EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
22397875
Authors
Carlomagno G. Pirozzi C. Mercurio V. Ruvolo A. Fazio S.
Institution
(Carlomagno, Pirozzi, Mercurio, Ruvolo, Fazio) Department of Clinical
Medicine, Cardiovascular and Immunological Sciences, Federico II
University, Via Pansini, 5, 80131 Naples, Italy
Title
Effects of a nutraceutical combination on left ventricular remodeling and
vasoreactivity in subjects with the metabolic syndrome.
Source
Nutrition, Metabolism and Cardiovascular Diseases. 22 (5) (pp e13-e14),
2012. Date of Publication: May 2012.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)

<2>
Accession Number
22395120
Authors
Johnson C.K. Cabreriza S.E. Sahar R.L. Rusanov A. Wang D.Y. Cheng B. Gendy
M.S. Quinn T.A. Spotnitz H.M.
Institution
(Johnson) Department of Surgery, Columbia University, New York, New York,
USA.
Title
Clinical validation of a real-time data processing system for cardiac
output and arterial pressure measurement during intraoperative
biventricular pacing optimization.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992). 58
(3) (pp 191-196), 2012. Date of Publication: 2012 May-Jun.
Abstract
Biventricular pacing (BiVP) improves cardiac output (CO) and mean arterial
pressure (MAP) after cardiopulmonary bypass (CPB) in selected patients at
risk for acute left heart failure after cardiac surgery. Optimization of
atrioventricular delay (AVD) and interventricular delay (VVD) to maximize
the hemodynamic effect of pacing requires rapid and accurate data
processing. Conventional post hoc data processing (PP) is accurate but
time-consuming, and infeasible in the intraoperative setting. We created a
customized, real-time data processing (RTP) system to improve data
processing efficiency, while maintaining accuracy. Biventricular pacing
optimization was performed within 1 hour of the conclusion of CPB in 10
patients enrolled in the Biventricular Pacing After Cardiac Surgery trial.
Cardiac output, measured by an electromagnetic flow meter, and arterial
pressure were recorded as AVD was randomly varied across seven settings
and VVD across nine settings. Post hoc data processing values calculated
by two observers were compared to RTP-generated outputs for CO and MAP.
Interexaminer reliability coefficients were generated to access the
dependability of RTP. Interexaminer reliability coefficient values ranged
from 0.997 to 0.999, indicating RTP is as reliable as PP for optimization.
Real-time data processing is instantaneous and therefore is more practical
in a clinical setting than the PP method. Real-time data processing is
useful for guiding intraoperative BiVP optimization and merits further
development.

<3>
Accession Number
2012362990
Authors
Hermida R.C.
Institution
(Hermida) Bioengineering and Chronobiology Laboratories, Vigo, Spain
Title
Use of >= 1 antihypertensive drug at bedtime reduced CV events more than
use of all drugs in the morning in CKD.
Source
Annals of Internal Medicine. 156 (12) (pp JC6-JC8), 2012. Date of
Publication: 19 Jun 2012.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Question Does taking >= 1 antihypertensive medication at bedtime reduce
cardiovascular (CV) events in patients with chronic kidney disease (CKD)
more than taking all antihypertensive medications in the morning? Methods
Design: Randomized controlled trial. ClinicalTrials.gov NCT00295542.
Allocation: {Concealed}*.+ Blinding: Blinded+ (outcome assessors, {data
analysts, and safety committee}*). Follow-up period:Median 5.4 years.
Setting: {Tertiary hospital in Spain}*. Patients: 661 patients >= 18 years
of age (mean age 59 y, 60% men) who had hypertension (mean awake blood
pressure [BP] >= 135/85 mm Hg or mean asleep BP >= 120/70 mm Hg) and CKD
(estimated glomerular filtration rate < 60 mL/min/1.73 m²
and/or urinary albumin excretion >= 30 mg/24-h urine on >= 2 occasions >=
3 mo apart). Exclusion criteria included night or shift work.
Intervention: >= 1 antihypertensive medication taken at bedtime (n = 329)
or all antihypertensive medications taken upon wakening (n = 332). 48-hour
ambulatory BP and wrist activity were monitored annually or 3 months after
any change in treatment. Outcomes: Primary outcome was total CV morbidity
and mortality (composite of all-cause mortality, myocardial infarction,
angina, coronary revascularization, heart failure, acute arterial
occlusion of lower extremities, thrombotic occlusion of the retinal
artery, stroke, and transient ischemic attack). Secondary outcome was
major CV events (composite of CV death, myocardial infarction, and
stroke). Patient follow-up: 100% (intention-to-treat analysis). Main
results The main results are in the Table. Conclusion In patients with
chronic kidney disease, taking >= 1 antihypertensive medication at bedtime
reduced cardiovascular events compared with taking all medications in the
morning. 2012 American College of Physicians.

