EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 15

Results Generated From:
Embase <1980 to 2012 Week 39>
Embase (updates since 2012-09-21)

<1>
Accession Number
2012546388
Authors
Vasques F. Lucenteforte E. Paone R. Mugelli A. Biancari F.
Institution
(Vasques, Paone, Biancari) Deptment of Surgery, Oulu University Hospital,
PO Box 21, 90029 Oulu, Finland
(Lucenteforte, Mugelli) Deptment of Preclinical and Clinical Pharmacology,
M. Aiazzi Mancini, University of Florence, Florence, Italy
Title
Outcome of patients aged >=80 years undergoing combined aortic valve
replacement and coronary artery bypass grafting: A systematic review and
meta-analysis of 40 studies.
Source
American Heart Journal. 164 (3) (pp 410-418.e1), 2012. Date of
Publication: September 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Aim: This study was planned to evaluate the outcome of patients aged >=80
years undergoing combined conventional aortic valve replacement (AVR) and
coronary artery bypass grafting (CABG). Methods: This is a systematic
review of the literature and meta-analysis of data on patients aged >=80
years who underwent combined AVR and CABG. Results: The literature search
yielded 40 observational studies reporting on 8,975 patients aged >=80
years. Pooled proportion of immediate postoperative mortality was 9.7%
(95% CI 8.4-11.1, 40 studies, 8,975 patients). Immediate mortality was
8.2% (95% CI 6.5-10.0) in 15 studies with a mid-date from 2000 to 2007 and
10.8% (95% CI 9.1-12.7) in 25 studies with a mid-date from 1982 to 1999 (P
=.043). Postoperative stroke rate was 3.7% (95% CI 2.8-4.8, 12 studies,
2,770 patients), and postoperative implantation of pacemaker was 4.3% (95%
CI 2.6-6.5, 5 studies, 535 patients). The mean length of stay in intensive
care unit was 5.3 days (95% CI 3.3-7.3, 5 studies, 490 patients), and the
mean length of in-hospital stay was 16.9 days (95% CI 12.4-21.4, 5
studies, 424 patients). One-, 3-, 5- and 10-year pooled survival rates
after combined AVR and CABG were 83.2%, 72.9%, 60.8%, and 25.7%,
respectively. Conclusions: Conventional AVR and CABG in patients aged >=80
years are associated with significant operative mortality and morbidity as
well as prolonged in-hospital treatment. However, conventional surgery is
associated with remarkably good late survival. This suggests that any
alternative treatment modality must prove itself of being enough durable
also in the very elderly. 2012 Mosby, Inc. All rights reserved.

<2>
Accession Number
2012543435
Authors
Vermeltfoort I.A.C. Teule G.J.J. van Dijk A.B. Muntinga H.J. Raijmakers
P.G.H.M.
Institution
(Vermeltfoort, Teule, van Dijk) Department of Nuclear Medicine, Verbeeten
Institute, PO Box 90120, 5000 LA Tilburg, Netherlands
(Muntinga) Department of Cardiology, Tweesteden Hospital, Dr Deelenlaan 5,
5042 AD Tilburg, Netherlands
(Raijmakers) Department of Nuclear Medicine and PET Research, VU
University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands
Title
Long-term prognosis of patients with cardiac syndrome X: A review.
Source
Netherlands Heart Journal. 20 (9) (pp 365-371), 2012. Date of Publication:
September 2012.
Publisher
Bohn Stafleu van Loghum (P.O. Box 75971, Amsterdam 1070 A2, Netherlands)
Abstract
Aims Follow-up studies of patients with cardiac syndrome X (CSX) generally
report good prognosis. However, some recent studies report an adverse
outcome for women. Methods and results Structured literature search and
metaanalysis for studies regarding prognosis of cardiac syndrome X
patients. We identified 85 studies, ultimately selecting 16 for inclusion.
Meta-analysis yielded a pooled major cardiac event percentage of 1.5% per
5 years and a pooled vascular event percentage of 4.8% per 5 years (n=16
studies, n=1694 patients). Fourteen studies reported upon the recurrence
rate of angina pectoris: the pooled percentage of angina recurrence was
55% (n=1336 patients). Conclusion The present review of recent archival
literature demonstrates an overall major cardiac event rate of 1.5% per 5
years. Although this is an excellent prognosis for CSX patients, the
quality of life is impaired because of the high recurrence rate of angina
pectoris (55%). The Author(s) 2012.

<3>
Accession Number
2012543432
Authors
Ghani A. Dambrink J.-H.E. van't Hof A.W.J. Ottervanger J.P. Gosselink
A.T.M. Hoorntje J.C.A.
Institution
(Ghani, Dambrink, van't Hof, Ottervanger, Gosselink, Hoorntje) Department
of Cardiology, Isala klinieken, Groot Wezenland 20, 8011 JW, Zwolle,
Netherlands
Title
Treatment of non-culprit lesions detected during primary PCI: Long-term
follow-up of a randomised clinical trial.
Source
Netherlands Heart Journal. 20 (9) (pp 347-353), 2012. Date of Publication:
September 2012.
Publisher
Bohn Stafleu van Loghum (P.O. Box 75971, Amsterdam 1070 A2, Netherlands)
Abstract
Background There are conflicting data regarding optimal treatment of
non-culprit lesions detected during primary percutaneous coronary
intervention (PCI) in patients with ST-elevation myocardial infarction
(STEMI) and multi-vessel disease (MVD). We aimed to investigate whether
ischaemia-driven early invasive treatment improves the long-term outcome
and prevents major adverse cardiac events (MACE). Methods 121 patients
with at least one non-culprit lesion were randomised in a 2:1 manner, 80
were randomised to early fractional flow reserve (FFR)-guided PCI
(invasive group), and 41 to medical treatment (conservative group). The
primary endpoint was MACE at 3 years. Results Three-year follow-up was
available in 119 patients (98.3 %). There was no significant difference in
all-cause mortality between the invasive and conservative strategy, 4
patients (3.4 %) died, all in the invasive group (P=0.29). Re-infarction
occurred in 14 patients (11.8 %) in the invasive group versus none in the
conservative group (p=0.002). Re-PCI was performed in 7 patients (8.9 %)
in the invasive group and in 13 patients (32.5 %) in the conservative
group (P=0.001). There was no difference in MACE between these two
strategies (35.4 vs 35.0 %, p=0.96). Conclusions In STEMI patients with
MVD, early FFR-guided additional revascularisation of the non-culprit
lesion did not reduce MACE at three-year follow-up compared with a more
conservative strategy. The rate of MACE in the invasive group was
predominantly driven by death and re-infarction, whereas in the
conservative group the rate of MACE was only driven by repeat
interventions. Springer Media / Bohn Stafleu van Loghum 2012.

<4>
Accession Number
2012539842
Authors
Samantaray A. Rao M.H. Chandra A.
Institution
(Samantaray, Rao) Department of Anaesthesiology and Critical Care, Sri
Venkateswara Institute of Medical Sciences, SVIMS University, Tirupati,
Andhra Pradesh, Pin - 517 507, India
(Chandra) Departments of Cardiovascular and Thoracic Surgery, Sri
Venkateswara Institute of Medical Sciences, SVIMS University, Tirupati,
Andhra Pradesh, India
Title
The effect on post-operative pain of intravenous clonidine given before
induction of anaesthesia.
Source
Indian Journal of Anaesthesia. 56 (4) (pp 359-364), 2012. Date of
Publication: July/August 2012.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background: Treatment of acute post-thoracotomy pain is particularly
important not only to keep the patient comfortable but also to minimize
pulmonary complications. Aim: This study was designed to test the effect
of pre-induction administration of clonidine, given as a single
intravenous dose, on post-operative pain scores and fentanyl consumption
in patients after thoracic surgery. Setting and Design: Tertiary referral
centre. Prospective, randomised, double-blind, placebo-controlled trial.
Methods: Sixty patients were randomly allocated to receive clonidine (3
mcg/kg) or saline pre-operatively before induction of anaesthesia. The
primary endpoint was pain on coughing (visual analogue scale (VAS) 0-100
mm) 120 min after surgery, time to first analgesic injection in the
post-anaesthesia care unit (PACU) and 24-h fentanyl consumption.
Statistical Analysis: For between-group comparisons, t-test and U-test
were used as appropriate after checking normality of distribution. The
incidence of complications between the groups was compared by Fisher's
exact test. Results: The post-operative VAS for the first 120 min and the
fentanyl consumption at 24 h was significantly greater in the placebo
group compared with the clonidine group (P<0.05). The sedation score was
increased in the clonidine group during study drug infusion, but did not
differ significantly on admission to the PACU. Conclusions: A single
intravenous dose of clonidine (3 mcg/kg) given before induction of
anaesthesia significantly reduced the post-operative VAS score in the
initial period and fentanyl consumption during 24 h after thoracic
surgery.

<5>
Accession Number
2012533866
Authors
Abicht J.-M. Beiras-Fernandez A. Bengel D. Vicol C.
Institution
(Abicht) Department for Anaesthesiology, Ludwig-Maximilians-Universitat
Munchen, Marchioninistrase 15, 81377 Munich, Germany
(Bengel, Vicol) Department of Cardiac Surgery, Ludwig Maximilian
University of Munich, Munich, Germany
(Beiras-Fernandez) Department of Cardiothoracic and Vascular Surgery,
Goethe University Frankfurt, Frankfurt am Main, Germany
Title
Deep pericardial traction suture versus vacuum-assisted apical suction to
expose the posterior wall of the heart in off-pump coronary artery bypass:
A prospective, randomized study.
Source
Heart Surgery Forum. 15 (4) (pp E224-E231), 2012. Date of Publication:
August 2012.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Displacement of the heart to expose the posterior vessels
during off-pump coronary artery bypass (OPCAB) may cause hemodynamic
instability. Deep pericardial traction suture (DPTS) and vacuum-assisted
apical suction (VAS) with the Starfish positioning device help to provide
good exposure without relevant hemodynamic changes. Our aim was to compare
these two methods in patients undergoing multivessel OPCAB. Methods: We
prospectively randomized 20 patients undergoing multivessel OPCAB to the
use of VAS or DPTS. The Octopus device was used in both groups to
stabilize the target vessel. Hemodynamic parameters, including venous
oxygen content (SvO₂), cardiac index (CI), central venous
pressure (CVP), mean arterial pressure (MAP), pulmonary artery pressure
(PAP), and pulmonary capillary wedge pressure (PCWP), were measured before
grafting (baseline), after heart positioning, and during performance of
peripheral anastomoses. Results: Perioperative data for the two groups
were similar. During exposure of the lateral wall, there were fewer
hemodynamic changes in the DPTS group (increase in CVP) than in the VAS
group (increases in CVP, PAP, and PCWP); the CVP was significantly higher
in the DPTS group (P < .05). During exposure of the posterior wall,
significant hemodynamic changes occurred only in the DPTS group (increase
in PCWP). Values for all other parameters were similar, including
anastomosis time, graft flow, postoperative myocardial enzymes, and
inotropic support. Conclusions: Heart positioning during OPCAB with either
VAS or DPTS is a safe and effective maneuver for exposure of coronary
arteries. In our study, the use of the VAS device produced less
hemodynamic impairment during exposure of the lateral and posterior walls.
2012 Forum Multimedia Publishing, LLC.

<6>
Accession Number
2012543531
Authors
Wang M.S. Lang X.L. Cui S.T. Fei K. Zou L.J. Cao J. Wang L.X. Zhang S.H.
Wu X.T. Wang Y.L. Ji Q.
Institution
(Wang) Department of Thoracic Cardiovascular Surgery, Xinhua Hospital of
Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
(Lang, Zou) Department of Cardiothoracic Surgery, Changhai Hospital,
Second Military Medical University, Shanghai 200433, China
(Cui) Department of Emergency Surgery, Ninth People's Hospital of Shanghai
Jiaotong University School of Medicine, Shanghai 200072, China
(Fei) Department of Thoracic Surgery, Pulmonary Hospital of Tongji
University, Shanghai 200433, China
(Cao, Wang, Zhang, Wu, Wang) Department of Thoracic Cardiovascular
Surgery, Tenth People's Hospital of Tongji University, Shanghai 200072,
China
(Ji) Department of Thoracic Cardiovascular Surgery, Tongji Hospital of
Tongji University, Shanghai 200065, China
Title
Clinical application of pharmacogenetic-based warfarin-dosing algorithm in
patients of han nationality after rheumatic valve replacement: A
ran-domized and controlled trial.
Source
International Journal of Medical Sciences. 9 (6) (pp 472-479), 2012. Date
of Publication: 2012.
Publisher
Ivyspring International Publisher (POBox 9338, Wyoming, New South Wales
2250, Australia)
Abstract
Background The polymorphisms of VKORC1 and CYP2C9 play increasingly
important roles in the inter-individual variability in warfarin dose. This
study aimed to evaluate the fea-sibility of clinical application of
pharmacogenetic-based warfarin-dosing algorithm in patients of Han
nationality with rheumatic heart disease after valve replacement in a
randomized and controlled trial. Methods One hundred and one consecutive
patients of Han nationality with rheumatic heart disease undergoing valve
surgery were enrolled and randomly assigned to an experimental group
(n=50, based on CYP2C9 and VKORC1 genotypes, pharmacogenet-ic-based
"predicted warfarin dose" for 3 days and then was adjusted to INR until
stable warfarin maintenance dose) or a control group (n=51, 2.5mg/d for 3
days and then was ad-justed to INR until stable warfarin maintenance
dose). All included patients were followed for 50 days after initiation of
warfarin therapy. The primary end-point was the time to reach a stable
warfarin maintenance dose. Results During the follow-up, 84.0% patients in
the ex-perimental group and 58.8% patients in the control group received
warfarin maintenance dose. Compared with control group, patients in the
experimental group had shorter mean time elapse from initiation of
warfarin therapy until warfarin maintenance dose (27.5+/-1.8 d versus
34.7+/-1.8 d, p<0.001). Cox regression revealed that group (HR for
experimental versus control group: 1.568, 95%CI 1.103-3.284) and age were
two significant variables related to the time elapse from initiation of
warfarin therapy until warfarin maintenance dose. The predicted warfarin
maintenance dose was prominently correlated with the actual warfarin
maintenance dose (r=0.684, p<0.001). Conclusion: Based on CYP2C9 and
VKORC1 genotypes, the pharmacogenetic-based warfarin-dosing algorithm may
shorten the time elapse from initiation of warfarin therapy until warfarin
maintenance dose. It is feasible for the clinical application of the
pharmacogenetic-based warfarin-dosing algorithm in patients of Han
nationality with rheumatic heart disease after valve replacement.
Ivyspring International Publisher.

<7>
Accession Number
2012540821
Authors
Emir M. Kunt A.G. Cicek M. Bozok S. Karakisi S.O. Uguz E. Hidiroglu M.
Cetin L. Sener E.
Institution
(Emir, Bozok, Karakisi, Sener) Department of Cardiovascular Surgery, Recep
Tayyip Erdogan University Faculty of Medicine, Training and Research
Hospital, Rize, Turkey
(Kunt, Cicek, Uguz, Hidiroglu, Cetin) Department of Cardiovascular
Surgery, Yildirim Beyazit Univ. Faculty of Medicine, Ankara Ataturk
Training and Research Hospital, Ankara, Turkey
Title
Sequential radial artery for coronary artery bypass grafting: Five-year
follow-up and evaluation with multi-detector row computed tomography.
Source
Cardiovascular Revascularization Medicine. 13 (5) (pp 272-276), 2012. Date
of Publication: September 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
This study was undertaken to compare early postoperative results,
programmed multi-detector row computed tomography coronary angiographic
patency and midterm results of revascularization by sequential radial
artery grafting with those of single radial artery grafting during a
five-year period. Patients were grouped as those with sequential radial
artery grafts (Group A, n = 27) and single radial artery grafts (Group B,
n = 26). Multi-detector row computed tomography coronary angiography was
scheduled at 1 and 5. years postoperatively. Each distal anastomosis was
accepted as nonfunctional if a radial artery graft was occluded proximally
or there was a critical stenosis. One sequential radial artery graft and
two single radial artery grafts failed in the 1-year period (p>. 0.05). In
the 5-year period, three radial artery grafts failed in each group (p>.
0.05). In Group A, there was no mortality in the five-year period, but in
Group B, one patient died four years after the operation due to cardiac
problems (p>. 0.05). In addition to one death in Group B, there were three
percutaneous interventions and two myocardial infarctions among the 26
patients during the five-year follow-up. In group A, among 27 patients,
there were 4 percutaneous interventions and one myocardial infarction (p>.
0.05). Although the sample size is relatively small to be conclusive,
these data suggest that sequential radial artery grafting may be
considered as a method of choice for maximizing arterial graft survival
and patency. Noninvasive control of sequential and single radial artery
grafts with multi-detector row computed tomography is feasible with no
discomfort for the patient and excellent visualization of grafts. 2012.

<8>
Accession Number
2012535877
Authors
Hellstrom J. Owall A. Sackey P.V.
Institution
(Hellstrom, Owall) Institution of Molecular Medicine and Surgery, Section
of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet,
Stockholm, Sweden
(Sackey) Institution of Physiology and Pharmacology, Section of
Anesthesiology and Intensive Care Medicine, Karolinska Institutet,
Stockholm, Sweden
Title
Wake-up times following sedation with sevoflurane versus propofol after
cardiac surgery.
Source
Scandinavian Cardiovascular Journal. 46 (5) (pp 262-268), 2012. Date of
Publication: October 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objectives. Intravenous sedation in the intensive care unit (ICU) may
contribute to altered consciousness and prolonged mechanical ventilation.
We tested the hypothesis that replacing intravenous propofol with inhaled
sevoflurane for sedation after cardiac surgery would lead to shorter
wake-up times, quicker patient cooperation, and less delusional memories.
Design. Following coronary artery bypass surgery with cardiopulmonary
bypass, 100 patients were randomized to sedation with sevoflurane via the
anesthetic conserving device or propofol. Study drugs were administered
for a minimum of 2 hours until criteria for extubation were met. Primary
endpoints were time from drug stop to extubation and to adequate verbal
response. Secondary endpoints were adverse recovery events, memories
reported in the ICU Memory Tool test, and ICU/hospital stay. Results.
Median time from drug stop to extubation (interquartile range/total range)
was shorter after sevoflurane compared to propofol sedation; 10 (10/100)
minutes versus 25 (21/240) minutes (p <0.001). Time from extubation to
adequate verbal response was shorter (p 0.036). No differences were found
in secondary endpoints. Conclusions. Sevoflurane sedation after cardiac
surgery leads to shorter wake-up times and quicker cooperation compared to
propofol. No differences were seen in ICU-stay, adverse memories or
recovery events in our short-term sedation. 2012 Informa Healthcare.

