surgeons, New York, NY, United States
Title
Does Surgical Relief of Obstruction Improve Prognosis for Hypertrophic
Cardiomyopathy?.
Source
Progress in Cardiovascular Diseases. 54 (6) (pp 529-534), 2012. Date of
Publication: May 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Unique genetic characteristics of hypertrophic cardiomyopathy (HCM),
including heterogeneity and incomplete penetrance, have made making
predictions about prognosis complex. We reviewed data from septal myectomy
results as published from 1980 to 2011, most of which come from
specialized tertiary care centers. We also performed a retrospective
review of 132 consecutive patients who underwent HCM surgery at our
institution. At a mean follow-up of 4.2 +/- 3.2 years (range, 3 days to
14.2 years), there were no deaths within 30 days of surgery for our
cohort. Over the course of 15 years, 2 deaths occurred in older patients,
both of whom had surgery for HCM along with additional cardiac procedures.
Age, the presence of comorbidities, and concomitant cardiac procedures
were not statistically significant risk factors for mortality. Overall
survival at 1, 5, and 10 years was excellent: 99%, 99%, and 92%,
respectively. Surgical myectomy has been proven to be a safe and effective
procedure for symptomatic obstructive HCM, and it confers excellent
survival similar to that of the healthy population. 2012 Elsevier Inc.

<16>
Accession Number
2012351187
Authors
Thiele H. Schuler G. Neumann F.-J. Hausleiter J. Olbrich H.-G. Schwarz B.
Hennersdorf M. Empen K. Fuernau G. Desch S. De Waha S. Eitel I. Hambrecht
R. Bohm M. Kurowski V. Lauer B. Minden H.-H. Figulla H.-R. Braun-Dullaeus
R.C. Strasser R.H. Rochor K. Maier S.K.G. Mollmann H. Schneider S. Ebelt
H. Werdan K. Zeymer U.
Institution
(Thiele, Schuler, Fuernau, Desch, De Waha, Eitel) Department of Internal
Medicine/Cardiology, University of Leipzig - Heart Center, Strumpellstr.
39, 04289 Leipzig, Germany
(Neumann) Heart Center Bad Krozingen, Bad Krozingen, Germany
(Hausleiter) German Heart Center Munich, Munich, Germany
(Olbrich) Asklepios Clinic Langen-Seligenstadt, Langen, Germany
(Schwarz) Segeberger Kliniken, Bad Segeberg, Germany
(Hennersdorf) SLK Kliniken Heilbronn, Heilbronn, Germany
(Empen) Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
(Hambrecht) Klinikum Links der Weser, Bremen, Germany
(Bohm) University Clinic of Saarland, Homburg/Saar, Germany
(Kurowski) University Clinic Schleswig-Holstein, Lubeck, Germany
(Lauer) Zentralklinik Bad Berka, Bad Berka, Germany
(Minden) Oberhavel Kliniken Hennigsdorf, Hennigsdorf, Germany
(Figulla) University Clinic of the Friedrich-Schiller University, Jena,
Germany
(Braun-Dullaeus) Otto-von-Guericke University Magdeburg, Magdeburg,
Germany
(Strasser) Heart Center, Technical University Dresden, Dresden, Germany
(Rochor) Sana Heart Center Cottbus, Cottbus, Germany
(Maier) University Hospital Wurzburg, Wurzburg, Germany
(Mollmann) Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
(Schneider, Zeymer) Institut fur Herzinfarktforschung Ludwigshafen,
Ludwigshafen, Germany
(Ebelt, Werdan) Martin-Luther University Halle-Wittenberg, Halle/Saale,
Germany
(Zeymer) Heart Center Ludwigshafen, Ludwigshafen, Germany
Title
Intraaortic balloon counterpulsation in acute myocardial infarction
complicated by cardiogenic shock: Design and rationale of the Intraaortic
Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial.
Source
American Heart Journal. 163 (6) (pp 938-945), 2012. Date of Publication:
June 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: In current guidelines, intraaortic balloon pumping (IABP) is
considered a class 1 indication in cardiogenic shock complicating acute
myocardial infarction. However, evidence is mainly based on retrospective
or prospective registries with a lack of randomized clinical trials.