<4>
Accession Number
2012362984
Authors
Chopra V.
Institution
(Chopra) University of Michigan Health System, Ann Arbor, MI, United
States
Title
Review: Perioperative statins reduce perioperative MI and AF in
statin-naive patients.
Source
Annals of Internal Medicine. 156 (12) (pp JC6-JC2), 2012. Date of
Publication: 19 Jun 2012.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Question: Does perioperative statin treatment improve clinical outcomes in
adults having surgery and not using long-term statins? Review scope
Included studies evaluated perioperative statin treatment in patients >=
18 years of age who were having surgery and were not maintained on
long-term statin treatment before surgery (statinnaive). Exclusion
criteria included percutaneous coronary interventions and cardioversions.
Studies had to report >= 1 of the following outcomes: perioperative death,
myocardial infarction (MI), atrial fibrillation (AF), length of hospital
stay, or length of intensive care unit (ICU) stay. Review methods MEDLINE,
EMBASE/Excerpta Medica, Biosis, Cochrane Central Register of Controlled
Trials, Conference Proceedings Index, Web sites (ClinicalTrials.gov,
International Federation of Pharmaceutical Manufacturers, and
Pharmaceutical Research and Manufacturers of America), and reference lists
were searched to April 2011 for published and unpublished randomized
controlled trials (RCTs). Experts and study authors were contacted. 15
RCTs (n = 2292, 59% to 90% men) met inclusion criteria. Studies enrolled
patients having cardiac surgery (11 RCTs, n = 1056), noncardiac surgery (2
RCTs, n = 1030), and vascular surgery (2 RCTs, n = 206). 14 studies used a
placebo control, and 1 study compared high-dose with low-dose
atorvastatin. Statins assessed were atorvastatin (8 RCTs, n = 852),
fluvastatin (3 RCTS, n = 1076), simvastatin (2 RCTs, n = 121),
rosuvastatin (1 RCT, n = 200), and pravastatin (1 RCT, n = 43). 7 studies
were at low risk for bias (Cochrane Statistical Methods Group criteria).
Main results Compared with controls, perioperative statins reduced risk
for MI in patients having any surgery and AF in patients having cardiac
surgery; groups did not differ for mortality in patients having any
surgery (Table). Perioperative statins reduced length of hospital stay,
but not length of ICU stay, more than controls (Table). Conclusion
Perioperative statins reduce risk for myocardial infarction and atrial
fibrillation in statin-naIve patients. 2012 American College of
Physicians.

<5>
Accession Number
2012472435
Authors
Mihaylova B. Voysey M. Gray A. Baigent C. De Lemos J. Blazing M. Downs
J.R. Gotto A. Clearfield M. Gordon D. Davis B. Koren M. Dahlof B. Poulter
N. Sever P. Knopp R.H. Fellstrom B. Holdaas H. Jardine A. Schmieder R.
Zannad F. Goldbourt U. Kaplinsky E. Colhoun H.M. Betteridge D.J.
Durrington P.N. Hitman G.A. Fuller J. Neil A. Wanner C. Krane V. Sacks F.
Moye L. Pfeffer M. Hawkins C.M. Wedel H. Wikstrand J. Barter P. Tavazzi L.
Marchioli R. Tognoni G. Franzosi M.G. Maggioni A. Bloomfield H. Robins S.
Pedersen T.R. Ridker P.M. Holman R. Meade T. MacMahon S. Tonkin A. Shaw J.
Serruys P.W. Nakamura H. Knatterud G. Furberg C. Byington R. Murphy M.
Blauw G.J. Packard C. Kjekshus J. Pedersen T. Wilhelmsen L. Braunwald E.
Cannon C. Murphy S. Armitage J. Bowman L. Parish S. Peto R. Sleight P.
Landray M. La Rosa J. Rossouw J. Probstfi Eld J. Shepherd J. Cobbe S.
MacFarlane P. Ford I. Flather M. Kastelein J. Newman C. Shear C. Tobert J.
Varigos J. White H. Yusuf S. Mellies M. McGovern M. Barclay J. Belder R.
Mitchel M.Y. Musliner T. Ansquer J.-C. Llewellyn B.M. Pharma N. Bortolini
M. Brandrup-Wognsen G. Bryzinski B. Olsson G. Pears J. DeMicco D. Barnes
E.H. Baxter A. Bhala N. Blackwell L. Buck G. Collins R. Emberson J.
Herrington W.G. Holland L.E. Kearney P.M. Keech A. Kirby A. Lewis D.A.
Marschner I. Pollicino C. Reith C. Simes J. Sourjina T.
Institution
(Baigent, Barnes, Baxter, Bhala, Blackwell, Buck, Collins, Emberson,
Herrington, Holland, Kearney, Keech, Kirby, Lewis, Marschner, Pollicino,
Reith, Simes, Sourjina) National Health and Medical Research Council
(NHMRC), Clinical Trial Centre, University of Sydney, Mallett Street
Campus M02, NSW 2006, Australia
Title
The effects of lowering LDL cholesterol with statin therapy in people at
low risk of vascular disease: Meta-analysis of individual data from 27
randomised trials.
Source
The Lancet. 380 (9841) (pp 581-590), 2012. Date of Publication: Augustus
2012.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Background Statins reduce LDL cholesterol and prevent vascular events, but
their net effects in people at low risk of vascular events remain
uncertain. Methods This meta-analysis included individual participant data
from 22 trials of statin versus control (n=134 537; mean LDL cholesterol
difference 108 mmol/L; median follow-up 48 years) and five trials of more
versus less statin (n=39 612; difference 051 mmol/L; 51 years). Major
vascular events were major coronary events (ie, non-fatal myocardial
infarction or coronary death), strokes, or coronary revascularisations.
Participants were separated into five categories of baseline 5-year major
vascular event risk on control therapy (no statin or low-intensity statin)
(<5%, >=5% to <10%, >=10% to <20%, >=20% to <30%, >=30%); in each, the
rate ratio (RR) per 10 mmol/L LDL cholesterol reduction was estimated.
Findings Reduction of LDL cholesterol with a statin reduced the risk of
major vascular events (RR 079, 95% CI 077-081, per 10 mmol/L reduction),
largely irrespective of age, sex, baseline LDL cholesterol or previous
vascular disease, and of vascular and all-cause mortality. The
proportional reduction in major vascular events was at least as big in the
two lowest risk categories as in the higher risk categories (RR per 10
mmol/L reduction from lowest to highest risk: 062 [99% CI 047-081], 069
[99% CI 060-079], 079 [99% CI 074-085], 081 [99% CI 077-086], and 079 [99%
CI 074-084]; trend p=004), which reflected significant reductions in these
two lowest risk categories in major coronary events (RR 057, 99% CI
036-089, p=00012, and 061, 99% CI 050-074, p<00001) and in coronary
revascularisations (RR 052, 99% CI 035-075, and 063, 99% CI 051-079; both
p<00001). For stroke, the reduction in risk in participants with 5-year
risk of major vascular events lower than 10% (RR per 10 mmol/L LDL
cholesterol reduction 076, 99% CI 061-095, p=00012) was also similar to
that seen in higher risk categories (trend p=03). In participants without
a history of vascular disease, statins reduced the risks of vascular (RR
per 10 mmol/L LDL cholesterol reduction 085, 95% CI 077-095) and all-cause
mortality (RR 091, 95% CI 085-097), and the proportional reductions were
similar by baseline risk. There was no evidence that reduction of LDL
cholesterol with a statin increased cancer incidence (RR per 10 mmol/L LDL
cholesterol reduction 100, 95% CI 096-104), cancer mortality (RR 099, 95%
CI 093-106), or other non-vascular mortality. Interpretation In
individuals with 5-year risk of major vascular events lower than 10%, each
1 mmol/L reduction in LDL cholesterol produced an absolute reduction in
major vascular events of about 11 per 1000 over 5 years. This benefi t
greatly exceeds any known hazards of statin therapy. Under present
guidelines, such individuals would not typically be regarded as suitable
for LDL-lowering statin therapy. The present report suggests, therefore,
that these guidelines might need to be reconsidered.