<9>
Accession Number
2012535876
Authors
Juhl A.A. Koudahl V. Damsgaard T.E.
Institution
(Juhl, Koudahl, Damsgaard) Department of Plastic Surgery, Aarhus
University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark
Title
Deep sternal wound infection after open heart surgery reconstructive
options.
Source
Scandinavian Cardiovascular Journal. 46 (5) (pp 254-261), 2012. Date of
Publication: October 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objectives. The management of sternal defects arisen after deep sternal
wound infection is challenging and often requires extensive
interdisciplinary teamwork between plastic and thoracic surgeons. In this
study, the published literature on methods used to reconstruct sternal
defects arisen as a result of deep sternal wound infection after
open-heart surgery will be reviewed. Design. The Cochrane, Embase, PubMed,
and SveMed databases were searched in December 2011. Only papers regarding
treatment of deep sternal wound infection after open-heart surgery in
adults were included. Results. The literature search identified 224
original papers that met the inclusion criteria. The majority dealt with
surgical techniques. None of the studies regarding reconstructive options
were designed as randomized controlled trials, and the levels of evidence
are generally low. Conclusion. The treatment of deep sternal wound
infection has evolved considerably, but there is still little consensus
regarding optimal surgical management and a general lack of a standard
treatment protocol. The use of muscle flap transposition is well
documented. Recent studies recommend the use of topical negative pressure
therapy as an adjunct to surgical reconstruction. 2012 Informa
Healthcare.

<10>
Accession Number
2012538110
Authors
Martins G.F. Filho A.G.S. Santos J.B.F. Assuncao C.R.C. Vieira F.B.
Valencia A. de Carvalho K.G. Jessen B.
Institution
(Martins, Filho, Santos, Assuncao, Vieira, Valencia, de Carvalho, Jessen)
Instituto de Cardiologia Aloysio de Castro, Rio de Janeiro, RJ, Brazil
(Martins, Filho, Santos, Assuncao, Vieira, Valencia, de Carvalho, Jessen)
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
Title
Trimetazidine and inflammatory response in coronary artery bypass
grafting.
Source
Arquivos Brasileiros de Cardiologia. 99 (2) (pp 688-696), 2012. Date of
Publication: August 2012.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Background: Organic inflammatory response is a pathophysiological
mechanism present at every coronary artery bypass grafting with
extracorporeal circulation (CABG ECC), the release of inflammatory
mediators being one of itsdefense mechanisms. Objective: To assess, in a
prospective double-blind randomized and placebo-controlled study, the
effects of trimetazidine (Tmz) on the inflammatory response, by using the
variation in interleukins 6 and 8, TNF-alpha, complements C3 and C5, and
highly sensitive C-reactive protein (HS-CRP) levels in the pre- and
post-operative periods. Methods: This study assessed 30 patients
undergoing CABG-ECC with intermittent hypothermic cardioplegia, and
having, at most, mild ventricular dysfunction. The patients were divided
into two groups (placebo and Tmz), stratified by echocardiography, and
received drug/placebo at the dose of 60 mg/day. Measurements were taken as
follows: in the pre-operative period with no drug; on the day of surgery,
corresponding to 12 to 15 days on drug/placebo; five minutes after aortic
unclamping; 12 and 24 hours after surgery, for interleukins and
complements; and 48 hours after surgery, for HS-CRP. Results: No
significant difference between the levels of interleukin 8, TNF-alpha, C3
and C5, and HS-CRP was observed. However, the interleukin 6 levels were
significantly lower in the group treated as compared with those in the
control group at all time points assessed. Conclusion: Trimetazidine
proved to be effective only for reducing interleukin 6 in patients
undergoing CABG.

<11>
Accession Number
2012537302
Authors
Li J. Zheng H.
Institution
(Li, Zheng) Department of Anesthesia, The First Hospital, Xinjiang Medical
University, Xin Jiang 830054, China
Title
Influence of myocardial injury markers on the mortality after coronary
artery bypass grafting: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 12 (7) (pp 777-784), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To evaluate the influences of myocardial injury markers on the
short-term and long-term mortality after coronary artery bypass grafting
(CABG), so as to provide valuable references for clinical prognosis
assessment. Methods Literature was electronically searched in CBM, PubMed,
OVID, EMbase and CNKI from the date of their establishment to August 2011,
meanwhile the manual searches were also performed to systemize the papers.
According to the Cochrane Handbook for systematic reviews, the studies
were screened by two reviewers independently, the quality of the included
studies was evaluated, the data were extracted, and meta-analysis was
conducted using RevMan5.0 software. Results A total of 10 observational
studies including creatine kinase-myocardial band (CK-MB) and cardiac
troponin I (cTnI), and the patients involved were 10 793 totally. Results
of meta-analysis showed that the increasing release of CK-MB was
associated with an increasing short-term mortality risk of both on-pump
(RR=2.88, 95%CI 1.94 to 4.28, P<0.000 01) and off-pump group (RR=3.64,
95%CI 1.07 to 12.42), P=0.04). Also the increasing release of CK-MB was
associated with an increasing long-term mortality risk of both on-pump
(RR=2.55, 95%CI 1.91 to 3.40, P<0.000 01) and offpump group (RR=3.36,
95%CI1.46 to 7.72, P=0.004). The increasing release of cTnI was also
associated with an increasing risk of both short-term mortality (RR=6.45,
95%CI 2.50 to 16.66, P<0.1) and long-term mortality (RR=4.18, 95%CI 2.78
to 6.28, P<0.1). Conclusion The evidence shows that the increasing release
of both CK-MB and cTnI is associated with an increasing risk of the
short-term and long-term mortality. 2012 Editorial Board of Chin J
Evid-based Med.

<12>
Accession Number
2012536473
Authors
Ben-Dor I. Dvir D. Barbash I.M. Okubagzi P. Torguson R. Xue Z. Lindsay J.
Satler L.F. Pichard A.D. Waksman R.
Institution
(Ben-Dor, Dvir, Barbash, Okubagzi, Torguson, Xue, Lindsay, Satler,
Pichard, Waksman) Division of Cardiology, Washington Hospital Center,
Washington, DC, United States
Title
Outcomes of patients with severe aortic stenosis at high surgical risk
evaluated in a trial of transcatheter aortic valve implantation.
Source
American Journal of Cardiology. 110 (7) (pp 1008-1014), 2012. Date of
Publication: 01 Oct 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Recent randomized clinical trials have demonstrated that transcatheter
aortic valve implantation (TAVI) reduces mortality in high-risk patients
with aortic stenosis who are not candidates for aortic valve replacement
(AVR). In similar patients who are acceptable candidates for AVR, TAVI
provides equivalent outcomes to AVR. In this study, 900 patients with
severe aortic stenosis at high surgical risk were evaluated as possible
candidates for TAVI. Of these, 595 (66.1%) had neither TAVI nor AVR and
constituted the medical arm. In addition to the best available
conservative care, 345 patients (39.3%) in this group had balloon aortic
valvuloplasty. The AVR arm consisted of 146 patients (16.2%) and the TAVI
arm of 159 patients (17.6%). The AVR group had significantly lower
clinical risk compared to the medical and TAVI groups, with lower mean
age, Society of Thoracic Surgeons score, and logistic European System for
Cardiac Operative Risk Evaluation score. Patients in the medical and
balloon aortic valvuloplasty group had significantly higher B-type
natriuretic peptide levels compared to those in the AVR and TAVI groups
and had, on average, lower ejection fractions. The medical and balloon
aortic valvuloplasty group was followed for a median of 206 days; the
mortality rate was 46.6% (n = 277). The AVR group was followed for 628
days; 39 patients died (26.7%). In 399 days of follow-up, the mortality
rate in the TAVI group was 30.8% (n = 49). In conclusion, patients with
severe AS who did not undergo TAVI or AVR had high mortality. In properly
selected patients, TAVI and AVR improve outcomes. Renal failure is the
strongest correlate for adverse outcomes, irrespective of treatment group.
2012 Published by Elsevier Inc.

<13>
Accession Number
70878755
Authors
Huang A. Mallet L.
Institution
(Huang) Geriatric Medicine, McGill University Health Centre, Montreal, QC,
Canada
(Mallet) University of Montreal, Faculty of Pharmacy, Montreal, QC, Canada
Title
The medication reconciliation process: Keys to success.
Source
European Geriatric Medicine. Conference: 8th Congress of the European
Union Geriatric Medicine Society Brussels Belgium. Conference Start:
20120926 Conference End: 20120928. Conference Publication: (var.pagings).
3 (pp S113), 2012. Date of Publication: September 2012.
Publisher
Elsevier Masson SAS
Abstract
Introduction.- The medication reconciliation process is a required
organizational practice mandated by the hospital accreditation
organizations in both Canada and the United States. However, the evidence
of the effectiveness and efficiency of this intervention as a standard
operating procedure across a general hospital, for all patients is
questionable. Method.- Cluster randomized controlled trial in two adult
sites within an academic hospital. Five service pairs = Geriatrics,
General Internal Medicine, General Surgery, Cardiac/Thoracic Surgery and
Urology/ENT/Vascular Surgery. Cohort = 3714 adults who are covered by the
provincial drug insurance plan, admitted to the study sites. Study
initiated February 2012. Intervention = use of a customdeveloped web
application which electronically collects both the medications dispensed
in the community and the active hospital medications profile. The
application also includes a computerassisted tool to validate the
community medications, generate the best possible medication history,
perform a reconciliation against the in-hospital list and generate a
discharge prescription. On discharge, communication of stops, changes and
additions to the community medication list is sent to the dispensing
pharmacies and prescribing physicians. Outcome = decreased in adverse
events, return to Emergency Department and readmission to hospital 30-
days post discharge compared to controls. Results.- Preliminary data
showed that pharmacists spent 88+/-38 min completing the best possible
medication history and physicians spent 28+/-23 min doing medication
reconciliation and generating a final discharge prescription. Conclusion.-
Once full results are obtained and the analyses are completed better
targeting parameters (patient, service, area) will be clarified, to make
best use of this important intervention to improve patient safety.

<14>
Accession Number
70878424
Authors
Ettema R. Van Koeven H. Peelen L. Schuurmans M.
Institution
(Ettema) Healthcare, University of Applied Science Utrecht, Utrecht,
Netherlands
(Van Koeven) Division of Anesthesiology, Intensive Care and Emergency
Medicine, University Medical Center Utrecht, Utrecht, Netherlands
(Peelen) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
(Schuurmans) Nursing Research, University Medical Center Utrecht, Utrecht,
Netherlands
Title
Preadmission interventions preventing postoperative complications in older
cardiac surgery patients: A systematic review of the literature.
Source
European Geriatric Medicine. Conference: 8th Congress of the European
Union Geriatric Medicine Society Brussels Belgium. Conference Start:
20120926 Conference End: 20120928. Conference Publication: (var.pagings).
3 (pp S8-S9), 2012. Date of Publication: September 2012.
Publisher
Elsevier Masson SAS
Abstract
Objective(s).- The literature on postoperative complications in cardiac
surgery patients shows high incidences of delirium, depression, pressure
ulcers, hospital infections, postoperative pulmonary complications and
atrial fibrillation. These complications are associated with functional
and cognitive decline and a decrease in the quality of life and well-being
after discharge. It is unclear how older cardiac surgery patients can best
be prepared for their hospital admission with cardiac surgery. Therefore,
we aimed to provide an overview of preadmission interventions designed to
prevent postoperative complications or adverse events in older elective
cardiac surgery patients. Methods.- We systematically reviewed the
literature following the PRISMA statement guidelines. Results.- of 1,335
initial citations, 31 were subjected to critical appraisal. Finally, 23
studies were included, of which we derived a list of interventions that
were applied in the preadmission period. These interventions, some ofwhich
are have multiple components, have been shown to effectively reduce
postoperative depression, infection and postoperative pulmonary
complications in older elective cardiac surgery patients. No studies of
good quality were found that described effective interventions to prevent
postoperative delirium.We did not find any studies that targeted the
prevention of pressure ulcers in older cardiac surgery patients.
Conclusions.- There are interventions that prevent the occurrence of
postoperative depression (comprehensive approaches), postoperative
pulmonary complications (comprehensive approach) and infection (combined
disinfection with CHX and immuneenhancing nutritional supplement) in older
patients undergoing cardiac surgery. Unfortunately, there are no studies
of strong or moderate evidence that have demonstrated effective strategies
preventing delirium or pressure ulcers in these patients.

<15>
Accession Number
70877999
Authors
Cholette J.M. Powers K.S. Alfieris G.M. Angona R. Henrichs K.F. Masel D.S.
Swartz M. Daugherty L.E. Belmont K. Blumberg N.
Institution
(Henrichs, Masel, Blumberg) Transfusion Medicine, University of Rochester
Medical Center, Rochester, NY, United States
(Cholette, Powers, Daugherty) Pediatrics, University of Rochester Medical
Center, Rochester, NY, United States
(Alfieris, Angona, Swartz, Belmont) Surgery, University of Rochester
Medical Center, Rochester, NY, United States
Title
Transfusion of salvaged blood in pediatric heart surgery reduces
allogeneic transfusions: A prospective, randomized trial.
Source
Transfusion. Conference: AABB Annual Meeting and CTTXPO 2012 Boston, MA
United States. Conference Start: 20121006 Conference End: 20121009.
Conference Publication: (var.pagings). 52 (pp 121A), 2012. Date of
Publication: September 2012.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: There are no randomized trials evaluating the
impact of blood conservation via intra-operative cell saver blood salvage
on post-operative allogeneic transfusion needs of newborns and infants. We
hypothesized that transfusion of salvaged blood from the bypass circuit,
washed and stored at the bedside in a simple temperature controlled cooler
for 24 hours post-operatively, would decrease the number of post-operative
allogeneic RBC transfusions and donor exposures without increasing the
risk of nosocomial infection. Study Design/Methods: A prospective,
randomized, controlled, clinical trial was conducted in the pediatric
cardiac intensive care unit of a teaching hospital. Neonates and infants
(n = 106) with congenital heart disease undergoing cardiac surgical repair
or palliation with cardiopulmonary bypass were randomized to a cell saver
transfusion group, where salvaged blood was available for re-infusion up
to 24 hours post-collection, or to a control group. Cell saver subjects
received salvaged blood for volume replacement and/or anemia therapy.
Control subjects received crystalloid or albumin for volume replacement
and RBCs for anemia with hemodynamic instability or impaired oxygen
utilization, per the current standard of care. Blood transfusions and
donor exposures, and clinical outcomes were compared between treatment
groups. Results/Findings: Children randomized to the cell saver group
received significantly fewer allogeneic RBC transfusions (cell saver: 0.19
+/- 0.44 [SD] vs. control: 0.75 +/- 1.2; p = 0.003) and
platelet/plasma/cryoprecipitate transfusions in the first 48 hours post-op
(cell saver: 0.09 +/- 0.45 vs. control: 0.62 +/- 1.4; p = 0.013). The
total number of allogeneic donor exposures over the entire hospitalization
was significantly less in the cell saver group when compared to controls
(cell saver: 0.83 +/- 1.7 v. control: 2.7 +/- 5.3; p = 0.018). There were
no significant clinical outcome differences. Conclusion: Cell saver
salvaged blood can be safely stored at the bedside and available for
re-infusion for up to 24 hours post-collection. Administration of cell
saver blood significantly reduces the number of allogeneic RBC and
hemostatic component transfusions in the immediate post-operative period
and reduces total donor exposures. Reduction of allogeneic blood
transfusions may also have the potential to reduce transfusion-associated
complications and improve clinical outcomes.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 18

Results Generated From:
Embase <1980 to 2012 Week 38>
Embase (updates since 2012-09-13)

<1>
Accession Number
2012520825
Authors
Ozarslan N.G. Ayhan B. Kanbak M. Celebiolu B. Demircin M. Ince C. Aypar U.
Institution
(Ozarslan, Ayhan, Kanbak, Celebiolu, Aypar) Faculty of Medicine,
Department of Anesthesiology and Reanimation, Hacettepe University, Shhye,
Ankara 06100, Turkey
(Demircin) Department of Cardiothoracic Surgery, Hacettepe University,
Ankara, Turkey
(Ince) Department of Translational Physiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
Title
Comparison of the effects of sevoflurane, isoflurane, and desflurane on
microcirculation in coronary artery bypass graft surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (5) (pp 791-798),
2012. Date of Publication: October 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: This investigation was performed to compare the effects of
inhalation agents on microcirculation in coronary artery bypass grafting
(CABG) using orthogonal polarization spectral imaging. Design: This
prospective and randomized study was performed in patients scheduled for
CABG surgery from March through September 2010. Setting: Tertiary care
university hospital. Participants: Thirty patients undergoing elective
CABG. Interventions: Patients were assigned to sevoflurane, desflurane, or
isoflurane. Measurements and Main Results: Orthogonal polarization
spectral imaging was used to evaluate the sublingual microcirculation.
Hemodynamic variables (heart rate, mean arterial pressure, central venous
pressure, cardiac output, and pulmonary capillary wedge pressure),
laboratory parameters (hematocrit, lactate, and potassium), and
microcirculatory variables (total vascular density [TVD]
[mm/mm²], microvascular flow index [MFI] [arbitrary units],
perfused vessel density [PVD] [mm/mm²], and proportion of
perfused vessels [PPV] [percentage] were obtained before induction, after
induction, during cardiopulmonary bypass, at the end of surgery, and 24
hours after surgery. The greatest alterations in microcirculation
parameters were found during cardiopulmonary bypass. In the sevoflurane
group, TVD (14.7%), PVD (22%), PPV (5.97%, p < 0.05), and MFI (7.69%, p >
0.05) were decreased. In the isoflurane group, TVD (14.7%) and PVD (20.3%)
were decreased, whereas PPV (1.69%) and MFI (17.99%) were increased (p <
0.05). In the desflurane group, there were no changes in TVD and PVD, but
MFI (8.99%, p > 0.05) and PPV (1.48%, p < 0.05) were increased in the
small vessels. These changes returned to their initial values 24 hours
postoperatively. Conclusions: Sevoflurane had a negative effect on the
microcirculation. Isoflurane decreased vascular density and increased
flow. Desflurane produced stable effects on the microcirculation. These
inhalation agents induced transient alterations in microvascular
perfusion. 2012 Elsevier Inc.

