EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<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.