<6>
Accession Number
2012467249
Authors
Finlay M.C. Hunter R.J. Baker V. Richmond L. Goromonzi F. Thomas G.
Rajappan K. Duncan E. Tayebjee M. Dhinoja M. Sporton S. Earley M.J.
Schilling R.J.
Institution
(Hunter, Baker, Richmond, Goromonzi, Thomas, Rajappan, Duncan, Tayebjee,
Dhinoja, Sporton, Earley, Schilling) Cardiology Research Department, Barts
and the London NHS Trust and Queen Mary University of London, St
Bartholomew's Hospital, 60 Bartholomew Close, West Smithfield, London EC1A
7BE, United Kingdom
(Finlay) Cardiology Research Department, Barts and the London NHS Trust
and University College London, St Bartholomew's Hospital, 60 Bartholomew
Close, West Smithfield, London EC1A 7BE, United Kingdom
Title
A randomised comparison of Cartomerge vs. NavX fusion in the catheter
ablation of atrial fibrillation: The CAVERN trial.
Source
Journal of Interventional Cardiac Electrophysiology. 33 (2) (pp 161-169),
2012. Date of Publication: March 2012.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Purpose: Integration of a 3D reconstruction of the left atrium into
cardiac mapping systems can aid catheter ablation of atrial fibrillation
(AF). The two most widely used systems are NavX Fusion and Cartomerge. We
aimed to compare the clinical efficacy of these systems in a randomised
trial. Methods: Patients undergoing their first ablation were randomised
to mapping using either NavX fusion or CartoMerge. Pulmonary vein
isolation by wide area circumferential ablation was performed for
paroxysmal AF with additional linear and fractionated potential ablation
for persistent AF. Seven-day Holter monitoring was used for confirmation
of sinus rhythm maintenance at 6 months. Results: Ninety-seven patients
were randomised and underwent a procedure. There was no difference in the
primary endpoint of freedom from arrhythmia at 6 months (51% in the
Cartomerge group vs. 48% in the NavX Fusion group, p=0.76). 3D image
registration was faster with Cartomerge (24 vs. 33 min, p=0.0001), used
less fluoroscopic screening (11 vs. 15 min, p=0.039) with a lower
fluoroscopic dose (840 vs. 1,415 mGyCm², p=0.043). There was a
strong trend to lower ablation times in the Cartomerge group, overall RF
time (3,292 s vs. 4,041, p=0.07). Distance from 3D lesion to 3D image
shell was smaller in the Cartomerge group (2.7+/-1.9 vs. 3.3+/-3.7 mm,
p<0.001). Conclusions Cartomerge appears to be faster and uses less
fluoroscopy to achieve registration than NavX Fusion, but overall
procedural times and clinical outcomes are similar. Springer
Science+Business Media, LLC 2011.