<2>
Accession Number
2012514412
Authors
Rodriguez A.E. Rodriguez-Granillo A.M. Antoniucci D. Mieres J.
Fernandez-Pereira C. Rodriguez-Granillo G.A. Santaera O. Rubilar B.
Palacios I.F. Serruys P.W.
Institution
(Rodriguez, Mieres, Fernandez-Pereira, Rodriguez-Granillo, Rubilar)
Cardiac Unit, Sanatorio Otamendi, Buenos Aires, Argentina
(Rodriguez, Rodriguez-Granillo) Centro de Estudios en Cardiologia
Intervencionista (CECI), Buenos Aires, Argentina
(Antoniucci) Careggi Hospital, Florence, Italy
(Santaera) Cardiac Unit, Clinica IMA, Buenos Aires, Argentina
(Palacios) Argentina Society for Cardiac Interventions (CACI), Buenos
Aires, Argentina
(Palacios) Massachusetts General Hospital, Boston, MA, United States
(Serruys) Cardialysis, Rotterdam, Netherlands
Title
Randomized comparison of cost-saving and effectiveness of oral rapamycin
plus bare-metal stents with drug-eluting stents: Three-year outcome from
the randomized oral rapamycin in Argentina (ORAR) III trial.
Source
Catheterization and Cardiovascular Interventions. 80 (3) (pp 385-394),
2012. Date of Publication: 01 Sep 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives: The Oral Rapamycin in ARgentina (ORAR) III trial is a
randomized study comparing a strategy of oral rapamycin (OR) plus
bare-metal stent (BMS) versus a strategy of drug-eluting stents (DES) in
patients with de novo coronary lesions. The purpose of this study was to
assess the 3 years cost-effectiveness outcome of each strategy.
Background: OR after BMS has been associated with reduction of target
vessel revascularization (TVR) although its value in long-term efficacy in
comparison with DES is unknown. Methods: In three hospitals in Buenos
Aires, Argentina, 200 patients were randomized to OR plus BMS (n = 100) or
DES (n = 100). Primary objectives were costs and effectiveness. Cost
analysis included in-hospital and follow-up costs. Safety was defined as
the composite of death, myocardial infarction (MI), and stroke. Efficacy
was defined as TVR. Results: Baseline characteristics between groups were
similar. The 3-year follow-up rate was 99%. Cardiac mortality was 2% and
5% in OR group and DES group, respectively (P = 0.44). The composite of
death, MI and stroke rate was 11% in OR group and 20% in DES group (P =
0.078). TVR rate was 14.5% in OR group and 17.6% in DES group (P = 0.50),
respectively. Three year cumulative costs were significantly lower in the
OR arm as compared to the DES arm (P = 0.0001) and DES strategy did not
result cost-effective according to the non-inferiority test. Conclusions:
At 3 years follow-up, there were no differences in effectiveness between
the two strategies, and DES strategy was not more cost-effective as
compared to OR plus BMS. 2012 Wiley Periodicals, Inc.

<3>
Accession Number
2012519080
Authors
Almquist T. Jacobson S.H. Lins P.-E. Farndale R.W. Hjemdahl P.
Institution
(Almquist, Hjemdahl) Department Medicine Solna, Clinical Pharmacology
Unit, Karolinska University Hospital/Solna, Stockholm SE-171 76, Sweden
(Almquist, Jacobson) Department Clinical Sciences, Division Nephrology,
Danderyd Hospital, Stockholm, Sweden
(Lins) Department Clinical Sciences, Division Diabetology, Danderyd
Hospital, Stockholm, Sweden
(Farndale) Department Biochemistry, University of Cambridge, Cambridge,
United Kingdom
Title
Effects of lipid-lowering treatment on platelet reactivity and
plateletleukocyte aggregation in diabetic patients without and with
chronic kidney disease: A randomized trial.
Source
Nephrology Dialysis Transplantation. 27 (9) (pp 3540-3546), 2012. Date of
Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Background. Diabetes mellitus (DM) is associated with hyperreactive
platelets and increased plateletleukocyte aggregation (PLA), but the
impact of concomitant chronic kidney disease (CKD) has been much less
studied. Lipid-lowering treatment (LLT) may have favorable effects on
platelet activation and inflammation. The objective of this mechanistic
study was to investigate the impact of CKD on platelet function and
inflammatory parameters in patients with DM and the effects of LLT.
Methods. After a placebo run-in period, the effects of simvastatin alone
(S) or simvastatin ezetimibe (S E) were compared in a randomized,
double-blind, cross-over study on platelet reactivity, PLA formation and
inflammatory parameters. Eighteen DM patients with estimated glomerular
filtration rate (eGFR) 1559 mL/min x 1.73 m² (CKD stages 34)
(DM-CKD) and 21 DM patients with eGFR >75 mL/min (DM-only) were included.
Results. PLAs were elevated at baseline in DM-CKD compared with DM-only (P
= 0.04). S E reduced PLAs among total leukocytes and neutrophils in DM-CKD
patients (P = 0.01 for both) but not in the DM-only group. Platelet
reactivity did not differ between patient groups or with LLT. Plasma
levels of sCD40L (P < 0.001), elastase (P < 0.01) and von Willebrand
factor (VWF) (P < 0.001) were elevated in DM-CKD compared with DM-only. S
E reduced sCD40L in DM-CKD patients (P = 0.01), but LLT did not influence
VWF or elastase. Conclusions. DM patients with CKD stages 34 had increased
PLA and inflammatory activity compared with DM patients with normal GFR.
Simvastatin ezetimbe decreased PLAs and plasma sCD40L in DM patients with
concomitant CKD. Clinical Trial registrationhttp://www.clinicaltrials.gov.
Identifier NCT01035320. 2012 The Author.

<4>
Accession Number
22408037
Authors
Head S.J. Mokhles M.M. Osnabrugge R.L. Pibarot P. Mack M.J. Takkenberg
J.J. Bogers A.J. Kappetein A.P.
Institution
(Head) Department of Cardio-Thoracic Surgery, Erasmus University Medical
Center, Rotterdam, The Netherlands.
Title
The impact of prosthesis-patient mismatch on long-term survival after
aortic valve replacement: a systematic review and meta-analysis of 34
observational studies comprising 27 186 patients with 133 141
patient-years.
Source
European heart journal. 33 (12) (pp 1518-1529), 2012. Date of Publication:
Jun 2012.
Abstract
Numerous studies have linked prosthesis-patient mismatch (PPM) after
aortic valve replacement (AVR) to adverse outcomes. Its correlation with
long-term survival has been described but with contradicting results. This
systematic review and meta-analysis of observational studies aims to
determine the hazard of PPM after AVR. The Medline and EMBase databases
were searched for English-language original publications. Two researchers
independently screened studies and extracted data. Pooled estimates were
obtained by random effects model. Subgroup analyses were performed to
detect sources of heterogeneity. The search yielded 348 potentially
relevant studies; 34 were included comprising 27 186 patients and 133 141
patient-years. Defined by the universally accredited indexed effective
orifice area <0.85 cm(2)/m(2), 44.2% of patients were categorized as
having PPM. In 34.2 and 9.8% of patients moderate (0.65-0.85 cm(2)/m(2))
and severe (<0.65 cm(2)/m(2)) PPM was present, respectively.
Prosthesis-patient mismatch was associated with a statistically
significant increase in all-cause mortality (HR = 1.34, 95% CI:
1.18-1.51), but only a trend to an increase in cardiac-related mortality
(HR = 1.51, 95% CI: 0.88-2.60) was recognized. Analysis by severity of PPM
demonstrated that both moderate and severe PPM increased all-cause
mortality (HR = 1.19, 95% CI: 1.07-1.33 and HR = 1.84, 95% CI: 1.38-2.45)
and cardiac-related mortality (HR = 1.32, 95% CI: 1.02-1.71 and HR = 6.46,
95% CI: 2.79-14.97). Further analyses showed a consistent effect over
separate time intervals during follow-up. Prosthesis-patient mismatch is
associated with an increase in all-cause and cardiac-related mortality
over long-term follow-up. We recommend that current efforts to prevent PPM
should receive more emphasis and a widespread acceptance to improve
long-term survival after AVR.

<5>
Accession Number
2012526630
Authors
Johnston K. Stephens Dr. S.
Institution
(Johnston) College of Pharmacy, University of Utah, Salt Lake City, United
States
(Johnston) Pharmacy Practice Resident, University of Utah Health Care,
United States
(Stephens Dr.) Department of Pharmacotherapy, College of Pharmacy,
University of Utah, United States
Title
Effect of angiotensin-converting enzyme inhibitors and angiotensin
receptor blockers on risk of atrial fibrillation before coronary artery
bypass grafting.
Source
Annals of Pharmacotherapy. 46 (9) (pp 1239-1244), 2012. Date of
Publication: 20120901.
Publisher
Harvey Whitney Books Company (8044 Montgomery Road, Suite 415, Cincinnati
OH 45236, United States)
Abstract
OBJECTIVE: To review the primary literature evaluating the effect
preoperative use of angiotensin-converting enzyme (ACE) inhibitors and
angiotensin receptor blockers (ARBs) has on the risk of postoperative
atrial fibrillation following coronary artery bypass grafting (CABG). DATA
SOURCES: PubMed was searched from January 1, 2000, to May 17, 2012, using
the MeSH terms coronary artery bypass, angiotensin-converting enzyme
inhibitors, angiotensin receptor antagonists, and atrial fibrillation.
Additional articles were identified from the reference lists of the
articles identified in the PubMed search. STUDY SELECTION AND DATA
EXTRACTION: Abstracts from the PubMed search were screened for relevance
to the topic. Articles including information on the effect of ACE
inhibitors or ARBs on postoperative atrial fibrillation following CABG
were indentified for further review. Data extracted from these studies
included patient baseline characteristics, outcome definitions, incidence
of atrial fibrillation after CABG, and preoperative use of ACE inhibitors
or ARBs. DATA SYNTHESIS: The PubMed search resulted in 6 articles, 4 of
which were applicable to the clinical question. Four other articles were
identified from the reference lists of the applicable studies, resulting
in a literature review of 8 studies. These studies included patients
undergoing CABG with or without valve procedures. Four studies included
patients undergoing isolated CABG procedures; the remaining 4 included
patients undergoing CABG with a valve procedure. Information on
preoperative ACE inhibitor or ARB use was included in all studies. Two
studies suggested a decreased risk of postoperative atrial fibrillation
following CABG with preoperative ACE inhibitor or ARB therapy, 3 suggested
an increased risk, and 3 found no effect on risk. CONCLUSIONS: The studies
reviewed here had conflicting results. Randomized placebo-controlled
trials are necessary to determine the risk for atrial fibrillation after
CABG associated with preoperative use of ACE inhibitors and ARBs. The
decision to continue or withhold the drugs is not evidence-based and
should be based on a patient's other clinical characteristics.

<6>
Accession Number
2012524414
Authors
Jonsson A. Lehto M. Ahn H. Hermansson U. Linde P. Ahlsson A. Koistinen J.
Savola J. Raatikainen P. Lepojarvi M. Sahlman A. Werkkala K. Toivonen L.
Walfridsson H.
Institution
(Jonsson, Walfridsson) Department of Cardiology, Linkoping University
Hospital, Linkoping, Sweden
(Lehto, Toivonen) Department of Cardiology, Helsinki University Hospital,
Helsinki, Finland
(Ahn, Hermansson) Department of Cardiothoracic Surgery, Linkoping
University Hospital, Linkoping, Sweden
(Sahlman, Werkkala) Department of Cardiothoracic Surgery, Helsinki
University Hospital, Helsinki, Finland
(Linde) Department of Cardiology, Orebro University Hospital, Orebro,
Sweden
(Ahlsson) Department of Cardiothoracic Surgery, Orebro University
Hospital, Orebro, Sweden
(Koistinen) Department of Cardiology, Turku University Hospital, Turku,
Finland
(Savola) Department of Cardiothoracic Surgery, Turku University Hospital,
Turku, Finland
(Lepojarvi) Department of Cardiothoracic Surgery, Oulu University
Hospital, Oulu, Finland
(Raatikainen) Heart Center, Tampere University Hospital, Tampere, Finland
Title
Microwave ablation in mitral valve surgery for atrial fibrillation (MAMA).
Source
Journal of Atrial Fibrillation. 5 (2) , 2012. Date of Publication: August
2012.
Publisher
CardioFront LLC (135th St, Ste 264, Overland Park KS 66223, United States)
Abstract
Objective: Microwave ablation in conjunction with open heart surgery is
effective in restoring sinus-rhythm (SR) in patients with atrial
fibrillation (AF). In patients assigned for isolated mitral valve surgery
no prospective randomized trial has reported its efficacy. Methods: 70
patients with longlasting AF where included from 5 different centres. They
were randomly assigned to mitral valve surgery and atrial microwave
ablation or mitral valve surgery alone. Results: Out of 70 randomized, 66
and 64 patients were available for evaluation at 6 and 12 months. At 12
months SR was restored and preserved in 71.0% in the ablation group vs
36.4% in the control group (P=0.006), corresponding figures at 6 months
was 62.5% vs 26.5% (P=0.003). The 30-day mortality rate was 1.4%, with one
death in the ablation group vs zero deaths in the control group. At 12
months the mortality rate was 7,1% (Ablation n=3 vs Control n=2). No
significant differences existed between the groups with regard to the
overall rate of serious adverse events (SAE) during the perioperative
period or at the end of the study. 16% of patients randomized to ablation
were on antiarrhytmic drugs compared to 6% in the control group after 1
year (p=0.22) Conclusion: Microwave ablation of left and right atrium in
conjunction with mitral valve surgery is safe and effectively restores
sinus rhythm in patients with longlasting AF as compared to mitral valve
surgery alone.

<7>
Accession Number
2012520802
Authors
Landoni G. Zangrillo A. Cabrini L.
Institution
(Landoni, Zangrillo, Cabrini) Department of Cardiothoracic Anesthesia and
Intensive Care, Universita Vita-Salute San Raffaele, Istituto Scientifico
San Raffaele, Via Olgettina 60, Milano 20132, Italy
Title
Noninvasive ventilation after cardiac and thoracic surgery in adult
patients: A review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (5) (pp 917-922),
2012. Date of Publication: October 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)

<8>
[Use Link to view the full text]
Accession Number
2012525922
Authors
Kimura T. Morimoto T. Natsuaki M. Shiomi H. Igarashi K. Kadota K. Tanabe
K. Morino Y. Akasaka T. Takatsu Y. Nishikawa H. Yamamoto Y. Nakagawa Y.
Hayashi Y. Iwabuchi M. Umeda H. Kawai K. Okada H. Kimura K. Simonton C.A.
Kozuma K.
Institution
(Kimura, Natsuaki, Shiomi) Department of Cardiovascular Medicine, Kyoto
Univ Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto
606-8507, Japan
(Morimoto) Center for General Internal Medicine An Emergency Care, Kinki
University School of Medicine, Osaka, Japan
(Igarashi) Division of Cardiology, Hokkaido Social Insurance Hospital,
Hokkaido, Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Morino) Division of Cardiology, Tokai University Hospital, Kanagawa,
Japan
(Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University Hospital, Wakayama, Japan
(Takatsu) Division of Cardiology, Hyogo Prefectural Amagasaki Hospital,
Hyogo, Japan
(Nishikawa) Division of Cardiology, Mie Heart Center, Mie, Japan
(Yamamoto) Division of Cardiology, Iwaki Kyoritsu General Hospital, Iwaki,
Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Tenri, Japan
(Hayashi) Division of Cardiology, Tsuchiya General Hospital, Hiroshima,
Japan
(Iwabuchi) Division of Cardiology, Kokura Memorial Hospital, Kitakyushu,
Japan
(Umeda) Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan
(Kawai) Division of Cardiology, Chikamori Hospital, Kochi, India
(Okada) Division of Cardiology, Seirei Hamamatsu General Hospital,
Shizuoka, Japan
(Kimura) Division of Cardiology, Yokohama City Univ Medical Center,
Yokohama, Japan
(Simonton) Abbott Vascular, Abbott Park, IL, United States
(Kozuma) Division of Cardiology, Teikyo Univ Hospital, Tokyo, Japan
Title
Comparison of everolimus-eluting and sirolimus-eluting coronary stents:
1-year outcomes from the randomized evaluation of sirolimus-eluting versus
everolimus-eluting stent trial (RESET).
Source
Circulation. 126 (10) (pp 1225-1236), 2012. Date of Publication: 04 Sep
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Several recent randomized trials comparing everolimus-eluting
stent (EES) and sirolimus-eluting stent (SES) reported similar outcomes.
However, only 1 trial was powered for a clinical end point, and no trial
was powered for evaluating target-lesion revascularization. Methods and
Results-Randomized Evaluation of Sirolimus-eluting versus
Everolimus-eluting stent Trial is a prospective multicenter randomized
open-label trial comparing EES with SES in Japan. The trial was powered
for evaluating noninferiority of EES relative to SES in terms of
target-lesion revascularization. From February and July 2010, 3197
patients were randomly assigned to receive either EES (1597 patients) or
SES (1600 patients). At 1 year, the primary efficacy end point of
target-lesion revascularization occurred in 65 patients (4.3%) in the EES
group and in 76 patients (5.0%) in the SES group, demonstrating
noninferiority of EES to SES (P_{noninferiority}<0.0001, and
P_superiority=0.34). Cumulative incidence of definite stent
thrombosis was low and similar between the 2 groups (0.32% versus 0.38%,
P=0.77). An angiographic substudy enrolling 571 patients (EES, 285
patients and SES, 286 patients) demonstrated noninferiority of EES
relative to SES regarding the primary angiographic end point of in-segment
late loss (0.06+/-0.37 mm versus 0.02+/-0.46 mm,
P_{noninferiority}<0.0001, and P_superiority=0.24) at
278+/-63 days after index stent implantation. Conclusions-One-year
clinical and angiographic outcome after EES implantation was noninferior
to and not different from that after SES implantation in a stable coronary
artery disease population with relatively less complex coronary anatomy.
One-year clinical outcome after both EES and SES use was excellent with a
low rate of target-lesion revascularization and a very low rate of stent
thrombosis. Clinical Trial Registration-URL:
http://www.clinicaltrials.gov. Unique identifier: NCT01035450. 2012
American Heart Association, Inc.