Therefore, IABP is currently only used in 20% to 40% of cardiogenic shock
cases. The hypothesis of this trial is that IABP in addition to early
revascularization by either percutaneous coronary intervention or coronary
artery bypass grafting will improve clinical outcome of patients in
cardiogenic shock. Study Design: The IABP-SHOCK II study is a 600-patient,
prospective, multicenter, randomized, open-label, controlled trial. The
study is designed to compare the efficacy and safety of IABP versus
optimal medical therapy on the background of early revascularization by
either percutaneous coronary intervention or coronary artery bypass
grafting. Patients will be randomized in a 1:1 fashion to 1 of the 2
treatments. The primary efficacy end point of IABP-SHOCK II is 30-day
all-cause mortality. Secondary outcome measures, such as hemodynamic,
laboratory, and clinical parameters, will serve as surrogate end points
for prognosis. Furthermore, an intermediate and long-term follow-up at 6
and 12 months will be performed. Safety will be assessed, by the GUSTO
bleeding definition, peripheral ischemic complications, sepsis, and
stroke. Conclusions: The IABP-SHOCK II trial addresses important questions
regarding the efficacy and safety of IABP in addition to early
revascularization in patients with cardiogenic shock complicating
myocardial infarction. 2012 Mosby, Inc.

<17>
Accession Number
2012351186
Authors
Van De Werf F. Brueckmann M. Connolly S.J. Friedman J. Granger C.B.
Hartter S. Harper R. Kappetein A.P. Lehr T. Mack M.J. Noack H. Eikelboom
J.W.
Institution
(Van De Werf) University Hospitals Leuven, Department of Cardiovascular
Medicine, Herestraat 49, 3000 Leuven, Belgium
(Brueckmann, Hartter, Lehr, Noack) Boehringer Ingelheim GmbH and Co. KG,
Ingelheim am Rhein, Germany
(Connolly, Eikelboom) McMaster University, Hamilton Health Sciences,
Hamilton, ON, Canada
(Friedman) Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT,
United States
(Granger) Duke Clinical Research Institute, Durham, NC, United States
(Harper) Boehringer Ingelheim Ltd., Bracknell, United Kingdom
(Kappetein) Erasmus MC, Dept. Thoracic Surgery, Rotterdam, Netherlands
(Mack) Heart Hospital Baylor, Plano, TX, United States
Title
A comparison of dabigatran etexilate with warfarin in patients with
mechanical heart valves: The Randomized, phase II study to Evaluate the
sAfety and pharmacokinetics of oraL dabIGatran etexilate in patients after
heart valve replacemeNt (RE-ALIGN).
Source
American Heart Journal. 163 (6) (pp 931-937.e1), 2012. Date of
Publication: June 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Vitamin K antagonists are the only oral anticoagulants
approved for long-term treatment of patients with a cardiac valve
replacement. Objective: This study aims to test a new dosing regimen for
dabigatran etexilate in patients with a mechanical bileaflet valve.
Methods: Patients aged >=18 years and <=75 years, either undergoing
implantation of a mechanical bileaflet valve (aortic or mitral or both)
during the current hospital stay or having undergone implantation a mitral
bileaflet valve >3 months before randomization, will be randomized between
dabigatran etexilate or warfarin (in a ratio of 2:1) in an open-label
design. Initial doses of dabigatran will be based on the estimated
creatinine clearance, and the doses will be adjusted based on measuring
trough dabigatran plasma levels to achieve levels >=50 ng/mL at steady
state. Doses will range between 150 mg twice a day and 300 mg twice a day.
Warfarin management and target international normalized ratio will be
according to current practice guidelines at the discretion of the treating
physicians. The plan is to treat 270 patients with dabigatran etexilate
for a total study population of approximately 405 patients. Clinical
efficacy and safety outcomes will be analyzed in an exploratory manner.
Conclusions: RE-ALIGN is the first study to test an alternative to
warfarin in patients with mechanical heart valves. A definitive phase III
study will be planned based on the results of this study. 2012 Mosby,
Inc.

<18>
Accession Number
2012349674
Authors
Jin B. Dong X.-H. Zhang C. Li Y. Shi H.-M.