<7>
[Use Link to view the full text]
Accession Number
2012462000
Authors
Lambert-Kerzner A. Del Giacco E.J. Fahdi I.E. Bryson C.L. Melnyk S.D.
Bosworth H.B. Davis R. Mun H. Weaver J. Barnett C. Radcliff T. Hubbard A.
Bosket K.D. Carey E. Virchow A. Mihalko-Corbitt R. Kaufman A.
Marchant-Miros K. Ho P.M.
Institution
(Lambert-Kerzner, Davis, Radcliff, Carey, Virchow, Ho) Denver VA Medical
Center, Cardiology 111B, 1055 Clermont St., Denver, CO 80220, United
States
(Del Giacco, Fahdi, Weaver, Barnett, Hubbard, Mihalko-Corbitt,
Marchant-Miros) Little Rock VA Medical Center, Little Rock, AR, United
States
(Bryson, Mun, Bosket) Puget Sound VA Medical Center, Seattle, WA, United
States
(Melnyk, Bosworth, Kaufman) Durham VA Medical Center, Durham, NC, United
States
Title
Patient-centered adherence intervention after acute coronary syndrome
hospitalization.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (4) (pp 571-576),
2012. Date of Publication: July 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background-Adherence to cardioprotective medications in the year after
acute coronary syndrome hospitalization is generally poor and is
associated with increased risk of rehospitalization and mortality. Few
interventions have specifically targeted this high-risk patient population
to improve medication adherence. We hypothesize that a multifaceted
patientcentered intervention could improve adherence to cardioprotective
medications. Methods and Results-To evaluate this intervention, we propose
enrolling 280 patients with a recent acute coronary syndrome event into a
multicenter randomized, controlled trial. The intervention comprises4 main
components: (1) pharmacist-led medication reconciliation and tailoring;
(2) patient education; (3) collaborative care between pharmacist and
primary care provider/cardiologist; and (4) 2 types of voice messaging
(educational and medication refill reminder calls). Patients in the
intervention arm will visit with the study pharmacist 1 week post-hospital
discharge. The pharmacist will work with the patient and collaborate with
providers to reconcile medication issues. Voice messages will augment the
educational process and remind patients to refill their cardioprotective
medications. The study will compare the intervention versus usual care for
12 months. The primary outcome of interest is adherence using the ReComp
method. Secondary and tertiary outcomes include achievement of targets for
blood pressure and low-density lipoprotein, and reduction in the combined
cardiovascular end points of myocardial infarction hospitalization,
coronary revascularization, and all-cause mortality. Finally, we will also
evaluate the cost-effectiveness of the intervention compared with usual
care. Conclusions-If the intervention is effective in improving medication
adherence and demonstrating a lower cost, the intervention has the
potential to improve cardiovascular outcomes in this high-risk patient
population. 2012 American Heart Association, Inc.

<8>
[Use Link to view the full text]
Accession Number
2012461956
Authors
Arnold S.V. Magnuson E.A. Wang K. Serruys P.W. Kappetein A.P. Mohr F.W.
Cohen D.J.
Institution
(Arnold, Magnuson, Wang, Cohen) St. Luke's Mid America Heart Institute,
University of Missouri, Kansas City School of Medicine, 4401 Wornall Rd,
Kansas City, MO 64111, United States
(Serruys, Kappetein) Erasmus University Medical Center Rotterdam,
Rotterdam, Netherlands
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
Do differences in repeat revascularization explain the antianginal
benefits of bypass surgery versus percutaneous coronary intervention?
Implications for future treatment comparisons.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (3) (pp 267-275),
2012. Date of Publication: May 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background-Patients with multivessel coronary disease treated with
coronary artery bypass graft (CABG) have less angina than those treated
with percutaneous coronary intervention (PCI); however, there is
uncertainty as to the mechanism of greater angina relief with CABG and
whether more frequent repeat revascularization in patients treated with
PCI could account for this treatment difference. Methods and Results-In
the Synergy between percutaneous coronary intervention (PCI) with TAXUS
and Cardiac Surgery trial, 1800 patients with 3-vessel or left main
coronary artery disease were randomized to CABG or PCI with
paclitaxel-eluting stents. Health status was assessed at baseline, 1, 6,
and 12 months, using the Seattle Angina Questionnaire and the Medical
Outcomes Study Short Form General Health Survey, and the association
between repeat revascularization and health status during follow-up was
assessed using longitudinal models. In adjusted analyses, patients who
underwent repeat revascularization had worse angina frequency scores than
patients who did not in both treatment groups, with differences of 8.5
points at 6 months and 3.1 points at 12 months in patients treated with
PCI and 19.8 points at 6 months and 11.2 points at 12 months in patients
with patients treated with CABG. Among patients who did not require repeat
revascularization, the adjusted effect of CABG versus PCI on 12-month
angina frequency scores was nearly identical to the overall benefit in the
intention-to-treat analysis. Conclusions-Among patients with multivessel
coronary artery disease treated with PCI or CABG, the occurrence of repeat
revascularization during follow-up did not fully explain the antianginal
benefit of CABG in the overall population. The differential association
between repeat revascularization and anginal status, according to the type
of initial revascularization procedure, suggests that this end point
should play a limited role in any direct comparison of the 2 treatment
strategies. 2012 American Heart Association, Inc.

<9>
Accession Number
2012457914
Authors
Sievert A.N. Sistino J.
Institution
(Sievert, Sistino) Medical University of South Carolina, Charleston, SC,
United States
Title
A meta-analysis of renal benefits to pulsatile perfusion in cardiac
surgery.
Source
Journal of Extra-Corporeal Technology. 44 (1) (pp 10-14), 2012. Date of
Publication: 2012.
Publisher
American Society of Extra-Corporeal Technology (P.O. Box 11086, Richmond
VA 23230, United States)
Abstract
Multiple studies have evaluated the efficacy of pulsatile flow during
cardiopulmonary bypass (CPB) showing controversial results. Suggested
benefits to pulsatile perfusion include reducing the systemic inflammatory
response syndrome associated with bypass, decreased need for inotropic
support, shortened hospital stay, and superior organ preservation. This
study aims to compare prior studies to determine if there is a significant
difference in post-operative renal function with pulsatile perfusion
compared to non-pulsatile perfusion during cardiac surgery. Studies
included in the analysis were identified by searching keywords - pulsatile
perfusion, pulse, pulsatile flow, cardiopulmonary bypass, and cardiac
surgery. To maintain a homogenous sample, manuscripts were included if
they met the following criteria: research was prospective in nature,
subjects were human, paper contained documented baseline demographics,
outcome data included markers of renal function. A meta-analysis was
performed to compare post-op renal function between pulsatile and
non-pulsatile perfusion groups. A total of 298 articles were screened. Ten
articles met the criteria, of these, 477 patients underwent non-pulsatile
perfusion while 708 received pulsatile perfusion during CPB. There was
insufficient evidence to show a difference in mean postoperative
creatinine or BUN between the groups, however, the pulsatile perfusion
group had significantly higher creatinine clearance (standardized
difference in means = 2.48, p =.004) and lower serum lactate levels
(standardized difference in means = -2.08, p =.012) in the intensive care
unit. This study found that there is great variability among pulsatile
perfusion research. The methods to create and assess effective pulsatility
on bypass varied widely among manuscripts. This analysis suggests that
pulsatile perfusion during CPB is beneficial in renal preservation and
should be considered. 2011 AmSECT.