<9>
Accession Number
2012520836
Authors
Landoni G. Rodseth R.N. Santini F. Ponschab M. Ruggeri L. Szekely A.
Pasero D. Augoustides J.G. Del Sarto P.A. Krzych L.J. Corcione A.
Slullitel A. Cabrini L. Le Manach Y. Almeida R.M.S. Bignami E.
Biondi-Zoccai G. Bove T. Caramelli F. Cariello C. Carpanese A. Clarizia L.
Comis M. Conte M. Covello R.D. De Santis V. Feltracco P. Giordano G.
Pittarello D. Gottin L. Guarracino F. Morelli A. Musu M. Pala G. Pasin L.
Pezzoli I. Paternoster G. Remedi R. Roasio A. Zucchetti M. Petrini F.
Finco G. Ranieri M. Zangrillo A.
Institution
(Landoni, Ruggeri, Cabrini, Bignami, Bove, Carpanese, Covello, Pasin,
Zangrillo) Department of Anesthesia and Intensive Care, Universita
Vita-Salute San Raffaele, Istituto Scientifico San Raffaele, via Olgettina
60, Milano 20132, Italy
(Rodseth) Department of Anaesthetics, Nelson R. Mandela School of
Medicine, University of KwaZulu-Natal, South Africa
(Rodseth) Department of Anaesthetics, Inkosi Albert Luthuli Central
Hospital, Durban, South Africa
(Santini) Division of Cardiac Surgery, University of Verona, Medical
School, Verona, Italy
(Ponschab) Department of Anaesthesia and Intensive Care, Trauma Hospital,
Linz, Linz, Austria
(Szekely) Department of Anesthesiology and Intensive Care, Semmelweis
University, Budapest, Hungary
(Pasero) Department of Anesthesia and Critical Care Medicine, San Giovanni
Battista Hospital, University of Turin, Turin, Italy
(Augoustides) Department of Anesthesiology and Critical Care, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Del Sarto) Department of Anesthesia, FTGM, G. Pasquinucci Heart Hospital,
Massa, Italy
(Krzych) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
(Corcione) Anesthesia and Intensive Care, AORN V. MONALDI, Naples, Italy
(Slullitel) Service of Anesthesia, Analgesia and Pain Management, Santa
Paula Hospital, Sao Paulo, Brazil
(Le Manach) Centre for Statistics in Medicine, Wolfson College Annexe,
University of Oxford, Oxford, United Kingdom
(Almeida) Department of Cardiology and Cardiovascular Surgery, Parana
Western State University, Cascavel, Parana, Brazil
(Biondi-Zoccai) Division of Cardiology, University of Modena, Reggio
Emilia, Modena, Italy
(Caramelli) Cardiothoracic and Vascular Anaesthesia and Intensive Care, S.
Orsola-Malpighi University Hospital, Bologna, Italy
(Cariello, Guarracino) Cardiothoracic Department, University Hospital of
Pisa, Pisa, Italy
(Clarizia) Sanitary Direction, National Association of Nurses in Critical
Care and Emergency (AISACE), Pordenone, Italy
(Comis) Cardiac and Vascular Department, Mauriziano Hospital, Turin, Italy
(Conte) Cardiovascular Department, Citta di Lecce Hospital, GVM Care and
Research, Lecce, Italy
(De Santis, Morelli) Department of Anesthesiology, Intensive Care
Medicine, Sapienza Universita Di, Rome, Rome, Italy
(Feltracco, Pittarello) Department of Pharmacology and Anesthesia,
University Hospital of Padova, Padova, Italy
(Giordano) Cardiac Anesthesia and Intensive Care, Hesperia Hospital,
Modena, Italy
(Gottin) Intensive Care and Perioperative Medicine Unit, University
Hospital of Verona, Verona, Italy
(Musu) Department of Anesthesia and Intensive Care, University of
Cagliari, Cagliari, Italy
(Pala) Cardioanesthesia and Intensive Care, Civil Hospital SS Annunziata,
Sassari, Italy
(Pezzoli, Remedi) University Magna Graecia of Catanzaro, Italy
(Paternoster) Cardiovascular Anesthesia and Intensive Care, San Carlo
Hospital, Potenza, Italy
(Roasio) Department of Anesthesia, Intensive Care Medicine, Cardinal
Massaia Hospital, Asti, Italy
(Zucchetti) Anetsesia e Rianimazione, Azienda Ospedali Riiuniti
Papardo-piemonte, Messina, Italy
(Petrini) Department of Emergency Medicine, Perioperative Medicine,
Intensive Care and Pain Therapy Unit, University Gabriele d'Annunzio,
Chieti-Pescara, Chieti, Italy
(Finco) Department of Medical Sciences M. Aresu, University of Cagliari,
Cagliari, Italy
(Ranieri) Department of Anesthesia and Intensive Care Medicine, University
of Turin, Turin, Italy
Title
Randomized evidence for reduction of perioperative mortality.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (5) (pp 764-772),
2012. Date of Publication: October 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: With more than 220 million major surgical procedures performed
annually, perioperative interventions leading to even minor mortality
reductions would save thousands of lives per year. This international
consensus conference aimed to identify all nonsurgical interventions that
increase or reduce perioperative mortality as suggested by randomized
evidence. Design and Setting: A web-based international consensus
conference. Participants: More than 1,000 physicians from 77 countries
participated in this web-based consensus conference. Interventions:
Systematic literature searches (MEDLINE/PubMed, June 8, 2011) were used to
identify the papers with a statistically significant effect on mortality
together with contacts with experts. Interventions were considered
eligible for evaluation if they (1) were published in peer-reviewed
journals, (2) dealt with a nonsurgical intervention
(drug/technique/strategy) in adult patients undergoing surgery, and (3)
provided a statistically significant mortality increase or reduction as
suggested by a randomized trial or meta-analysis of randomized trials.
Measurements and Main Results: Fourteen interventions that might change
perioperative mortality in adult surgery were identified. Interventions
that might reduce mortality include chlorhexidine oral rinse, clonidine,
insulin, intra-aortic balloon pump, leukodepletion, levosimendan,
neuraxial anesthesia, noninvasive respiratory support, hemodynamic
optimization, oxygen, selective decontamination of the digestive tract,
and volatile anesthetics. In contrast, aprotinin and extended-release
metoprolol might increase mortality. Conclusions: Future research and
health care funding should be directed toward studying and evaluating
these interventions. 2012 Elsevier Inc.

<10>
Accession Number
2012520814
Authors
Ma J. Wang X. Xie Y. Yu J. He Q. Li Z. Du J. Jiang X.
Institution
(Ma, Xie, Yu, He, Li, Du, Jiang) Department of Anesthesiology, Yantai
Yuhuangding Hospital, Qingdao University, Yantai, China
(Wang) Yantai Center of Disease Control and Prevention, Yantai, China
Title
Spectral entropy monitoring reduces anesthetic dosage for patients
undergoing off-pump coronary artery bypass graft surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (5) (pp 818-821),
2012. Date of Publication: October 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: The measurement of the depth of anesthesia is of clinical
interest for patients undergoing off-pump coronary artery bypass graft
(OPCAB) surgery in order to avoid intraoperative awareness and cardiac
depression. Entropy recently was introduced as a monitor of anesthetic
depth. This study was conducted to investigate the feasibility of entropy
monitoring during the conduct of OPCAB surgery and to find out whether it
reduced the anesthetic dosage for patients undergoing OPCAB surgery.
Design: A prospective, randomized, single-blind, controlled study.
Setting: A teaching hospital. Participants: Seventy patients scheduled for
OPCAB surgery were randomized to receive propofol-sufentanil anesthesia
either with the entropy values visible (the entropy group, n = 35) or
without the entropy values visible (the control group, n = 35).
Interventions: In the entropy group, propofol and sufentanil infusion
rates were titrated to maintain a state entropy (SE) value of 45 to 55 and
a response entropy (RE)-SE difference below 10 U. In the control group,
patients were anesthetized to keep the heart rate and blood pressure
within 25% of the baseline values. Measurements and Main Results: The
course of surgery, the consumption of anesthetics, and intraoperative
recall were recorded. Plasma levels of adrenocorticotropic hormone (ACTH)
and cortisol were measured. The average SE during anesthesia was 50 +/- 5
in the entropy group; the entropy values were lower in the control group
(p < 0.05). Compared with the control group, propofol and sufentanil
consumption were significantly less in the entropy group, which shortened
the time to tracheal extubation (p < 0.05). Significantly, patients in the
control group needed more phenylephrine to maintain arterial pressure than
patients in the entropy group (p < 0.05). ACTH and cortisol release were
prevented completely, and there was no intraoperative recall reported in
the 2 groups. Conclusions: Entropy monitoring reduced propofol and
sufentanil dosage for patients undergoing OPCAB surgery. 2012 Elsevier
Inc.

<11>
Accession Number
2012520818
Authors
Novak-Jankovic V. Milan Z. Potocnik I. Stupnik T. Maric S. Stopar-Pintaric
T. Kremzar B.
Institution
(Novak-Jankovic, Potocnik, Maric, Stopar-Pintaric, Kremzar) Clinical
Department of Anesthesiology and Intensive Therapy, University Medical
Center, Zaloska 7, 1000 Ljubljana, Slovenia
(Stupnik) Clinical Department of Thoracic Surgery, University Medical
Center, Ljubljana, Slovenia
(Milan) Leeds Teaching Hospitals, St James's University Hospital, Leeds,
United Kingdom
Title
A prospective, randomized, double-blinded comparison between multimodal
thoracic paravertebral bupivacaine and levobupivacaine analgesia in
patients undergoing lung surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (5) (pp 863-867),
2012. Date of Publication: October 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To compare the effects of paravertebral analgesia with
levobupivacaine or bupivacaine on intra- and postoperative pain for
thoracic surgery. Design: A prospective, randomized, and double-blinded
study. Setting: A university hospital. Participants: Forty patients
undergoing thoracic surgery. Interventions: Patients received
paravertebral catheterization and a bolus (14-20 mL) of 0.5% bupivacaine
(n = 20) or 0.5% levobupivacaine (n = 20) with morphine, 60 mug/kg, before
the induction of general anesthesia that consisted of a propofol infusion.
A paravertebral continuous infusion (0.05 mL/kg/h) of 0.25% bupivacaine or
0.25% levobupivacaine, 100 mL, with added morphine, 10 mg, and clonidine,
0.15 mg, was started at the end of surgery for 72 hours postoperatively.
Postoperative rescue diclofenac analgesia was available if required.
Measurements and Main Results: The primary outcome was intraoperative
fentanyl consumption. Static and dynamic pain scores measured by a visual
analog scale were assessed regularly. Intraoperative fentanyl consumption
was significantly lower in the levobupivacaine group compared with the
bupivacaine group (p = 0.001). On all 3 postoperative days, static pain
scores were significantly lower in the levobupivacaine group compared with
the bupivacaine group (p < 0.05). Dynamic pain scores were significantly
lower in the levobupivacaine group compared with the bupivacaine group
during the 2 postoperative days (p < 0.05). A smaller proportion of
patients in the levobupivacaine group used rescue analgesia (p < 0.005).
Conclusions: Paravertebral analgesia with levobupivacaine resulted in less
intraoperative fentanyl consumption, lower static (3 days) and dynamic (2
days) pain scores, and less rescue analgesia than analgesia with
bupivacaine. 2012 Elsevier Inc.

<12>
Accession Number
2012520809
Authors
Hua J. Chen G. Li H. Fu S. Zhang L.-M. Scott M. Li Q.
Institution
(Hua, Chen, Fu, Li) Department of Anesthesiology, Shanghai Tenth People's
Hospital, Tongji University School of Medcine, 301 Yanchang Middle Road,
Shanghai 200072, China
(Hua) First Clinical Medical College, Nanjing Medical University, Nanjing,
China
(Li, Zhang) Department of Anesthesiology, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Scott) Department of Surgery, University of Pittsburgh, Pittsburgh, PA,
United States
Title
Intensive intraoperative insulin therapy versus conventional insulin
therapy during cardiac surgery: A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (5) (pp 829-834),
2012. Date of Publication: October 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: The goal of this meta-analysis was to determine the benefits
and risks of rigorous glycemic control during cardiac surgery. Design: The
authors conducted searches of MEDLINE (January 1966 through February
2011), Embase (January 1985 through February 2011), the Cochrane Central
Register of Controlled Trials (Cochrane Library issue 2, 2011), and the
reference lists of the included trials. The authors searched for studies
in any language in which adult cardiac surgical patients were assigned
randomly to intensive insulin therapy (IIT) versus conventional insulin
therapy (CIT). Two authors independently extracted the information and
assessed the methodologic quality of the trials. The summary effects were
estimated with the risk ratio or risk difference using random- and
fixed-effects models. Setting: Randomized controlled trials.
Interventions: A meta-analysis of 5 randomized control trials.
Measurements and Main Results: Five randomized controlled trials that
included 706 patients were identified. Overall, the risk difference of
30-day/in-hospital mortality with IIT compared with CIT was 0.01 (95%
confidence interval [CI] = -0.01 to 0.03; p = 0.25) and the risk
difference of hypoglycemic events with IIT was -0.02 (95% CI = 0.05-0.01;
p = 0.26) and thus not different between treatments. The infection rate
was lower in patients randomized to the IIT arm (risk ratio = 0.50; 95% CI
= 0.29-0.84; p = 0.009). Among the 4 trials that reported cardiovascular
events, the pooled risk ratio with IIT was 0.85 (95% CI = 0.45-1.59; p =
0.61). Conclusions: The intraoperative use of IIT may decrease the
infection rate in cardiac surgical patients compared with the CIT group.
However, IIT may not decrease mortality, the incidence of hypoglycemia, or
the incidence of cardiovascular events. Additional well-designed
randomized trials are required to clarify the potential benefit of IIT on
30-day/in-hospital mortality and the incidence of perioperative
hypoglycemia. 2012 Elsevier Inc.

<13>
Accession Number
2012529708
Authors
Eichhorn V. Goepfert M.S. Eulenburg C. Malbrain M.L.N.G. Reuter D.A.
Institution
(Eichhorn, Goepfert, Reuter) Department of Anesthesiology, Center of
Anesthesiology and Intensive Care Medicine, University Medical Center
Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
(Eulenburg) Department of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
(Malbrain) Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, ZNA
Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen, Belgium
Title
Comparison of values in critically ill patients for global end-diastolic
volume and extravascular lung water measured by transcardiopulmonary
thermodilution: A metaanalysis of the literature.
Source
Medicina Intensiva. 36 (7) (pp 467-474), 2012. Date of Publication:
October 2012.
Publisher
Ediciones Doyma, S.L. (Travesera de Gracia 17-21, Barcelona 08021, Spain)
Abstract
Introduction: Hemodynamic parameters such as the global end-diastolic
volume index (GEDVI) and extravascular lung water index (EVLWI), derived
by transpulmonary thermodilution, have gained increasing interest for
guiding fluid therapy in critically ill patients. The proposed normal
values (680-800ml/m² for GEDVI and 3-7ml/kg for EVLWI) are
based on measurements in healthy individuals and on expert opinion, and
are assumed to be suitable for all patients. We analyzed the published
data for GEDVI and EVLWI, and investigated the differences between a
cohort of septic patients (SEP) and patients undergoing major surgery
(SURG), respectively. Methods: A PubMed literature search for GEDVI, EVLWI
or transcardiopulmonary single/double indicator thermodilution was carried
out, covering the period from 1990 to 2010. Intervention: Meta-regression
analysis was performed to identify any differences between the surgical
(SURG) and non-surgical septic groups (SEP). Results: Data from 1925
patients corresponding to 64 studies were included. On comparing both
groups, mean GEDVI was significantly higher by 94ml/m² (95%CI:
[54; 134]) in SEP compared to SURG patients (788ml/m² 95%CI:
[762; 816], vs. 694ml/m², 95%CI: [678; 711], p<0.001). Mean
EVLWI also differed significantly by 3.3ml/kg (95%CI: [1.4; 5.2], SURG
7.2ml/kg, 95%CI: [6.9; 7.6] vs. SEP 11.0ml/kg, 95%CI: [9.1; 13.0],
p=0.001). Conclusions: The published data for GEDVI and EVLWI are
heterogeneous, particularly in critically ill patients, and often exceed
the proposed normal values derived from healthy individuals. In the group
of septic patients, GEDVI and EVLWI were significantly higher than in the
group of patients undergoing major surgery. This points to the need for
defining different therapeutic targets for different patient populations.
2011 Elsevier Espana, S.L. y SEMICYUC.