Institution
(Jin, Li, Shi) Department of Cardiology, Huashan Hospital, Fudan
University, 12 Middle Urumqi Road, Shanghai 200040, China
(Dong) Department of Endocrinology, Sir Run Run Shaw Hospital, Zhejiang
University, Zhejiang, China
(Zhang) Department of Orthopedics, Huashan Hospital, Fudan University,
Shanghai, China
Title
Distal protection devices in primary percutaneous coronary intervention of
native coronary artery lesions: A meta-analysis of randomized controlled
trials.
Source
Current Medical Research and Opinion. 28 (6) (pp 871-876), 2012. Date of
Publication: June 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objective: The use of embolic protection devices to decrease major adverse
cardiac events (MACEs) in patients with saphenous vein graft lesions is
considered class I therapy by the recent practice guidelines. However, the
benefits of adjunctive protection devices to prevent distal embolization
in patients with native coronary artery lesions are still a matter of
debate. Therefore, we performed the meta-analysis to determine whether the
use of distal protection devices during revascularization can improve
myocardial perfusion and reduce the occurrence of MACEs compared with
primary percutaneous coronary intervention (PCI) alone. Methods and
results: Studies were identified in English-language articles by search of
Medline and Embase database (inception to December 2011). A total of 15
prospective randomized controlled trials involving 2783 patients were
included for analysis (1378 patients in the distal protection device group
and 1405 cases in the control group). Overall, adjunctive embolic
protection was associated with significantly improved postprocedural TIMI
3 (thrombolysis in myocardial infarction 3) flow (OR 1.71; 95 CI
1.13-2.57; P=0.01) and MBG 3 (myocardial blush grade 3) (OR 1.50; 95 CI
1.09-2.07; P=0.01), whereas the overall MACEs analysis demonstrated that a
nonsignificant trend was observed toward better clinical outcomes
associated with adjunctive protection devices at 1 month (OR 0.80; 95 CI
0.55-1.15; P=0.23) and at 6 months (OR 0.80; 95 CI 0.55-1.17; P=0.24).
When stratified by MACEs, no statistical differences were found among
mortality, reinfarction, and target vessel revascularization (TVR),
respectively. Conclusions: The meta-analysis indicated an improvement of
myocardial perfusion in AMI patients treated with adjunctive protection
devices. However, a nonsignificant trend was observed toward a lower risk
of MACEs in the distal protection device group when compared with the
control group. 2012 Informa UK Ltd. All rights reserved.

<19>
Accession Number
22357783
Authors
van Valen R. van Vuuren H. van Domburg R.T. van der Woerd D. Hofland J.
Bogers A.J.
Institution
(van Valen) Department of Cardio-Thoracic Surgery, Erasmus Medical Center,
the Netherlands.
Title
Pain management after cardiac surgery: experience with a nurse-driven pain
protocol.
Source
European journal of cardiovascular nursing : journal of the Working Group
on Cardiovascular Nursing of the European Society of Cardiology. 11 (1)
(pp 62-69), 2012. Date of Publication: Mar 2012.
Abstract
Management of post-operative pain is important for decreasing
post-operative morbidity and mortality. After evaluating our pain score
database of patients undergoing cardiac surgery (2007-2009) we revised our
pain protocol. The new protocol allows nurses to administer analgesic
medication without consulting the attending physician. The setting was a
medium care unit, a nursing ward with additional monitoring of heart rate
and rhythm. We investigated the effects of this revised pain protocol in a
prospective consecutive cohort study. We evaluated 193 patients treated
according to the revised protocol (RP group) during the first 72 hours
post-cardiac surgery on the medium care unit. A visual analogue scale
(VAS) was used as pain scoring system. These patients were compared with a
control group (Ctrl group) consisting of 1535 patients. Patients from the
RP group had a mean VAS of 2.2 compared to a mean VAS of 2.8 in the Ctrl
group (p < 0.0001). In the Ctrl group 44% of patients with a VAS >= 4
maintained this score for 8 hours afterwards. In contrast, in the RP group
81% had a reduction in VAS score within 3 hours. Using the new protocol
there were no adverse events requiring intervention such as medication or
readmission to an intensive care unit. This study shows that in
post-cardiac surgery patients a significant reduction in VAS scores can be
safely realized by a nurse-driven protocol. Furthermore, a reduction in
time to achieve an acceptable pain score (VAS < 4) was realized.