<10>
Accession Number
2012457913
Authors
Marguerite S. Levy F. Quessard A. Dupeyron J.-P. Gros C. Steib A.
Institution
(Marguerite, Levy, Quessard, Dupeyron, Gros, Steib) Department of Surgical
Anesthesia and Intensive Care, Civil Hospital, Strasbourg University
Hospital, Strasbourg, France
Title
Impact of a Phosphorylcholine-Coated Cardiac Bypass Circuit on Blood Loss
and Platelet Function: A Prospective, Randomized Study.
Source
Journal of Extra-Corporeal Technology. 44 (1) (pp 05-09), 2012. Date of
Publication: 2012.
Publisher
American Society of Extra-Corporeal Technology (P.O. Box 11086, Richmond
VA 23230, United States)
Abstract
Platelet dysfunction due to cardiopulmonary bypass (CPB) surgery increases
the risk of bleeding. This study analyzed the effect of a
phosphorylcholine (PC)-coated CPB circuit on blood loss, transfusion
needs, and platelet function. We performed a prospective, randomized study
at Strasbourg University Hospital, which included 40 adults undergoing
coronary artery bypass graft surgery (CABG) (n = 20) or mitral valve
repair (n = 20) using CPB. Patients were randomized either to PC-coated
CPB or uncoated CPB (10 CABG patients and 10 mitral valve repair patients
in each group). Blood loss and transfusion needs were evaluated intra- and
postoperatively. Markers of platelet activation and thrombin generation
were measured at anesthesia induction, at the beginning and end of CPB, on
skin closure, and on days 0, 1, and 5. Comparisons were made by Student's
t test or covariance analysis (significance threshold p .05). Blood loss
was significantly lower in the PC group during the first 6 postoperative
hours (171 +/- 102 vs. 285 +/- 193 mL, p =.024), at the threshold of
significance from 6- 24 hours (p =.052), and similar in both groups after
24 hours. During CPB, platelet count decreased by 48% in both groups.
There was no difference in markers of platelet activation, thrombin
generation, or transfusion needs between the two groups. Norepinephrine
use was more frequent in the control group (63% vs. 33%) but not
significantly. PC-coating of the CPB surface reduced early postoperative
bleeding, especially in CABG patients, but had no significant effect on
platelet function because of large interindividual variations that
prevented the establishment of a causal relationship. 2011 AmSECT.

<11>
Accession Number
2012453140
Authors
Benyamin R.M. Wang V. Vallejo R. Singh V. Helm S.
Institution
(Benyamin, Vallejo) Millennium Pain Center, Bloomington, IL, United States
(Benyamin, Vallejo) University of Illinois, Urbana-Champaign, IL, United
States
(Wang) University of Illinois School of Medicine, Urbana, IL, United
States
(Vallejo) Illinois State University, United States
(Singh) Illinois State University, Normal, IL, United States
(Helm) The Helm Center for Pain Management, Laguna Hills, CA, United
States
Title
A systematic evaluation of thoracic interlaminar epidural injections.
Source
Pain Physician. 15 (4) (pp E497-E514), 2012. Date of Publication:
July/August 2012.
Publisher
American Society of Interventional Pain Physicians (Pain Physicians, 81
Lakeview Drive, Paducah KY 42001, United States)
Abstract
Background: There is a paucity of literature on the use of epidural
injections for the treatment of chronic mid and upper back pain due to
disc herniation and radiculitis, axial or discogenic pain, spinal
stenosis, post surgery syndrome, and post thoracotomy pain syndrome. Study
Design: A systematic review of therapeutic thoracic epidural injection
therapy for chronic mid and upper back pain. Objective: The objective of
this systematic review is to determine the effects of thoracic
interlaminar epidural injections with or without steroids, with or without
fluoroscopy, and for various conditions including disc herniation and
radiculitis, axial or discogenic pain, spinal stenosis, post thoracic
surgery syndrome, and post thoracotomy pain syndrome. Methods: The
available literature on thoracic interlaminar epidural injections with or
without steroids in managing various types of chronic mid and upper back
pain was reviewed. The quality assessment and clinical relevance criteria
utilized were the Cochrane Musculoskeletal Review Group criteria as
utilized for interventional techniques for randomized trials and the
criteria developed by the Newcastle-Ottawa Scale criteria for
observational studies. The level of evidence was classified as good, fair,
or limited (or poor) based on the quality of evidence developed by the
U.S. Preventive Services Task Force (USPSTF). Data sources included
relevant literature identified through searches of PubMed and EMBASE from
1966 to March 2012, and manual searches of the bibliographies of known
primary and review articles. Outcome Measures: The primary outcome measure
was pain relief (short-term relief = up to 6 months and long-term > 6
months). Secondary outcome measures were improvement in functional status,
psychological status, return to work, and reduction in opioid intake.
Results: For this review, 17 studies were identified, including studies
examining adverse reactions. Only 2 studies were included: one randomized
trial and one non-randomized or observational study. The results of this
systematic review evaluating the effectiveness of thoracic epidural
injections with or without steroids in managing chronic thoracic pain
shows fair evidence with one randomized trial in patients with various
causes; whereas the evidence is limited based on one non-randomized study
evaluating chronic pain in post thoracotomy syndrome. Limitations: The
limitations of this study include paucity of evidence. Conclusion: The
evidence based on this systematic review for thoracic epidural injection
in treating chronic thoracic pain is considered fair and limited for post
thoracotomy pain.