<14>
Accession Number
2012515157
Authors
Wu W. Shan J. Li Y. Luo L. Sun G. Zhou Y. Yang T. Xia M. Guo Y. Feng L.
Institution
(Wu, Shan, Li, Luo, Sun, Zhou, Yang, Xia, Guo, Feng) Key Lab. of
Transplant Engineering and Immunology of Health Ministry of China,
Regenerative medical research center, West China Hospital, Sichuan
University, Chengdu, China
(Li) Chinese Cochrane Centre, Chinese Evidence-Based Medicine Centre,
Chengdu, China
Title
Adoptive transfusion of tolerance dendritic cells prolongs the survival of
cardiac allograft: A systematic review of 44 basic studies in mice.
Source
Journal of Evidence-Based Medicine. 5 (3) (pp 139-153), 2012. Date of
Publication: August 2012.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Background and Objective: Tolerogenic DCs (Tol-DCs), a group of cells with
imDC phenotype, can stably induce T cells low-reactivity and immune
tolerance. We systematically reviewed the adoptive transfusion of Tol-DCs
induced by different ways to prolong cardiac allograft survival and its
possible mechanism. Method: MEDLINE (1966 to March 2011), EMbase (1980 to
March 2011), and ISI (inception to March 2011) were searched for
identification of relevant studies. We used allogeneic heart graft
survival time as endpoint outcome to analyze the effect of adoptive
transfusion of Tol-DC on cardiac allograft. By integrating studies'
information, we summarized the mechanisms of Tol-DC in prolonging cardiac
grafts. Results: Four methods were used to induce Tol-DC in all of the 44
included studies including gene-modified, drug-intervened,
cytokine-induced, and other-derived (liver-derived & spleen-derived) DCs.
The results showed that all types of Tol-DC can effectively prolong graft
survival, and the average extension of graft survival time for each group
was as follows: 22.02 +/- 21.9 days (3.2 folds to control group) in the
gene modified group, 25.94 +/- 16.9 days (4.3 folds) in the
drug-intervened groups, 9.00 +/- 8.13 days (1.9 folds) in the
cytokine-induced group, and 10.69 +/- 9.94 days (2.1 folds) in the
other-derived group. The main mechanisms of Tol-DCs to prolong graft
survival were as follows: (1) induceT-cell hyporeactivity (detected by
MLR); (2) reduce the effect of cytotoxic lymphocyte (CTL); (3) promote Th2
differentiation; (4) induce Treg; (5) induce chimerism. Conclusion: For
fully MHC mismatched allogeneic heart transplant recipients of inbred
mouse, adoptive transfusion of Tol-DC, which can be gene-modified,
drug-intervened, cytokine-induced, spleen-derived or liver-derived, can
clearly prolong the survival of cardiac allograft or induce immune
tolerance. Gene-modified and drug-induced Tol-DC can prolong graft
survival most obviously. Having better reliability and stability than
drug-induction, gene-modification is the best way to induce Tol-DCs at
present. One-time intravenous infusion of 2 x 10⁶ Tol-DC is a
simple and feasible way to induce long-term graft survival. Multiple
infusions will prolong it but increase the risk and cost. Adoptive
transfusion of Tol-DC in conjunction with immunosuppressive agents may
also prolong the graft survival time. 2012 Wiley Publishing Asia Pty Ltd
and Chinese Cochrane Center, West China Hospital of Sichuan University.

<15>
Accession Number
2012524975
Authors
Cho J.S. Song J.W. Na S. Moon J.-H. Kwak Y.L.
Institution
(Cho, Song, Na, Moon, Kwak) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Song, Kwak) Anesthesia and Pain Research Institute, Yonsei University
College of Medicine, Seoul, South Korea
(Kwak) Severance Biomedical Science Institute, Yonsei University College
of Medicine, Seoul, South Korea
Title
Effect of a single bolus of methylene blue prophylaxis on vasopressor and
transfusion requirement in infective endocarditis patients undergoing
cardiac surgery.
Source
Korean Journal of Anesthesiology. 63 (2) (pp 142-148), 2012. Date of
Publication: August 2012.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: The accentuated nitric oxide (NO) release that is induced by
the systemic inflammatory response associated with infective endocarditis
(IE) and cardiopulmonary bypass (CPB) may result in catecholamine
refractory hypotension (vasoplegia) and increased transfusion requirement
due to platelet inhibition. Methylene blue (MB) is an inhibitory drug of
inducible NO. We aimed to evaluate the effect of prophylactic MB
administration before CPB on vasopressor and transfusion requirements in
patients with IE undergoing valvular heart surgery (VHS). Methods:
Forty-two adult patients were randomly assigned to receive 2 mg/kg of MB
(MB group, n = 21) or saline (control group, n = 21) for 20 min before the
initiation of CPB. The primary end points were comparisons of vasopressor
requirements serially assessed after weaning from CPB and hemodynamic
parameters serially recorded before and after CPB. The secondary endpoint
was the comparison of transfusion requirements. Results: Two patients in
the control group received MB after weaning from CPB due to norepinephrine
and vasopressin refractory vasoplegia and were thus excluded. There were
no significant differences in vasopressor requirements and hemodynamic
parameters between the two groups. The mean number of units of packed
erythrocytes transfused per transfused patient was significantly less in
the MB group. The numbers of patients transfused with fresh frozen plasma
and platelet concentrates were less in the MB group. Conclusions: In IE
patients undergoing VHS, prophylactic MB administration before CPB did not
confer significant benefits in terms of vasopressor requirements and
hemodynamic parameters, but it was associated with a significant reduction
in transfusion requirement. the Korean Society of Anesthesiologists,
2012.

<16>
Accession Number
22403352
Authors
Koning N.J. Vonk A.B.A. Van Barneveld L.J. Beishuizen A. Atasever B. Van
Den Brom C.E. Boer C.
Institution
(Koning, Van Den Brom, Boer) Department of Anesthesiology, Institute for
Cardiovascular Research, VU University Medical Center, De Boelelaan 1117,
1081 HV Amsterdam, Netherlands
(Koning, Vonk, Van Barneveld, Atasever) Department of Cardio-Thoracic
Surgery, Institute for Cardiovascular Research, VU University Medical
Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
(Beishuizen) Department of Intensive Care Medicine, Institute for
Cardiovascular Research, VU University Medical Center, Amsterdam,
Netherlands
Title
Pulsatile flow during cardiopulmonary bypass preserves postoperative
microcirculatory perfusion irrespective of systemic hemodynamics.
Source
Journal of Applied Physiology. 112 (10) (pp 1727-1734), 2012. Date of
Publication: 15 May 2012.
Publisher
American Physiological Society (9650 Rockville Pike, Bethesda MD
20814-3991, United States)
Abstract
The onset of nonpulsatile cardiopulmonary bypass is known to deteriorate
microcirculatory perfusion, but it has never been investigated whether
this may be prevented by restoration of pulsatility during extracorporeal
circulation. We therefore investigated the distinct effects of
nonpulsatile and pulsatile flow on microcirculatory perfusion during
on-pump cardiac surgery. Patients undergoing coronary artery bypass graft
surgery were randomized into a nonpulsatile (n = 17) or pulsatile (n = 16)
cardiopulmonary bypass group. Sublingual mucosal microvascular perfusion
was measured at distinct perioperative time intervals using sidestream
dark field imaging, and quantified as the level of perfused small vessel
density and microvascular flow index (vessel diameter < 20 mum).
Microcirculation measurements were paralleled by hemodynamic and free
hemoglobin analyses. The pulse wave during pulsatile bypass estimated 58
+/- 17% of the baseline blood pressure waveform. The observed reduction in
perfused vessel density during aorta cross-clamping was only restored in
the pulsatile flow group and increased from 15.5 +/- 2.4 to 20.3 +/- 3.7
mm/mm² upon intensive care admission (P < 0.01). The median
postoperative microvascular flow index was higher in the pulsatile group
[2.6 (2.5-2.9)] than in the nonpulsatile group [2.1 (1.7-2.5); P < 0.001].
Pulsatile flow was not associated with augmentation of free hemoglobin
production and was paralleled by improved oxygen consumption from 70 +/-
14 to 82 +/- 16 ml min^-1 m^-2 (P = 0.01) at the end
of aortic cross-clamping. In conclusion, pulsatile cardiopulmonary bypass
preserves microcirculatory perfusion throughout the early postoperative
period, irrespective of systemic hemodynamics. This observation is
paralleled by an increase in oxygen consumption during pulsatile flow,
which may hint toward decreased microcirculatory heterogeneity during
extracorporeal circulation and preservation of microcirculatory perfusion
throughout the perioperative period. 2012 the American Physiological
Society.

<17>
Accession Number
22091690
Authors
Mcanulty J.F.
Institution
(Mcanulty) Department of Surgical Sciences, School of Veterinary Medicine,
University of Wisconsin, Madison, WI, United States
Title
Prospective Comparison of Cisterna Chyli Ablation to Pericardectomy for
Treatment of Spontaneously Occurring Idiopathic Chylothorax in the Dog.
Source
Veterinary Surgery. 40 (8) (pp 926-934), 2011. Date of Publication:
December 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objective: Prospective comparison of cisterna chyli ablation (CCA) or
pericardectomy (PC) for chylothorax. Study Design: Randomized prospective
study. Subject Population: Dogs with idiopathic chylothorax (n= 23).
Methods: Dogs were treated by thoracic duct ligation (TDL) with either CCA
(n = 12) or PC (n = 11). Long-term outcomes, intraoperative central venous
pressures (CVPs) and pericardial histology were assessed. Dogs with
persistent chylothorax were offered retreatment by the alternative
procedure. Results: Ten (83%) dogs treated by CCA-TDL and 6 (60%) treated
by PC-TDL resolved their chylothorax. Retreatment in 4 dogs resulted in
resolution in 2 dogs and 2 perioperative deaths. Four dogs developed
nonchylous effusions; 2 of which resolved after initiating steroid
therapy, 1 of which was unsuccessfully treated by PC, and 1 continues to
be managed by thoracocentesis 6.5 years later. CVPs were normal in most
dogs and unaffected by PC. On histology, pericardial tissues had extensive
external surface fibrosis with mild inflammation. On follow-up (<=6.5
years), no recurrence of pleural effusions occurred after initial
resolution. Conclusions: CCA-TDL appears to offer improved outcomes over
historical results with TDL. Results with PC-TDL were more variable for
unknown reasons. Venous pressure measurements did not support the
hypothesis that venous hypertension was involved in chylothorax or
response to therapy in these dogs. 2011 by The American College of
Veterinary Surgeons.

<18>
Accession Number
70866141
Authors
Hutton B. Joseph L. Fergusson D. Mazer D. Shapiro S. Tinmouth A.
Institution
(Hutton, Joseph, Shapiro) McGill University, Montreal, Canada
(Hutton, Fergusson, Tinmouth) Ottawa Hospital, Research Institute, Ottawa,
Canada
(Mazer) Saint Mike's Hospital, Toronto, Canada
Title
Combining randomized and observational data using network meta-analysis to
explore drug safety: The case of antifibrinolytics in cardiac surgery.
Source
Clinical Trials. Conference: Society for Clinical Trials Annual Meeting
2012 Miami, FL United States. Conference Start: 20120521 Conference End:
20120523. Conference Publication: (var.pagings). 9 (4) (pp 483-484), 2012.
Date of Publication: August 2012.
Publisher
SAGE Publications Ltd
Abstract
Background: Aprotinin was used to minimize blood loss in cardiac surgery
patients before withdrawal from the market in 2008 for safety reasons. The
drug has again become available. Methods: We performed a systematic review
and network meta-analyses to estimate the relative risks of death,
myocardial infarction (MI), stroke and renal failure/dysfunction between
aprotinin, tranexamic acid (TXA), epsilon-aminocaproic acid (EACA), and no
therapy. A 2011 Cochrane review was used to identify relevant randomized
controlled trials (RCTs), and a search of Medline, Embase and the Cochrane
Register of Trials was conducted to identify propensity matched/adjusted
observational studies. Odds ratios and 95% credible intervals for
comparisons between therapies were estimated, as were the average rank and
probability that each therapy was most safe. The probabilities of odds
ratios excluding a null difference were also estimated. Network
meta-analyses based on RCTs were fit first, and then observational
evidence was incorporated. Results: 83 RCTs and 11 obervational studies
(>41,000 patients) were included (Figure 1). Based on RCTs, TXA was
associated with a reduced risk of death versus aprotinin, while pairwise
comparisons were inconclusive for MI, stroke, and renal
failure/dysfunction; point estimates and coverage probabilities of these
intervals suggested aprotinin was often associated with an elevated
probability of increased risk (Table 1). When observational data were
incorporated, pairwise comparisons showed increased risks of death with
aprotinin relative to TXA and EACA, as well an increased risk of renal
failure/dysfunction relative to all comparators. There were also
probabilities suggestive of increased risks of MI with aprotinin compared
to TXA and EACA (Table 1). Conclusions: Data suggests there remains reason
for concern regarding aprotinin safety. While meta-analyses of RCTs can
lack sufficient sample size to definitively identify harms imbalances,
appropriate incorporation of observational evidence and use of network
meta-analysis can help reduce uncertainty in analyses of such data.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 25

Results Generated From:
Embase <1980 to 2012 Week 37>
Embase (updates since 2012-09-06)

<1>
Accession Number
2012517613
Authors
Abdollahi M.H. Forouzannia S.K. Bagherinasab M. Barzegar K. Fekri A.
Sarebanhassanabadi M. Entezari A.
Institution
(Abdollahi, Bagherinasab, Fekri, Sarebanhassanabadi, Entezari) Yazd
Cardiovascular Research Center, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Forouzannia, Barzegar) School of Medicine, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
Title
The effect of ondansetron and meperedin on preventing shivering after
off-pump coronary artery bypass graft.
Source
Acta Medica Iranica. 50 (6) (pp 395-398), 2012. Date of Publication: 2012.
Publisher
Medical Sciences University of Teheran (Poursina St, Teheran 14-174, Iran,
Islamic Republic of)
Abstract
Abstract- One of the most common complications of operation and anesthesia
is shivering. The purpose of this study was to compare the effectiveness
of Ondanseton and Meperedine in preventing shivering after offpump
coronary artery bypass graft (OPCAB). In this double-blind randomized
clinical trial, the sample consisted of 90 patients, who were candidates
of CABG under general anesthesia. These patients were assigned to three
groups, each containing 30 subjects: meperedine group (A), ondansetron
group (B) and control group (C). Group (A) received 0.4 mg/Kg/IV of
meperedine, group (B) received 8mg/IV of ondansetron and group (C)
received Normal Saline. All these drugs were injected 15 minutes before
the end of surgery. After the end of surgery, the intubated patients were
transferred to the ICU and their body temperature was assessed through
eardrum by a specialist who was blind to the research. The incidence of
shivering in groups A, B, and C was 46.48%, 31.18%, and 60.83%,
respectively (P=<0.01). The incidence of shivering was 64.4% in males and
35.6% in females (P=0.222). Also, the amount of incidence of shivering up
to 3 hours after surgery was 75.87 % (P=0.064). Bradycardia was 3.3% in
group (A) and 0.0 % in group (B). Other variables (myoclonus, seizure and
rash) showed no statistically significant difference (P=0.353). According
to the findings, it was demonstrated that ondansetron is more effective in
preventing shivering after Off-pump CABG than meperedine. 2012 Tehran
University of Medical Sciences. All rights reserved.

<2>
[Use Link to view the full text]
Accession Number
2012505163
Authors
Narsule C.K. Sales Dos Santos R. Gupta A. Ebright M.I. Rivas R. Daly
B.D.T. Fernando H.C.
Institution
(Narsule, Ebright, Rivas, Daly, Fernando) Department of Cardiothoracic
Surgery, Boston University School of Medicine, 88 East Newton Street,
Robinson B-402, Boston, MA 02118, United States
(Sales Dos Santos) Department of Thoracic Surgery, Albert Einstein Israeli
Hospital, Sao Paulo, Brazil
(Gupta) Department of Radiology, Boston University School of Medicine,
Boston, MA, United States
Title
The efficacy of electromagnetic navigation to assist with computed
tomography-guided percutaneous thermal ablation of lung tumors.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 7 (3) (pp 187-190), 2012. Date of Publication: May-June 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
OBJECTIVE: Electromagnetic (EM) navigation is increasingly used to assist
with bronchoscopic interventions such as biopsy or fiducial placement.
Electromagnetic navigation can also be a useful adjunct to computed
tomography (CT)-guided thermal ablation and biopsy of lung tumors. This
study compares procedures carried out using an EM navigation system (Veran
Medical Technologies Inc, St Louis, MO) with procedures using CT
fluoroscopy only. METHODS: Over a 23-month period, 17 patients scheduled
for thermal ablation were prospectively enrolled in this study. The mean
age was 72 years (range, 60-84 years). Seven patients were women. Patients
were randomized to EM navigation (n = 7) or CT fluoroscopy alone (n = 10).
In some cases, additional ablation or biopsies were performed with or
without EM navigation depending on the randomization arm. All procedures
were performed under general anesthesia either by a thoracic surgeon or a
radiologist. RESULTS: A total of 23 procedures were performed in 17
patients: 20 were ablation procedures and 3 were biopsies. Fourteen were
performed for non-small cell lung cancer, and 9 for pulmonary metastases
from other organs. Despite randomization, patients receiving EM navigation
had a trend for smaller tumors (mean diameter, 1.45 vs 2.90 cm; P = 0.06).
For thermal ablation procedures, the time to complete intervention was
significantly less when EM navigation was used (mean, 7.6 vs 19 minutes; P
= 0.022). Although not statistically significant, there were fewer skin
punctures (mean, 1 vs 1.25; P = 0.082), fewer adjustments (mean, 5.6 vs
11.8; P = 0.203), less CT fluoroscopy time (mean, 21.3 vs 34.3 seconds; P
= 0.345), and fewer CT scans (mean, 7 vs 15; P = 0.204) whenever EM
navigation was used. CONCLUSIONS: Electromagnetic navigation reduces the
time to successfully place an ablation probe in a target tumor. Further
study is required to determine whether EM navigation may also reduce the
number of adjustments, skin punctures, and CT scans as well as decrease CT
fluoroscopy time. Copyright 2012 by the International Society for
Minimally Invasive Cardiothoracic Surgery.

