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<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>
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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.