<12>
Accession Number
2012467432
Authors
Ruberg F.L. Maurer M.S. Judge D.P. Zeldenrust S. Skinner M. Kim A.Y. Falk
R.H. Cheung K.N. Patel A.R. Pano A. Packman J. Grogan D.R.
Institution
(Ruberg, Skinner) Department of Medicine, Boston University, School of
Medicine, Boston, MA, United States
(Maurer) Center for Advanced Cardiac Care, Columbia University Medical
Center, New York, NY, United States
(Judge) Center for Inherited Heart Disease, Johns Hopkins University,
Baltimore, MD, United States
(Zeldenrust) Division of Hematology, Mayo Clinic, Rochester, MN, United
States
(Kim) Division of Cardiovascular Medicine, Oregon Health and Science
University, Portland, OR, United States
(Falk) Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston,
MA, United States
(Cheung, Pano, Packman, Grogan) FoldRx Pharmaceuticals, Pfizer Inc,
Cambridge, MA, United States
(Patel) Division of Cardiology, Tufts Medical Center, Boston, MA, United
States
Title
Prospective evaluation of the morbidity and mortality of wild-type and
V122I mutant transthyretin amyloid cardiomyopathy: The Transthyretin
Amyloidosis Cardiac Study (TRACS).
Source
American Heart Journal. 164 (2) (pp 222-228.e1), 2012. Date of
Publication: August 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background TRACS sought to describe the clinical outcomes and disease
progression of transthyretin (TTR) cardiac amyloidosis (ATTR) in an
observational study. Clinical course is largely determined by disease type
with ATTR categorized as wild-type (ATTRwt) or genetic-variant protein
(ATTRm). Prospective data are lacking in the most common TTR mutation,
V122I, present in approximately 3.5% of African Americans. Methods
Patients with ATTRwt (n = 18) and V122I ATTRm (n = 11) were longitudinally
assessed every 6 months for up to 2 years by functional class assessments,
biochemical markers, and echocardiography. Results At baseline, no
differences in clinical characteristics, biomarkers, or echocardiographic
parameters were noted between patients with ATTRwt and patients with
ATTRm. After 15.5 +/- 8 months, there were 11 deaths and 1 cardiac
transplant, with higher mortality (73% vs 22%, P = .03) and cardiovascular
hospitalization (64% vs 28%, P = .02) among patients with ATTRm. The
median survival from diagno is was 25.6 months for ATTRm vs 43.0 months
for ATTRwt (P = .04). nivariate predictors of mortality included disease
duration, heart rate <=70 beats/min, baseline stroke volume, left
ventricular ejection fraction b50%, and ATTRm status. For each 6-month
increment, the mean 6-minute walk distance declined by 25.8 m, N-terminal
pro b-type natriuretic peptide increased by 1,816 pg/mL, and left
ventricular ejection fraction fell by 3.2%, for the entire cohort.
Conclusions In this prospective study, disease progression, morbidity, and
mortality were observed in ATTR cardiomyopathy, particularly due to V122I,
over a short duration. Given the prevalence of this mutation, further
study of V122I in at-risk African American patients is warranted. (Am
Heart J 2012;164:222-228.e1.) 2012, Mosby, Inc. All rights reserved.

<13>
Accession Number
2012454929
Authors
Nuszkowski M.M. Deutsch N. Jonas R.A. Zurakowski D. Montague E. Holt D.W.
Institution
(Nuszkowski, Deutsch, Jonas, Zurakowski, Montague, Holt) Children's
National Medical Center, Washington, DC, United States
Title
Randomized trial of the terumo capiox fx05 oxygenator with integral
arterial filter versus terumo capiox baby rx05 and terumo capiox af02
arterial filter in infants undergoing cardiopulmonary bypass.
Source
Journal of Extra-Corporeal Technology. 43 (4) (pp 207-214), 2011. Date of
Publication: 2011.
Publisher
American Society of Extra-Corporeal Technology (P.O. Box 11086, Richmond
VA 23230, United States)
Abstract
The purpose of this clinical trial was to evaluate the effect of the
Terumo Capiox FX05 oxygenator with integrated arterial filter during
cardiopulmonary bypass (CPB) compared with the Terumo Capiox RX05 Baby RX
and arterial filter on inflammatory mediators and blood product
utilization. Forty patients weighing less than 10 kg who underwent
congenital heart surgery utilizing cardiopulmonary bypass were randomized
into either oxygenator group. The endpoints included measuring
inflammatory markers at six different time points (preoperative baseline,
CPB circuit being primed, 15 minutes after CPB initiation, status post
protamine administration, prior to transport to intensive care unit, and
within 12 to 24 hours post surgery), blood product utilization, extubation
time, and days until discharge. The inflammatory mediators showed no
significant differences between oxygenators at any time points. However,
looking at the inflammatory mediators of both the FX and RX groups
combined, a statistically significant difference was seen in interleukin
(IL)-6 at 12/24 hour post surgery (p < .001) versus baseline and all other
time points. IL-8 at status post protamine (p < .001) and 12/24 hours post
surgery (p < .001) demonstrated significant differences versus all other
time points, and IL-10 at status post protamine (p < .001) and prior to
leaving the operating room (p < .001) were statistically different
compared to all other time points. Cardiopulmonary bypass stimulates the
systemic inflammatory response through various components of the
extracorporeal system. This investigation did not find significant
differences in cytokines interferon-g, IL-1b, IL-2, IL-4, IL-5, IL-6,
IL-8, IL-10, IL-12 p70, tumor necrosis factor (TNF)-alpha, and TNF-b when
comparing these two oxygenators. It is well known that various mechanisms
contribute to the levels of cytokines circulating in a patient's blood
volume and many manipulations throughout cardiac surgery have the ability
to demonstrate anti-inflammatory interventions. Further investigation is
needed as to how modification of the extracorporeal circuit may minimize
increases in inflammatory mediators.