<3>
Accession Number
70861321
Authors
Lucenteforte E. Zagli G. Romoli M. Vannacci A.
Institution
(Lucenteforte, Vannacci) University of Florence, CIMMBA, Preclinical and
Clinical Pharmacology, Florence, Italy
(Zagli) Careggi General Hospital, Anaesthesiology, Florence, Italy
(Romoli) PratoItaly
Title
The diagonal ear lobe crease (Frank's sign) as a marker of cardiovascular
disease. A systematic review.
Source
European Journal of Integrative Medicine. Conference: 3rd European
Congress for Integrative Medicine, ECIM 2010 Berlin Germany. Conference
Start: 20101203 Conference End: 20101204. Conference Publication:
(var.pagings). 2 (4) (pp 208), 2010. Date of Publication: December 2010.
Publisher
Elsevier GmbH
Abstract
The diagonal ear lobe crease (ELC) is one of the most investigated
auricular signs in literature. Itwas firstly describe by Frank in 1973, in
a letter to the New England Journal of Medicine, as an 'aural sign of
coronary artery disease'. Currently, there are more than 40 reports and
articles in the literature, written mainly by cardiologists, dealing with
the following aspects of the question: * is ELC a reliable diagnostic sign
of coronary heart disease (CHD)? * does it have a predictive value for
cardiac events such as cardiac death, acute myocardial infarction or
coronary bypass operation in high risk patients? * can ELC be associated
with conventional risk factors such as hypertension, smoking, diabetes,
cholesterol, triglycerides, obesity etc? * should ELC be considered a sign
of ageing of the cardiovascular system? * should ELC be considered an
androgen-sensitive trait like baldness and ear-canal hair? Here we report
a comprehensive review of medical literature on ELC diagnostic role for
CHD, with the following conclusions: (1) ELC manifests itself after the
age of 40 but becomes more evident and frequent around the 6th and 7th
decade of life, especially in males. There is a general consensus that
those patients showing an ELC before 40 have a higher risk of
cardiovascular disease. (2) ELC may manifest unilaterally or bilaterally.
Bilateral ELC, especially deep and clear cut creases, seem prospectively
to be associated with a lower cardiac event-free survival. (3) There is
often a lack of association between ELC and the conventionally accepted
risk factors. However, the factors which seemingly show a higher
association to ELC are hypertension and obesity. (4) ELC can be considered
an indicator of biologic age as opposed to chronologic age and could be
used to identify subjects who are ageing more quickly than the general
population. (5) Some articles report a possible association between CHD,
ELC, ear-canal hair and male pattern baldness. This association is
supposed to be due to the long-term exposure to androgens which may
facilitate the development of atherosclerosis and CHD.

<4>
Accession Number
2012508844
Authors
Shu D.F. Dong B.R. Lin X.F. Wu T.X. Liu G.J.
Institution
(Shu, Dong, Lin) Geriatrics, West China Hospital, Sichuan University,
Chengdu, China
(Wu, Liu) Chinese Cochrane Centre, West China Hospital, Sichuan
University, Chengdu, China
Title
Long-term beta blockers for stable angina: Systematic review and
meta-analysis.
Source
European Journal of Preventive Cardiology. 19 (3) (pp 330-341), 2012. Date
of Publication: June 2012.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Objectives: To assess the effects of long-term beta blockers in patients
with stable angina.Methods: We reviewed the literature up to June 2010
from CENTRAL, MEDLINE, EMBASE, CBM, and CNKI for randomized controlled
trials. The appropriate data were meta-analysed using Revman 5.0.Results:
Twenty-six trials including 6108 patients were identified. The treatment
with beta blockers has significantly decreased all-cause mortality when
compared with no control (OR 0.40, 95% CI 0.20 to 0.79), but has had no
statistically differences when compared with placebo (OR 0.92, 95% CI 0.62
to 1.38) and with calcium-channel blocker (CCB) (OR 0.84, 95% CI 0.49 to
1.44). This was similar in patients with fatal and non-fatal acute
myocardial infarction when compared with placebo (OR 0.82, 95% CI 0.57 to
1.17) or CCB (OR 1.08, 95% CI 0.71 to 1.66); on revascularization and
quality of life. The beta blockers reduced the incident of unstable angina
compared to no treatment (OR 0.14, 95% CI 0.07 to 0.29), but increased
unstable angina compared to placebo (OR 3.32, 95% CI 1.50 to 7.36). There
was a significant reduction of nitrate consumption when beta blockers were
compared with CCBs (OR -1.18, 95% CI -1.54 to -0.82), but not with placebo
and trimetazidine. There was no significant difference in angina attack
between each group. Side effects in beta blocker were similar with ones in
controls.Conclusions: Beta blockers may decrease the death and unstable
angina when compared with no treatment, but no more effective than other
anti-anginal agents on prophylaxis of myocardial ischaemia in stable
angina patients. The European Society of Cardiology 2011 Reprints and
permissions: sagepub.co.uk/journalsPermissions.nav.

<5>
Accession Number
2012516989
Authors
Rocco G.
Institution
(Rocco) Department of Thoracic Surgery and Oncology, National Cancer
Institute, Pascale Foundation, Naples, Italy
Title
One-port (uniportal) video-assisted thoracic surgical resections - A clear
advance.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (3) (pp S27-S31),
2012. Date of Publication: September 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
One-port (uniportal) video-assisted thoracic surgery (VATS) consists of
approaching an intrathoracic target lesion through a sagittal,
craniocaudal plane through 1 single-port incision. The use of articulating
instruments inserted parallel to the videothoracoscope enables the surgeon
to mimic inside the chest the maneuvers that are usually performed during
open surgery. Through this VATS approach, several thoracic conditions can
be addressed, including lung cancer in selected patients. Unlike
conventional, 3-port VATS, the uniportal VATS technique enables the
surgeon to bring the operative fulcrum inside the chest when the target
lunge lesion is approached through a sagittal plan, thanks to articulating
instruments. Uniportal wedge VATS resections of peripheral nodules can
help in solving diagnostic dilemmas, be of therapeutic benefit, and
provide tissue for biomolecular studies. Copyright 2012 by The American
Association for Thoracic Surgery.

<6>
Accession Number
2012516961
Authors
Loor G. Koch C.G. Sabik III J.F. Li L. Blackstone E.H.
Institution
(Loor, Sabik III, Blackstone) Cleveland Clinic, Department of
Cardiothoracic Anesthesia, 9500 Euclid Avenue/Desk J4-331, Cleveland, OH
44195, United States
(Koch) Department of Cardiothoracic Anesthesia, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Li, Blackstone) Department of Quantitative Health Sciences, Research
Institute, Cleveland Clinic, Cleveland, OH, United States
Title
Implications and management of anemia in cardiac surgery: Current state of
knowledge.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (3) (pp 538-546),
2012. Date of Publication: September 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)

<7>
Accession Number
2012516966
Authors
Donndorf P. Kuhn F. Vollmar B. Rosner J. Liebold A. Gierer P. Steinhoff G.
Kaminski A.
Institution
(Donndorf, Kuhn, Steinhoff, Kaminski) Department of Cardiac Surgery,
University of Rostock, Schillingallee 35, 18057 Rostock, Germany
(Vollmar) Institute of Experimental Surgery, University of Rostock,
Rostock, Germany
(Rosner) Department of Anesthesiology and Intensive Care Medicine,
University of Rostock, Rostock, Germany
(Liebold) Department of Cardiovascular and Thoracic Surgery, University of
Ulm, Ulm, Germany
(Gierer) Department of Trauma and Reconstructive Surgery, University of
Rostock, Rostock, Germany
Title
Comparing microvascular alterations during minimal extracorporeal
circulation and conventional cardiopulmonary bypass in coronary artery
bypass graft surgery: A prospective, randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (3) (pp 677-683),
2012. Date of Publication: September 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Minimal extracorporeal circulation (MECC) has been introduced
in coronary artery bypass graft (CABG) surgery, offering clinical benefits
owing to reduced hemodilution and no blood-air interface. Yet, the effects
of MECC on the intraoperative microvascular perfusion in comparison with
conventional extracorporeal circulation (CECC) have not been studied so
far. Methods: The current study aimed to analyze alterations in
microvascular perfusion at 4 predefined time points (T1-T4) during on-pump
CABG using orthogonal polarization spectral imaging. Forty patients were
randomized for being operated on with either MECC or CECC. Changes in
functional capillary density (FCD), blood flow velocity, and vessel
diameter were analyzed by a blinded investigator. Results: After start of
extracorporeal circulation (ECC) and aortic crossclamping (T2), both
groups showed a significant drop of FCD, with a significantly higher FCD
in the MECC group (206.8 +/- 33.6 cm/cm2 in CECC group versus 217.8 +/-
35.3 cm/cm in MECC group; P = .034). In the late phase of the ECC (T3),
FCD in the MECC group was already recovered, whereas FCD in the CECC group
was still significantly depressed (223.1 +/- 35.6 cm/cm2 in MECC group; P
= .100 vs T1; 211.1 +/- 36.9 cm/cm in CECC group; P = .017 vs T1). After
termination of ECC (T4), FCD recovered in both groups to baseline. Blood
flow velocity tended to be higher in the MECC group, with a significant
intergroup difference after aortic crossclamping (T2). Conclusions:
Orthogonal polarization spectral imaging data reveal an impairment of
microvascular perfusion during on-pump CABG. Changes in FCD indicate a
faster recovery of the microvascular perfusion in MECC during the
reperfusion period. Beneficial recovery of microvascular organ perfusion
could partly explain the perioperative advantages reported for MECC.
Copyright 2012 by The American Association for Thoracic Surgery.

<8>
Accession Number
2012516956
Authors
Wee J.O.
Institution
(Wee) Division of Thoracic Surgery, Brigham and Women's Hospital, 75
Francis St, Boston, MA 02115, United States
Title
Redo laparoscopic repair of benign esophageal disease.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (3) (pp S71-S73),
2012. Date of Publication: September 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Laparoscopic fundoplication for gastroesophageal reflux disease has been
associated with excellent symptom control. Compared with medical
treatment, laparoscopic Nissen fundoplication has shown favorable control
of typical reflux symptoms. However, in approximately 2% to 17% of
patients, surgical treatment fails. The role of reoperative repair for
reflux disease and the factors that contribute to it are examined.
Copyright 2012 by The American Association for Thoracic Surgery.

<9>
Accession Number
2012516959
Authors
Chaudhuri K. Storey E. Lee G.A. Bailey M. Chan J. Rosenfeldt F.L. Pick A.
Negri J. Gooi J. Zimmet A. Esmore D. Merry C. Rowland M. Lin E. Marasco
S.F.
Institution
(Chaudhuri, Lee, Chan, Rosenfeldt, Pick, Negri, Gooi, Zimmet, Esmore,
Merry, Rowland, Marasco) Department of Cardiothoracic Surgery, CJ Officer
Brown, Alfred Hospital, Commercial Rd, Prahran, Melbourne, VIC 3181,
Australia
(Chaudhuri, Rosenfeldt, Marasco) Department of Surgery, Monash University,
Alfred Hospital, Melbourne, Australia
(Marasco) Epworth Hospital, Richmond, VIC, Australia
(Storey) Department of Medicine (Neuroscience), Monash University (Alfred
Hospital Campus), Melbourne, Australia
(Bailey) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Lin) Department of Anaesthesia, Alfred Hospital, Melbourne, Australia
Title
Carbon dioxide insufflation in open-chamber cardiac surgery: A
double-blind, randomized clinical trial of neurocognitive effects.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (3) (pp 646-653.e1),
2012. Date of Publication: September 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The aims of this study were first to analyze neurocognitive
outcomes of patients after open-chamber cardiac surgery to determine
whether carbon dioxide pericardial insufflation reduces incidence of
neurocognitive decline (primary end point) as measured 6 weeks
postoperatively and second to assess the utility of carbon dioxide
insufflation in cardiac chamber deairing as assessed by transesophageal
echocardiography. Methods: A multicenter, prospective, double-blind,
randomized, controlled trial compared neurocognitive outcomes in patients
undergoing open-chamber (left-sided) cardiac surgery who were assigned
carbon dioxide insufflation or placebo (control group) in addition to
standardized mechanical deairing maneuvers. Results: One hundred
twenty-five patients underwent surgery and were randomly allocated.
Neurocognitive testing showed no clinically significant differences in z
scores between preoperative and postoperative testing. Linear regression
was used to identify factors associated with neurocognitive decline.
Factors most strongly associated with neurocognitive decline were
hypercholesterolemia, aortic atheroma grade, and coronary artery disease.
There was significantly more intracardiac gas noted on intraoperative
transesophageal echocardiography in all cardiac chambers (left atrium,
left ventricle, and aorta) at all measured times (after crossclamp
removal, during weaning from cardiopulmonary bypass, and at declaration of
adequate deairing by the anesthetist) in the control group than in the
carbon dioxide group (P < .04). Deairing time was also significantly
longer in the control group (12 minutes [interquartile range, 9-18] versus
9 minutes [interquartile range, 7-14 minutes]; P = .002). Conclusions:
Carbon dioxide pericardial insufflation in open-chamber cardiac surgery
does not affect postoperative neurocognitive decline. The most important
factor is atheromatous vascular disease. Copyright 2012 by The American
Association for Thoracic Surgery.

<10>
Accession Number
2012516960
Authors
Torina A.G. Silveira-Filho L.M. Vilarinho K.A.S. Eghtesady P. Oliveira
P.P.M. Sposito A.C. Petrucci O.
Institution
(Torina, Silveira-Filho, Vilarinho, Oliveira, Petrucci) Department of
Surgery, Discipline of Cardiac Surgery, Faculty of Medical Science, State
University of Campinas, Rua Joao Baptista Geraldi, 135, Campinas, SP, CEP
13085020, Brazil
(Sposito) Department of Internal Medicine, Discipline of Cardiology,
Faculty of Medical Science, State University of Campinas, Campinas, Sao
Paulo, Brazil
(Eghtesady) Division of Cardiothoracic Surgery, Children's Hospital,
Washington University, St Louis, MO, United States
Title
Use of modified ultrafiltration in adults undergoing coronary artery
bypass grafting is associated with inflammatory modulation and less
postoperative blood loss: A randomized and controlled study.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (3) (pp 663-670),
2012. Date of Publication: September 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Modified ultrafiltration (MUF) has been shown to decrease the
postcardiac surgery inflammatory response and to improve respiratory
function and cardiac performance in pediatric patients; however, this
approach has not been well established in adults. The present study
hypothesized that MUF could decrease the postsurgical inflammatory
response, leading to improved respiratory and cardiac function in adults
undergoing coronary artery bypass grafting. Methods: Sixty patients
undergoing coronary artery bypass grafting were randomized to the MUF or
control group (n = 30 each). MUF was performed for 15 minutes at the end
of bypass. The following data were recorded at the beginning of
anesthesia, end of bypass, end of experimental treatment, and 24 and 48
hours after surgery: alveolar-arterial oxygen gradient, red blood cell
units transfused, chest tube drainage, hemodynamic parameters, and
cytokine levels (interleukin-6, P-selectin, intercellular adhesion
molecule, and soluble tumor necrosis factor receptor). Results: The MUF
group displayed less chest tube drainage than the control group after 48
hours (598 +/- 123 mL vs 848.0 +/- 455 mL; P = .04) and less red blood
cell transfusions (0.6 +/- 0.6 units/patient vs 1.6 +/- 1.1 units/patient;
P = .03). Hematocrit level was higher in the MUF group than in the control
group at the end of bypass (37.8% +/- 1.1% vs 34.1% +/- 1.1%; P < .05),
but the levels were comparable at 48 hours. Similar values for
interleukin-6 and P-selectin were observed at all stages. Plasma levels of
intercellular adhesion molecule were higher in the MUF group than in the
control group, particularly in the first sampling after experimental
treatment (P = .01). Plasma levels of soluble tumor necrosis factor
receptor were higher in the MUF group than in the control group at 48
hours. Hemodynamic and oxygen transport parameters were similar in both
groups throughout the observation period. There were no differences in
other clinical outcomes. Conclusions: Use of MUF was associated with
increased inflammatory response, reduced blood loss, and less blood
transfusions in adults undergoing coronary artery bypass grafting.
Copyright 2012 by The American Association for Thoracic Surgery.

<11>
Accession Number
2012484144
Authors
Zhang F. Yang Y. Hu D. Lei H. Wang Y.
Institution
(Zhang, Wang) School of Public Health and Health Management, Chongqing
Medical University, Chongqing, China
(Yang, Lei) Department of Cardiology, First Affiliated Hospital, Chongqing
Medical University, Chongqing, China
(Hu) Chongqing Medical University, Chongqing, China
Title
Percutaneous coronary intervention (PCI) versus coronary artery bypass
grafting (CABG) in the treatment of diabetic patients with multi-vessel
coronary disease: A meta-analysis.
Source
Diabetes Research and Clinical Practice. 97 (2) (pp 178-184), 2012. Date
of Publication: August 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Diabetes is prevalent in patients with coronary artery disease. In
diabetic patients with multi-vessel coronary disease, percutaneous
coronary intervention (PCI) and coronary artery bypass grafting (CABG) are
widely used for revascularization. We aimed to compare the effectiveness
and safety of PCI and CABG in these patients. Nine randomized controlled
trials were identified in which a total of 1047 diabetic patients were
randomly assigned to PCI and 1054 to CABG. Results showed that five-year
mortality was significantly higher in diabetic patients after PCI than
after CABG (risk difference (RD) of 7%; P< 0.001); repeated
revascularization was more common after PCI than after CABG (one-year RD
of 13%; P< 0.001); major adverse cardiac and cerebrovascular events were
also more frequent after PCI (one-year RD of 12%; P< 0.001); however, the
cerebrovascular accident rate was lower in the PCI group than the CABG
group (one-year RD of -2%; P= 0.004). Conclusively, in diabetic patients
with multi-vessel coronary disease, CABG was not only more effective than
PCI in reducing mortality but also led to fewer repeated
revascularizations and fewer major adverse cardiac and cerebrovascular
events. Despite these benefits, CABG did put diabetic patients at higher
risk for cerebrovascular accident than PCI. 2012 .

<12>
Accession Number
2012514102
Authors
Atallah M.M.M. Saber H.I. Mageed N.A. Motawea A.A. Alghareeb N.A.
Institution
(Atallah, Saber, Mageed, Motawea) Anesthesia and Surgical Intensive Care
Department, Cardiothoracic Unit Faculty of Medicine, Mansoura University,
Egypt
(Alghareeb) Clinical Pathology Department, Faculty of Medicine, Mansoura
University, Egypt
Title
Feasibility of adding magnesium to intrathecal fentanyl in pediatric
cardiac surgery.
Source
Egyptian Journal of Anaesthesia. 27 (3) (pp 173-180), 2011. Date of
Publication: July 2011.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background: Magnesium is (NMDA) receptor antagonist used as an adjuvant
for postoperative analgesia. There are several studies comparing the
efficacy of the different routes of administration of magnesium. We aimed
to study the effects of adding magnesium to IT fentanyl on peri-operative
analgesic requirements after elective pediatric cardiac surgery. Methods:
This prospective double controlled randomized study (closed envelop
method) included eighty pediatric patients subjected to elective open
cardiac surgery. They were randomly allocated into four equal groups (20
patients each): (A) control group (i.v. fentanyl), (B) intrathecal
fentanyl group (ITF) (received IT 1 lg/kg of fentanyl), (C) intrathecal
fentanyl and magnesium (0.5 mg/kg) group (received IT 1 lg/kg of fentanyl
citrate and 0.5 mg/kg magnesium sulfate), and (D) intrathecal fentanyl
magnesium (1 mg) group (received IT 1 lg/kg of fentanyl citrate, and 1
mg/kg magnesium sulphate). The perioperative anesthetic management was
standardized. Results: The results of this study demonstrated that the
analgesic profile tended to be better with ITF, ITF-Mg 0.5 mg/kg and
ITF-Mg 1 mg/kg groups than the control group. Also, intraoperative
fentanyl used in ITF-Mg (1 mg) was statistically less as compared with ITF
and ITF-Mg (0.5 mg)groups. Time to extubation (h) was surprisingly,
shorter in ITF-Mg (1 mg) as compared with ITF and control groups. Also,
postoperative intravenous fentanyl consumption lg/kg/24 h was more in
control group as compared with other groups. Conclusion: In conclusion,
the use of intrathecal fentanyl-magnesium (1 mg/kg) in pediatric patients
subjected to open cardiac surgery reduced intra and postoperative
analgesic consumption, prolonged the time to first analgesic requirement
and allowed early tracheal extubation when compared with intravenous
fentanyl, intrathecal fentanyl or intrathecal fentanyl-magnesium (0.5
mg/kg). 2011 Egyptian Society of Anesthesiologists.

<13>
Accession Number
2012507476
Authors
Eggebrecht H. Schmermund A. Voigtlander T. Kahlert P. Erbel R. Mehta R.H.
Institution
(Eggebrecht, Schmermund, Voigtlander) Cardioangiological Center Bethanien
(CCB), Im Prufling 23, 60389 Frankfurt, Germany
(Kahlert, Erbel) Department of Cardiology, West-German Heart Center Essen,
University Duisburg-Essen, Essen, Germany
(Mehta) Duke Clinical Research Institute, Durham, NC, United States
Title
Risk of stroke after transcatheter aortic valve implantation (TAVI): A
meta-analysis of 10,037 published patients.
Source
EuroIntervention. 8 (1) (pp 129-138), 2012. Date of Publication: May 2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Transcatheter aortic valve implantation (TAVI) represents a novel
treatment option for inoperable or high surgical risk patients with severe
symptomatic aortic valve disease. Recent randomised studies have raised
major safety concerns because of increased stroke/transient ischemic
attack (TIA) rates with TAVI compared to medical treatment and
conventional aortic valve replacement. We aimed to review all currently
published literature and estimate the incidence of periprocedural stroke
and outcomes in patients undergoing TAVI. Methods and results: Fifty-three
studies including a total of 10,037 patients undergoing transfemoral,
transapical or trans-subclavian TAVI for native aortic valve stenosis
published between 01/2004 and 11/2011 were identified and included in a
meta-analysis. Patients were 81.5+/-1.8-years-old and had a mean logistic
EuroSCORE of 24.77+/-5.60%. Procedural stroke (<24 h) occurred in
1.5+/-1.4%. The overall 30-day stroke/TIA was 3.3+/-1.8%, with the
majority being major strokes (2.9+/-1.8%). During the first year after
TAVI, stroke/TIA increased up to 5.2+/-3.4%. Differences in stroke rates
were associated with different approaches and valve prostheses used with
lowest stroke rates after transapical TAVI (2.7+/-1.4%). Average 30-day
mortality was more than 3.5-fold higher in patients with compared to those
without stroke (25.5+/-21.9% vs. 6.9+/-4.2%). Conclusions: TAVI was
associated with average 30-day stroke/TIA rate of 3.3+/-1.8% (range 0-6%).
Most of these strokes were major strokes and were associated with
increased mortality within in the first 30 days. Europa Edition 2012. All
rights reserved.

<14>
[Use Link to view the full text]
Accession Number
2012507885
Authors
Almansob M.A.S. Xu B. Zhou L. Hu X.-X. Chen W. Chang F.-J. Ci H.-B. Yao
J.-P. Xu Y.-Q. Yao F.-J. Liu D.-H. Zhang W.-B. Tang B.-Y. Wang Z.-P. Ou
J.-S.
Institution
(Almansob, Xu, Zhou, Hu, Chang, Ci, Yao, Xu, Zhang, Tang, Wang, Ou)
Division of Cardiac Surgery, First Affiliated Hospital, Sun Yat-sen
University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
(Almansob, Xu, Zhou, Hu, Chang, Ci, Yao, Xu, Zhang, Tang, Wang, Ou) Key
Laboratory of Assisted Circulation, Ministry of Health, China
(Yao, Liu) Department of Ultrasound, First Affiliated Hospital, Sun
Yat-sen University, Guangzhou, China
(Chen) Department of Medical Statistics and Epidemiology, School of Public
Health, Sun Yat-sen University, Guangzhou, China
Title
Simvastatin reduces myocardial injury undergoing noncoronary artery
cardiac surgery: A randomized controlled trial.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. 32 (9) (pp 2304-2313),
2012. Date of Publication: September 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective-Myocardial injury during cardiac surgery is a major cause of
perioperative morbidity and mortality. We determined whether perioperative
statin therapy is cardioprotective in patients undergoing noncoronary
artery cardiac surgery and the potential mechanisms. Methods and
Results-One hundred fifty-one patients undergoing noncoronary artery
cardiac surgery were randomly assigned to either a statin group (n=77) or
a control group (n=74). Simvastatin (20 mg) was administered
preoperatively and postoperatively. Plasma were analyzed for troponin T,
isoenzyme of creatine kinase, C-reaction protein, interleukin-6,
interleukin-8, creatinine, and blood urea nitrogen. Cardiac
echocardiography was performed. Endothelial nitric oxide synthase (eNOS),
Akt, p38, heat shock protein 90, caveolin-1, and nitric oxide (NO) in the
heart were detected. Simvastatin significantly reduced plasma troponin T,
isoenzyme of creatine kinase, C-reaction protein, blood urea nitrogen,
creatinine, interleukin-6, interleukin-8, and the requirement of inotropic
postoperatively. Simvastatin increased NO production, the expression of
eNOS and phosphorylation at serine1177, phosphorylation of Akt, expression
of heat shock protein 90, heat shock protein 90 association with eNOS and
decreased eNOS phosphorylation at threonine 495, phosphorylation of p38,
and expression of caveolin-1. Simvastatin also improved cardiac function
postoperatively. Conclusion-Perioperative statin therapy can improve
cardiac function and renal function by reducing myocardial injury and
inflammatory response through activating Akt-eNOS and attenuating p38
signaling pathways in patients undergoing noncoronary artery cardiac
surgery. Clinical trial registration-: URL: http://www.clinicaltrials.gov.
Unique identifier: NCT01178710. 2012 American Heart Association, Inc.

<15>
Accession Number
2012511816
Authors
Zuckermann A. Keogh A. Crespo-Leiro M.G. Mancini D. Vilchez F.G. Almenar
L. Brozena S. Eisen H. Tai S.S. Kushwaha S.
Institution
(Zuckermann) AKH Wien, Vienna, Austria
(Keogh) St. Vincent's Hospital, Sydney, NSW, Australia
(Crespo-Leiro) Hospital Universitario A Coruna, La Coruna, Spain
(Mancini) Columbia University Medical Center, New York, NY, United States
(Vilchez) Hospital Marques de Valdecilla, Santander Catabria, Spain
(Almenar) Hospital la Fe, Valencia, Spain
(Brozena) University of Pennsylvania, Philadelphia, PA, United States
(Eisen) Drexel University College of Medicine, Philadelphia, PA, United
States
(Tai) Wyeth Pharmaceuticals (Pfizer Inc), Collegeville, PA, United States
(Kushwaha) Mayo Clinic Rochester, Rochester, MN, United States
Title
Randomized controlled trial of sirolimus conversion in cardiac transplant
recipients with renal insufficiency.
Source
American Journal of Transplantation. 12 (9) (pp 2487-2497), 2012. Date of
Publication: September 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
This randomized, comparative, multinational phase 3b/4 study of patients
1-8 years postcardiac transplantation (mean 3.9 years) evaluated the
effect of conversion from a calcineurin inhibitor (CNI) to sirolimus on
renal function in patients with renal insufficiency. In total, 116
patients on CNI therapy with GFR 40-90 mL/min/1.73m² were
randomized (1:1) to sirolimus (n = 57) or CNI (n = 59). Intent-to-treat
analysis showed the 1-year adjusted mean change from baseline in
creatinine clearance (Cockcroft-Gault) was significantly higher with
sirolimus versus CNI treatment (+3.0 vs. -1.4 mL/min/1.73 m ²,
respectively; p = 0.004). By on-therapy analysis, values were +4.7 and
-2.1, respectively (p < 0.001). Acute rejection (AR) rates were
numerically higher in the sirolimus group; 1 AR with hemodynamic
compromise occurred in each group. A significantly higher treatment
discontinuation rate due to adverse events (AEs; 33.3% vs. 0%; p < 0.001)
occurred in the sirolimus group. Most common treatment-emergent AEs
significantly higher in the sirolimus group were diarrhea (28.1%), rash
(28.1%) and infection (47.4%). Conversion to sirolimus from CNI therapy
improved renal function in cardiac transplant recipients with renal
impairment, but was associated with an attendant AR risk and higher
discontinuation rate attributable to AEs. This randomized, comparative,
multinational study of cardiac transplant recipients with mild to moderate
renal insufficiency shows that conversion to sirolimus from calcineurin
inhibitor therapy significantly improves renal function but with an
attendant risk of acute rejection. Copyright 2012 The American Society of
Transplantation and the American Society of Transplant Surgeons.

<16>
Accession Number
2012508106
Authors
Pelliccia F. Trani C. Biondi-Zoccai G.G.L. Nazzaro M. Berni A. Patti G.
Patrizi R. Pironi B. Mazzarotto P. Gioffr G. Speciale G. Pristipino C.
Institution
(Pelliccia, Trani, Biondi-Zoccai, Nazzaro, Berni, Patti, Patrizi, Pironi,
Mazzarotto, Gioffr, Speciale, Pristipino) Dipartimento Universitario Del
Cuore e Grossi Vasi A. Reale, 1a Facolta di Medicina e Chirurgia,
Universita Degli Studi di Roma la Sapienza, Rome, Italy
Title
Comparison of the feasibility and effectiveness of transradial coronary
angiography via right versus left radial artery approaches (from the
PREVAIL study).
Source
American Journal of Cardiology. 110 (6) (pp 771-775), 2012. Date of
Publication: 15 Sep 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
It remains undefined if transradial coronary angiography from a right or
left radial arterial approach differs in real-world practice. To address
this issue, we performed a subanalysis of the PREVAIL study. The PREVAIL
study was a prospective, multicenter, observational survey of unselected
consecutive patients undergoing invasive cardiovascular procedures over a
1-month observation period, specifically aimed at assessing the outcomes
of radial approach in the contemporary real world. The choice of arterial
approach was left to the discretion of the operator. Prespecified end
points of this subanalysis were procedural characteristics. Of 1,052
patients consecutively enrolled, 509 patients underwent transradial
catheterization, 304 with a right radial and 205 with a left radial
approach. Procedural success rates were similar between the 2 groups.
Compared to the left radial group, the right radial group had longer
procedure duration (46 +/- 29 vs 33 +/- 24 minutes, p <0.0001) and
fluoroscopy time (765 +/- 787 vs 533 +/- 502, p <0.0001). At multivariate
analysis, including a parsimonious propensity score for the choice of left
radial approach, duration of procedure (beta coefficient 11.38, p <0.001)
and total dosearea product (beta coefficient 11.38, p <0.001) were
independently associated with the choice of the left radial artery
approach. The operator's proficiency in right/left radial approach did not
influence study results. In conclusion, right and left radial approaches
are feasible and effective to perform percutaneous procedures. In the
contemporary real world, however, the left radial route is associated with
shorter procedures and lower radiologic exposure than the right radial
approach, independently of an operator's proficiency. 2012 Elsevier Inc.
All rights reserved.

<17>
Accession Number
2012508107
Authors
Amin A.P. Reynolds M.R. Lei Y. Magnuson E.A. Vilain K. Durtschi A.J.
Simonton C.A. Stone G.W. Cohen D.J.
Institution
(Amin, Lei, Magnuson, Vilain, Cohen) Saint Luke's Mid America Heart
Institute, Kansas City, MO, United States
(Amin, Cohen) University of MissouriKansas City, Kansas City, MO, United
States
(Reynolds) Harvard Clinical Research Institute, Boston VA Healthcare
System, Boston, MA, United States
(Durtschi, Simonton) Abbott Vascular, Santa Clara, CA, United States
(Stone) New YorkPresbyterian Hospital, Columbia University Medical Center,
Cardiovascular Research Foundation, New York, NY, United States
Title
Cost-effectiveness of everolimus-versus paclitaxel-eluting stents for
patients undergoing percutaneous coronary revascularization (from the
SPIRIT-IV trial).
Source
American Journal of Cardiology. 110 (6) (pp 765-770), 2012. Date of
Publication: 15 Sep 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Although several drug-eluting stents (DESs) have been shown to be
economically attractive compared to bare-metal stents in patients at
moderate to high risk of restenosis, little is known about the
costeffectiveness of alternative DES designs, especially second-generation
DESs. We therefore performed an economic substudy alongside the SPIRIT-IV
trial, in which 3,687 patients undergoing single or multivessel
percutaneous coronary intervention were randomized to receive
second-generation everolimus-eluting stents (EESs; n = 2,458) or
first-generation paclitaxel-eluting stents (PESs; n = 1,229). Costs
through 2 years of follow-up were assessed from the perspective of the
United States health care system. The primary cost-effectiveness end point
was the incremental cost-effectiveness ratio assessed as cost per
quality-adjusted life year gained. Over a 2-year period, use of EESs
versus PESs led to a trend toward decreased overall repeat
revascularization procedures (14.2 vs 16.2 per 100 subjects, p = 0.20)
driven by a significant decrease in the number of target vessel
revascularization procedures (8.2 vs 11.0 per 100 subjects, p = 0.02) but
also a slight increase in the number of nontarget vessel revascularization
procedures (6.0 vs 5.1 per 100 subjects, p = 0.37). Follow-up
cardiovascular costs were decreased by $273/patient in the EES group (95%
confidence interval for difference 1,048 less to 502 more, p = 0.49).
Formal cost-effectiveness analysis based on these results demonstrated
that the probability that EES was an economically attractive strategy
(incremental cost-effectiveness ratio <$50,000/quality-adjusted life year
gained) was 85.7%. These findings demonstrate that in patients undergoing
percutaneous coronary intervention with DESs, use of EESs is economically
attractive compared to PESs with improved clinical outcomes and lower
overall medical care costs at 2 years. 2012 Elsevier Inc. All rights
reserved.

<18>
Accession Number
2012505291
Authors
Garcia-Garcia H.M. Klauss V. Gonzalo N. Garg S. Onuma Y. Hamm C.W. Wijns
W. Shannon J. Serruys P.W.
Institution
(Garcia-Garcia, Gonzalo, Garg, Onuma, Serruys) Thoraxcenter, Erasmus MC,
Ba583, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
(Garcia-Garcia) Cardialysis, Rotterdam, Netherlands
(Klauss) Campus Innenstadt University Hospital Munich, Munich, Germany
(Hamm) Kerckhoff Klinik, Bad Nauheim, Germany
(Wijns) Cardiovascular Center, Aalst, Belgium
(Shannon) GlaxoSmithKline, RTP, Durham, NC, United States
Title
Relationship between cardiovascular risk factors and biomarkers with
necrotic core and atheroma size: A serial intravascular ultrasound
radiofrequency data analysis.
Source
International Journal of Cardiovascular Imaging. 28 (4) (pp 695-703),
2012. Date of Publication: April 2012.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
We explored the impact of patient demographics, anthropometric
measurements, cardiovascular risk factors, and soluble biomarkers on
necrotic core and atheroma size in patients with coronary disease. The
IBIS-2 trial enrolled 330 patients. In the multivariate analysis, at
baseline, creatinine had a positive, whereas baseline mean lumen diameter
and myeloperoxidase had a negative, independent association with
percentage of necrotic core (PNC); while age, glomerular filtration rate
<60, HbA1c, previous PCI or CABG and baseline % diameter stenosis were
positively, and acute coronary syndromes (ACS) were negatively associated
with baseline percentage atheroma volume (PAV). The variables associated
with a decrease in PNC from baseline were darapladib, ACS and a large
content of NC at baseline, while variables associated with an increase in
PNC were previous stroke and % diameter stenosis at baseline. Those
variables associated with a decrease in PAV from baseline were waist
circumference, statin use, CD40L and baseline PAV, while the only variable
associated with an increase in PAV was baseline diastolic blood pressure.
Treatment with darapladib was associated with a decrease in necrotic core,
but was not associated with a decrease in percentage atheroma volume. On
the contrary, statin use was only associated with a decrease in percentage
atheroma volume. The Author(s) 2011.