<14>
Accession Number
2012456132
Authors
Fujii M. Bessho R. Ochi M. Shimizu K. Terajima K. Takeda S.
Institution
(Fujii, Bessho, Ochi, Shimizu) Department of Cardiovascular Surgery,
Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8603, Japan
(Terajima, Takeda) Department of Anesthesiology, Nippon Medical School,
Tokyo, Japan
Title
Effect of postoperative landiolol administration for atrial fibrillation
after off pump coronary artery bypass surgery.
Source
Journal of Cardiovascular Surgery. 53 (3) (pp 369-374), 2012. Date of
Publication: June 2012.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. Atrial fibrillation is one of the most common postoperative
arrhythmias following cardiac surgery. Despite many clinical studies,
there is still no consensus on the most appropriate prevention strategy
for atrial arrhythmia. A randomized prospective trial was conducted to
determine the efficacy of intravenous landiolol administration in the
early period after off-pump coronary artery bypass grafting (CABG)
followed by treatment with carvedilol for prevention of atrial
fibrillation. Methods. Seventy consecutive patients were enrolled in the
study prospectively. Patients in the treated group received landiolol
intravenously (5 mug/kg/min) in the ICU immediately after surgery. Heart
rate was maintained at 60-80 bpm and intravenous landiolol was continued
at 0-10 mug/kg/min until oral drug administration was possible. All
patients received oral carvedilol (2.5-5 mg/day) after extubation and this
was continued postoperatively. The primary endpoint was the overall
development of postoperative atrial fibrillation. Results. Postoperative
atrial fibrillation occurred in 4 (11.1%) of the 36 patients in the
landiolol group, compared with 11 (32.3%) of the 34 patients in the
control group, indicating that development of atrial fibrillation was
significantly inhibited by landiolol (P=0.042). No major postoperative
complications occurred in the landiolol group. Conclusions. Postoperative
intravenous landiolol therapy followed by oral carvedilol may be more
effective than oral carvedilol alone for prevention of atrial fibrillation
after off-pump CABG. We also found that intravenous landiolol is well
tolerated after cardiac surgery.

<15>
Accession Number
22358274
Authors
Lima P.M.B. Farias R.T.F.B. Carvalho A.C.A. da Silva P.N.C. Filho N.A.F.
de Brito R.F.
Institution
(Lima, Farias) University Center CESMAC, Maceio, AL, Brazil
(Carvalho) Traumatology and Orthopaedics, UGF, Physical Therapy,
University Center CESMAC, Maceio, AL, Brazil
(da Silva) University Center CESMAC, Maceio, AL, Brazil
(Filho) Applied Exercise Physiology for Health and Performance UNCISAL,
Graduate Hospital of FCBS - CESMAC, Maceio, AL, Brazil
(de Brito) Intensive Care and Rehabilitation, REDENTOR, Maceio, AL, Brazil
Title
Transcutaneous electrical nerve stimulation after coronary artery bypass
graft surgery.
Source
Brazilian Journal of Cardiovascular Surgery. 26 (4) (pp 591-596), 2011.
Date of Publication: October-December 2011.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Introduction: After cardiac surgery, patients have a limitation in
respiratory muscle strength, which favors the appearing of pulmonary
complications. Objective: To evaluate the effectiveness of transcutaneous
electrical nerve stimulation (TENS) on the painful process and respiratory
muscle strength in patients undergoing coronary artery bypass graft
(CABG). Methods: The study included patients after on-pump CABG through
sternotomy, general anesthesia, without being under the influence of
neuromuscular blockade, with use of chest and mediastinal tubes, and
extubation within 6 hours after the procedure and presenting index equal
to or greater than three visual analog scale (VAS) of pain being on the
first day after surgery. We recruited 20 patients divided into two groups
with no predominance of sex: the control group (n = 10), who received more
physiotherapy analgesic therapy, and TENS group received analgesic
therapy, physiotherapy and TENS. The TENS was applied for 30 minutes,
three times a day, a 3-hour period each application. Results: For the
degree of pain, there was an average start and end, respectively, 7.0/1.0
for the TENS group and 7.0/8.0 for the control group. For inspiratory
muscle strength, - 102.5 cmH₂O/- 141.17 cm H₂O to
the TENS group and - 97.0 cmH2O/- 100.3 cm H₂O for control. The
expiratory muscle strength, 63cmH₂O/125 cmH₂O for
the TENS group and 55.3 cmH₂O/ 53, 2 cmH₂O for the
control group. Conclusions: TENS has shown significant effectiveness in
reducing pain, and the increase in respiratory muscle strength at
first-day after CABG surgery.