<19>
Accession Number
22720974
Authors
Meier P. Indermuehle A. Pitt B. Traupe T. de Marchi S.F. Crake T. Knapp G.
Lansky A.J. Seiler C.
Institution
(Meier) The Heart Hospital London, University College London Hospital
Trust, London, UK.
Title
Coronary collaterals and risk for restenosis after percutaneous coronary
interventions: a meta-analysis.
Source
BMC medicine. 10 (pp 62), 2012. Date of Publication: 2012.
Abstract
The benefit of the coronary collateral circulation (natural bypass
network) on survival is well established. However, data derived from
smaller studies indicates that coronary collaterals may increase the risk
for restenosis after percutaneous coronary interventions. The purpose of
this systematic review and meta-analysis of observational studies was to
explore the impact of the collateral circulation on the risk for
restenosis. We searched the MEDLINE, EMBASE and ISI Web of Science
databases (2001 to 15 July 2011). Random effects models were used to
calculate summary risk ratios (RR) for restenosis. The primary endpoint
was angiographic restenosis > 50%. A total of 7 studies enrolling 1,425
subjects were integrated in this analysis. On average across studies, the
presence of a good collateralization was predictive for restenosis (risk
ratio (RR) 1.40 (95% CI 1.09 to 1.80); P = 0.009). This risk ratio was
consistent in the subgroup analyses where collateralization was assessed
with intracoronary pressure measurements (RR 1.37 (95% CI 1.03 to 1.83); P
= 0.038) versus visual assessment (RR 1.41 (95% CI 1.00 to 1.99); P =
0.049). For the subgroup of patients with stable coronary artery disease
(CAD), the RR for restenosis with 'good collaterals' was 1.64 (95% CI 1.14
to 2.35) compared to 'poor collaterals' (P = 0.008). For patients with
acute myocardial infarction, however, the RR for restenosis with 'good
collateralization' was only 1.23 (95% CI 0.89 to 1.69); P = 0.212. The
risk of restenosis after percutaneous coronary intervention (PCI) is
increased in patients with good coronary collateralization. Assessment of
the coronary collateral circulation before PCI may be useful for risk
stratification and for the choice of antiproliferative measures
(drug-eluting stent instead bare-metal stent, cilostazol).

<20>
Accession Number
2012512103
Authors
Weber C.F. Gorlinger K. Meininger D. Herrmann E. Bingold T. Moritz A. Cohn
L.H. Zacharowski K.
Institution
(Weber, Meininger, Bingold, Zacharowski) Clinic of Anesthesiology,
Intensive Care Medicine and Pain Therapy, Goethe-University Hospital
Frankfurt, Frankfurt am Main, Germany
(Gorlinger) Clinic of Anesthesiology and Intensive Care Medicine,
University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55,
D-45122 Essen, Germany
(Herrmann) Institute of Biostatistics and Mathematical Modeling,
Goethe-University Frankfurt, Germany
(Moritz) Department of Thoracic and Cardiovascular Surgery,
Goethe-University Hospital Frankfurt, Germany
(Cohn) Harvard Medical School, Boston, MA, United States
(Cohn) Division of Cardiac Surgery, Brigham and Women's Hospital, Boston,
MA, United States
Title
Point-of-care testing: A prospective, randomized clinical trial of
efficacy in coagulopathic cardiac surgery patients.
Source
Anesthesiology. 117 (3) (pp 531-547), 2012. Date of Publication: September
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
INTRODUCTION:: The current investigation aimed to study the efficacy of
hemostatic therapy guided either by conventional coagulation analyses or
point-of-care (POC) testing in coagulopathic cardiac surgery patients.
METHODS:: Patients undergoing complex cardiac surgery were assessed for
eligibility. Those patients in whom diffuse bleeding was diagnosed after
heparin reversal or increased blood loss during the first 24 postoperative
hours were enrolled and randomized to the conventional or POC group.
Thromboelastometry and whole blood impedance aggregometry have been
performed in the POC group. The primary outcome variable was the number of
transfused units of packed erythrocytes during the first 24 h after
inclusion. Secondary outcome variables included postoperative blood loss,
use and costs of hemostatic therapy, and clinical outcome parameters.
Sample size analysis revealed a sample size of at least 100 patients per
group. RESULTS:: There were 152 patients who were screened for eligibility
and 100 patients were enrolled in the study. After randomization of 50
patients to each group, a planned interim analysis revealed a significant
difference in erythrocyte transfusion rate in the conventional compared
with the POC group [5 (4;9) versus 3 (2;6) units [median (25 and 75
percentile)], P < 0.001]. The study was terminated early. The secondary
outcome parameters of fresh frozen plasma and platelet transfusion rates,
postoperative mechanical ventilation time, length of intensive care unit
stay, composite adverse events rate, costs of hemostatic therapy, and
6-month mortality were lower in the POC group. CONCLUSIONS:: Hemostatic
therapy based on POC testing reduced patient exposure to allogenic blood
products and provided significant benefits with respect to clinical
outcomes. Copyright 2012, the American Society of Anesthesiologists, Inc.
Lippincott Williams & Wilkins.

<21>
Accession Number
2012505190
Authors
Kiessling A.-H. Wedde S. Keller H. Reyher C. Stock U. Beiras-Fernandez A.
Moritz A.
Institution
(Kiessling, Wedde, Keller, Stock, Beiras-Fernandez, Moritz) Department of
Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University,
Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
(Reyher) Department of Anaesthesiology and Intensive Care, Johann Wolfgang
Goethe University, Frankfurt am Main, Germany
Title
Pre-filling of the extracorporeal circuit with autologous blood is safe,
but not effective in optimizing biocompatibility in high-risk patients.
Source
Perfusion (United Kingdom). 27 (5) (pp 371-377), 2012. Date of
Publication: September 2012.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objectives: Haemodilution resulting from crystalloid priming of the
cardiopulmonary bypass circuit represents a major risk factor for blood
transfusions in high-risk cardiac surgery patients. We designed this study
to evaluate the effects of antegrade autologous priming (AAP) on reducing
perioperative blood transfusion and markers of the inflammatory response
in older patients (<75 years). Methods: Seventy-two patients undergoing
first-time coronary bypass and/or aortic valve replacement were
prospectively randomised to a cardiopulmonary bypass (CPB) with or without
AAP. AAP was performed by adding the patients own blood to the prime
solution (mean 280ml). Perfusion and anaesthetic techniques were as usual.
The haematocrit was maintained at a minimum of 21% during CPB. Patients
were well matched for all preoperative variables, including established
transfusion risk factors. The primary endpoint was the requirement of red
cell transfusion. The surrogate endpoints were renal function,
inflammatory response and ischaemic parameters. Blood samples were drawn
pre- and intraoperatively and at intervals of 6 hours till POD 6. Results:
Current analysis shows no differences in patients receiving homologous
packed red cell transfusions. Also, markers of the inflammatory response
(IL6, IL8), renal function (cystatin C, creatinine) and myocardial
ischaemia (troponin T, CKMB) were comparable in both groups (p<0.05).
Clinical outcomes were similar with respect to pulmonary, renal and
hepatic function, length of ICU stay and hospital stay. Conclusion: These
data suggest that antegrade autologous priming is a safe procedure, but an
ineffective way for improving biocompatibility and reducing the need for
blood transfusion in older patients.

<22>
Accession Number
2012505185
Authors
Zhu X. Ji B. Wang G. Liu J. Long C.
Institution
(Zhu, Ji, Liu, Long) Department of Cardiopulmonary Bypass, Fuwai Hospital,
Chinese Academy of Medical Sciences, 167 Beilishi Road, Fuwai Dajie,
Xicheng qu, Beijing 100037, China
(Wang) Department of Anesthesia, Fuwai Hospital, Chinese Academy of
Medical Sciences, Beijing, China
Title
The effects of zero-balance ultrafiltration on postoperative recovery
after cardiopulmonary bypass: A meta-analysis of randomized controlled
trials.
Source
Perfusion (United Kingdom). 27 (5) (pp 386-392), 2012. Date of
Publication: September 2012.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objective: Considered as a significant ultrafiltration technology during
cardiopulmonary bypass (CPB), zero-balance ultrafiltration (Z-BUF) has
always received controversial support regarding its effectiveness in
reducing inflammatory mediators in plasma. Therefore, we conducted a
meta-analysis to evaluate the clinical effect of Z-BUF through screening
all relevant published randomized controlled trials (RCTs). Methods: A
comprehensive search was conducted to screen all RCTs of Z-BUF. Three
trained investigators searched databases, including PubMed, Embase, the
Cochrane Library, Google scholar, and Chinese literature databases (CNKI,
WanFang, WeiPu). RCTs that compared Z-BUF with non-ultrafiltration were
included. We focused on clinical outcomes such as length of stay in ICU,
duration of ventilation, hospital stay, total amount of chest tube
drainage and mortality. Finally, a total of 7 studies containing
appropriate criteria were divided into an adult group and a pediatric
group. A random effects model was used to calculate weighted mean
difference with 95% confidence intervals. Results: In the adult group, the
benefits of Z-BUF in duration of ventilation (WMD=-2.77, 95% CI = [-6.26,
0.72], I²=71%, p=0.12) and the length of ICU stay (WMD=-4.13,
95% CI = [-10.09, 1.84], I ²=77%, Z=1.36, p=0.17) were not
apparent, with significant heterogeneity existing in the statistical
results. The rest of the clinical parameters could not be evaluated due to
insufficient data. In the pediatric group, combined analysis showed Z-BUF
could reduce the duration of mechanical ventilation (WMD=3.07; 95%CI=
[-7.56, -3.46], I²=17%, p=0.27). The advantage of Z-BUF was not
observed in other clinical outcomes. Conclusion: The benefits of Z-BUF
were not apparent, according to the report. Further studies involving
combined ultrafiltration are expected to provide improved ultrafiltration
during CPB.

<23>
Accession Number
2012502038
Authors
Raber L. Kelbaek H. Ostoijc M. Baumbach A. Heg D. Tuller D. Von Birgelen
C. Roffi M. Moschovitis A. Khattab A.A. Wenaweser P. Bonvini R. Pedrazzini
G. Kornowski R. Weber K. Trelle S. Luscher T.F. Taniwaki M. Matter C.M.
Meier B. Juni P. Windecker S.
Institution
(Raber, Moschovitis, Khattab, Wenaweser, Taniwaki, Meier, Windecker)
Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland
(Kelbaek) Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen,
Denmark
(Ostoijc) Department of Cardiology, Clinical Center of Serbia, Belgrade,
Serbia
(Baumbach) Bristol Heart Institute, Bristol, United Kingdom
(Heg, Juni) Institute of Social and Preventive Medicine, University of
Bern, Bern, Switzerland
(Trelle, Juni, Windecker) Clinical Trials Unit, Department of Clinical
Research, University of Bern, Bern, Switzerland
(Tuller) Cardiology Department, Triemlispital, Zurich, Switzerland
(Von Birgelen) Thoraxcentrum Twente, Twente University, Enschede,
Netherlands
(Roffi, Bonvini) Division of Cardiology, University Hospital, Geneva,
Switzerland
(Pedrazzini) Cardiocentro, Lugano, Switzerland
(Kornowski) Rabin Medical Center, Petach Tikva, Israel
(Kornowski) Tel Aviv University, Tel Aviv, Israel
(Weber) Herzzentrum Bodensee, Kreuzlingen, Switzerland
(Luscher, Matter) Cardiology Department, University Hospital Zurich,
Zurich, Switzerland
Title
Effect of biolimus-eluting stents with biodegradable polymer vs bare-metal
stents on cardiovascular events among patients with acute myocardial
infarction: The comfortable AMI randomized trial.
Source
JAMA - Journal of the American Medical Association. 308 (8) (pp 777-787),
2012. Date of Publication: 22 Aug 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: The efficacy and safety of drug-eluting stents compared with
bare-metal stents remains controversial in patients with ST-segment
elevation myocardial infarction (STEMI) undergoing primary percutaneous
coronary intervention (PCI). Objective: To compare stents eluting biolimus
from a biodegradable polymer with bare-metal stents in primary PCI.
Design, Setting, and Patients: A prospective, randomized, single-blinded,
controlled trial of 1161 patients presenting with STEMI at 11 sites in
Europe and Israel between September 19, 2009, and January 25, 2011.
Clinical follow-up was performed at 1 and 12 months. Intervention:
Patients were randomized 1:1 to receive the biolimus-eluting stent (n=575)
or the bare-metal stent (n=582). Main Outcome Measures: Primary end point
was the rate of major adverse cardiac events, a composite of cardiac
death, target vessel-related reinfarction, and ischemiadriven
target-lesion revascularization at 1 year. Results: Major adverse cardiac
events at 1 year occurred in 24 patients (4.3%) receiving biolimus-eluting
stents with biodegradable polymer and 49 patients (8.7%) receiving
bare-metal stents (hazard ratio [HR], 0.49; 95% CI, 0.30-0.80; P=.004).
The difference was driven by a lower risk of target vessel-related
reinfarction (3 [0.5%] vs 15 [2.7%]; HR, 0.20; 95% CI, 0.06-0.69; P=.01)
and ischemia-driven target-lesion revascularization (9 [1.6%] vs 32
[5.7%]; HR, 0.28; 95% CI, 0.13-0.59; P<.001) in patients receiving
biolimus-eluting stents compared with those receiving bare-metal stents.
Rates of cardiac death were not significantly different (16 [2.9%] vs 20
[3.5%], P=.53). Definite stent thrombosis occurred in 5 patients (0.9%)
treated with biolimus-eluting stents and 12 patients (2.1%; HR, 0.42; 95%
CI, 0.15-1.19; P=.10) treated with bare-metal stents. Conclusion: Compared
with a bare-metal stent, the use of biolimus-eluting stents with a
biodegradable polymer resulted in a lower rate of the composite of major
adverse cardiac events at 1 year among patients with STEMI undergoing
primary PCI. Trial Registration: clinicaltrials.gov Identifier:
NCT00962416. 2012 American Medical Association. All rights reserved.

<24>
Accession Number
2012498687
Authors
Phillips A.A. Cote A.T. Bredin S.S.D. Warburton D.E.R.
Institution
(Phillips, Warburton) Experimental Medicine Program, Faculty of Medicine,
University of British Columbia, Vancouver, Canada
(Phillips, Cote, Bredin, Warburton) Physical Activity and Chronic Disease
Prevention Unit, University of British Columbia, Vancouver, Canada
(Warburton) Unit II Osborne Centre, University of British Columbia, 6108
Thunderbird Blvd, Vancouver, BC, V6T 1Z3, Canada
Title
Heart Disease and Left Ventricular Rotation - A Systematic Review and
Quantitative Summary.
Source
BMC Cardiovascular Disorders. 12 , 2012. Article Number: 46. Date of
Publication: 24 Jun 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Left ventricular (LV) rotation is increasingly examined in
those with heart disease. The available evidence measuring LV rotation in
those with heart diseases has not been systematically reviewed.Methods: To
review systematically the evidence measuring LV rotational changes in
various heart diseases compared to healthy controls, literature searches
were conducted for appropriate articles using several electronic databases
(e.g., MEDLINE, EMBASE). All randomized-controlled trials, prospective
cohort and case-controlled studies that assessed LV rotation in relation
to various heart conditions were included. Three independent reviewers
evaluated each investigation's quality using validated scales. Results
were tabulated and levels of evidence assigned.Results: A total of 1,782
studies were found through the systematic literature search. Upon review
of the articles, 47 were included. The articles were separated into those
investigating changes in LV rotation in participants with: aortic
stenosis, myocardial infarction, hypertrophic cardiomyopathy, dilated
cardiomyopathy, non-compaction, restrictive cardiomyopathy/ constrictive
pericarditis, heart failure, diastolic dysfunction, heart transplant,
implanted pacemaker, coronary artery disease and cardiovascular disease
risk factors. Evidence showing changes in LV rotation due to various types
of heart disease was supported by evidence with limited to moderate
methodological quality.Conclusions: Despite a relatively low quality and
volume of evidence, the literature consistently shows that heart disease
leads to marked changes in LV rotation, while rotational
systolic-diastolic coupling is preserved. No prognostic information exists
on the potential value of rotational measures of LV function. The
literature suggests that measures of LV rotation may aid in diagnosing
subclinical aortic stenosis and diastolic dysfunction. 2012 Phillips et
al.; licensee BioMed Central Ltd.

<25>
Accession Number
22520937
Authors
Gu W.J. Wu Z.J. Wang P.F. Aung L.H. Yin R.X.
Institution
(Gu) Department of Cardiology, Institute of Cardiovascular Diseases, the
First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road,
Nanning 530021, Guangxi, People's Republic of China.
Title
Intravenous magnesium prevents atrial fibrillation after coronary artery
bypass grafting: a meta-analysis of 7 double-blind, placebo-controlled,
randomized clinical trials.
Source
Trials. 13 (pp 41), 2012. Date of Publication: 2012.
Abstract
Postoperative atrial fibrillation (POAF) is the most common complication
after coronary artery bypass grafting (CABG). The preventive effect of
magnesium on POAF is not well known. This meta-analysis was undertaken to
assess the efficacy of intravenous magnesium on the prevention of POAF
after CABG. Eligible studies were identified from electronic databases
(Medline, Embase, and the Cochrane Library). The primary outcome measure
was the incidence of POAF. The meta-analysis was performed with the
fixed-effect model or random-effect model according to heterogeneity.
Seven double-blind, placebo-controlled, randomized clinical trials met the
inclusion criteria including 1,028 participants. The pooled results showed
that intravenous magnesium reduced the incidence of POAF by 36% (RR 0.64;
95% confidence interval (CI) 0.50-0.83; P = 0.001; with no heterogeneity
between trials (heterogeneity P = 0.8, I2 = 0%)). This meta-analysis
indicates that intravenous magnesium significantly reduces the incidence
of POAF after CABG. This finding encourages the use of intravenous
magnesium as an alternative to prevent POAF after CABG. But more high
quality randomized clinical trials are still need to confirm the safety.