<16>
Accession Number
22358273
Authors
Franco A.M. Torres F.C.C. Simon I.S.L. Morales D. Rodrigues A.J.
Institution
(Franco, Torres, Simon) Emergency Unit of Hospital das Clinicas, School of
Medicine of Ribeirao Preto - USP, Ribeirao Preto, Brazil
(Morales) Department of Neuroscience and Behavioral Sciences, Ribeirao
Preto, Brazil
(Rodrigues) Division of Thoracic and Cardiovascular Surgery, School of
Medicine of Ribeirao Preto - USP, Ribeirao Preto, Brazil
Title
Assessment of noninvasive ventilation with two levels of positive airway
pressure in patients after cardiac surgery.
Source
Brazilian Journal of Cardiovascular Surgery. 26 (4) (pp 582-590), 2011.
Date of Publication: October-December 2011.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Introduction: The application of two levels of ventilation by positive
pressure (BiPAP) associated with conventional respiratory
therapy (CRT) in postoperative periord of cardiac surgery may contribute
to reduction of pulmonary complications. Objectives: To evaluate the
safety and compliance of preventive application of BiPAP CRT
associated with immediate postoperative myocardial revascularization.
Methods: 26 patients undergoing coronary artery bypass grafting were
randomly allocated in one of the groups. Patients of the Control Group
(CG) were treated only with conventional respiratory therapy, compared to
BiPAP group (BG) (in addition to conventional respiratory therapy the
patients were subjected to 30 minutes of ventilation by two levels twice a
day). The conventional respiratory therapy was held in both groups, twice
a day. All patients were evaluated for vital capacity, airway
permeability, maximal respiratory pressures, oxygen saturation, heart
rate, respiratory frequency, Volume Minute, tidal volume, systolic and
diastolic blood pressure. Evaluations were performed during
hospitalization preoperatively, immediately after extubation, 24h and 48h
after extubation. Results: In CG 61.5% of patients had some degree of
atelectasias, in comparison to 54% of BG (P=0.691). The vital capacity was
higher in the GB postoperatively (P<0.015). All the other ventilometric,
gasometric, hemodynamic and manometric parameters were similar between
groups. Conclusion: Coronary artery bypass grafting leads to deterioration
of respiratory function postoperatively, and the application of positive
pressure ventilation (BiPAP) may be beneficial to restore lung
function more quickly, especially vital capacity, safely, and well
accepted by patients due to greater comfort with the sensation of pain
during the execution of respiratory therapy.

<17>
Accession Number
70832744
Authors
Van Herpe T. Mesotten D. Wouters P.J. Herbots J. Voets E. Buyens J. De
Moor B. Van Den Berghe G.
Institution
(Van Herpe, Mesotten, Wouters, Herbots, Voets, Buyens, Van Den Berghe)
Department Intensive Care Medicine, KU Leuven, Leuven, Belgium
(Van Herpe, De Moor) Department of Electrical Engineering-ESAT, SCD-SISTA,
KU Leuven Leuven, Heverlee, Belgium
Title
LOGIC-insulin algorithm-guided versus nurse-directed blood glucose control
during critical illness: The LOGIC-1 single-center randomized controlled
clinical trial.
Source
Endocrine Reviews. Conference: 94th Annual Meeting and Expo of the
Endocrine Society, ENDO 2012 Houston, TX United States. Conference Start:
20120623 Conference End: 20120626. Conference Publication: (var.pagings).
33 (3 MeetingAbstracts) , 2012. Date of Publication: June 2012.
Publisher
Endocrine Society
Abstract
Background: Tight blood glucose control in critically ill patients is
difficult and labor intensive, resulting in poor glycemic control efficacy
and an increased hypoglycemia rate. The LOGIC-Insulin computerized
algorithm has been developed to assist nurses in titrating insulin to
maintain blood glucose levels between 80-110 mg/dL and to avoid severe
hypoglycemia (<40 mg/dL). Methods: In the LOGIC-1 randomized,
single-center trial, 300 patients (heterogeneous mix of post-cardiac
surgery, other surgical and medical ICU admissions) were randomized, by
concealed computer allocation, to nurse-directed glycemic control
(Nurse-C) or to algorithm-guided blood glucose control (LOGIC-C). Results:
The baseline characteristics of 151 Nurse-C patients and 149 LOGIC-C
patients did not differ (age: 62+/-14 y vs 65+/-15 y, 61.6% vs 59.1% male,
21.2% vs 21.5% diabetes, APACHE-II: 21 (IQR 14-33) vs 19 (IQR 14-32)).
Study time was 1.9 (IQR 1.1-3.7) days for Nurse-C and 1.9 (IQR 1.2-4.7)
days for LOGIC-C (P=0.42). The mean blood glucose levels did not differ
between the 2 groups (Nurse-C: 106+/-11 mg/dL, LOGIC-C: 106+/-9 mg/dL,
P=0.36). The Glycemic Penalty Index, a marker of efficacy of blood glucose
control, decreased from 12.3 (IQR 8.2-18.5) in Nurse-C to 9.8 (IQR
6.0-14.5) in LOGIC-C (P<0.0001). The HyperGlycemic Index was also lower in
LOGIC-C (2.5 (IQR 1.2-4.4) mg/dL), compared with Nurse-C (4.2 (IQR
1.5-7.3) mg/dL) (P=0.0028). The proportion of study time spent in the
target range of 80-110 mg/dL was higher for LOGIC-C (68.5+/-16.7%) than
for Nurse-C patients (60.1+/-18.8%) (P=0.00016). The mean daily difference
between the min and the max blood glucose level, a marker of glycemic
variability, was lower in LOGIC-C (31 (IQR 24-45) mg/dL) than in Nurse-C
(37 (IQR 27-46) mg/dL) (P=0.045). The proportion of hypoglycemic
measurements <40 mg/dL was decreased (Nurse-C 0.13%, LOGIC-C 0%, P=0.015),
but not when considered as a proportion of patients (Nurse-C 3.3%, LOGIC-C
0%, P=0.060). However, the interval between blood glucose measurements, a
marker of workload, was slightly shorter in LOGIC-C (2.2+/-0.4 h),
compared with Nurse-C (2.5+/-0.5 h) (P<0.0001). Conclusion s: The
computerized algorithm LOGIC-Insulin improved the efficacy of blood
glucose control without increasing the rate of hypoglycemia in comparison
with blood glucose control by the expert Leuven nursing team.