EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2012627804
Authors
Moscariello A. Vliegenthart R. Schoepf U.J. Nance Jr. J.W. Zwerner P.L.
Meyer M. Townsend J.C. Fernandes V. Steinberg D.H. Fink C. Oudkerk M.
Bonomo L. O'Brien T.X. Henzler T.
Institution
(Moscariello, Vliegenthart, Schoepf, Nance Jr., Zwerner, Meyer, Townsend,
Fernandes, Steinberg, O'Brien, Henzler) Heart and Vascular Center, Medical
University of South Carolina, Ashley River Tower, 25 Courtenay Dr,
Charleston, SC 29425-2260, United States
(Moscariello, Bonomo) Department of Bioimaging and Radiological Sciences,
Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
(Vliegenthart, Oudkerk) Center for Medical Imaging-North East Netherlands,
Department of Radiology, University of Groningen, Netherlands
(Meyer, Fink, Henzler) Institute of Clinical Radiology and Nuclear
Medicine, University Medical Center Mannheim, Heidelberg University,
Germany
(Fernandes, O'Brien) Ralph H. Johnson Veterans Affairs Medical Center,
Charleston, SC, United States
Title
Coronary CT angiography versus conventional cardiac angiography for
therapeutic decision making in patients with high likelihood of coronary
artery disease.
Source
Radiology. 265 (2) (pp 385-392), 2012. Date of Publication: November 2012.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States)
Abstract
Purpose: To assess the efficacy of coronary computed tomographic (CT)
angiography for therapeutic decision making in patients with high
likelihood of coronary artery disease (CAD) - specifically the ability of
coronary CT angiography to help differentiate patients without and
patients with a need for revascularization and determine the appropriate
revascularization procedure. Materials and Methods: The study protocol was
approved by institutional review board, with written informed consent from
all patients. The study was conducted in compliance with HIPAA. One
hundred eighty-five consecutive symptomatic patients (121 men; mean age,
59.4 years +/- 9.7) with a positive single photon emission computed
tomography (SPECT) myocardial perfusion study underwent coronary CT
angiography and conventional cardiac angiography (hereafter, cardiac
catheterization). The management strategy (conservative treatment vs
revascularization) and revascularization procedure (percutaneous coronary
intervention [PCI] vs coronary artery bypass graft surgery [CABG]) were
prospectively selected on the basis of a combination of coronary CT
angiography and SPECT. In addition, the authors calculated the accuracy,
sensitivity, specificity, and negative and positive predictive values of
coronary CT angiography in the detection of obstructive CAD and the
selection of a revascularization strategy. Cardiac catheterization was
used as the standard of reference. Results: Of the 185 patients, 113 (61%)
did not undergo revascularization and 42 (23%) were free of CAD. In 178
patients (96%), the same therapeutic strategy (conservative treatment vs
revascularization) was chosen on the basis of coronary CT angiography and
catheterization. All patients in need of revascularization were identified
with coronary CT angiography. When revascularization was indicated, the
same procedure (PCI vs CABG) was chosen in 66 of 72 patients (92%).
Conclusion: In patients with high likelihood of CAD, the performance of
coronary CT angiography in the differentiation of patients without and
patients with a need for revascularization and the selection of a
revascularization strategy was similar to that of cardiac catheterization;
accordingly, coronary CT angiography has the potential to limit the number
of patients without obstructive CAD who undergo cardiac catheterization
and to inform decision making regarding revascularization. RSNA, 2012.

<2>
Accession Number
2012625943
Authors
Bourgonje V.J.A. Schoenmakers M. Beekman J.D.M. Van Der Nagel R. Houtman
M.J.C. Miedema L.F. Antoons G. Sipido K. De Windt L.J. Van Veen T.A.B. Vos
M.A.
Institution
(Bourgonje, Beekman, Van Der Nagel, Houtman, Miedema, De Windt, Van Veen,
Vos) Department of Medical Physiology, Division Heart and Lungs,
University Medical Center Utrecht, Yalelaan 50, 3584 CM Utrecht,
Netherlands
(Schoenmakers, De Windt) Department of Cardiology, Cardiovascular Research
Institute Maastricht, University Maastricht, Maastricht, Netherlands
(Antoons, Sipido) Laboratory of Experiment Cardiology, KU Leuven, Leuven,
Belgium
Title
Relevance of calmodulin/CaMKII activation for arrhythmogenesis in the AV
block dog.
Source
Heart Rhythm. 9 (11) (pp 1875-1883.e2), 2012. Date of Publication:
November 2012.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: The calcium-dependent signaling molecules calcineurin and
calcium/calmodulin-dependent protein kinase II (CaMKII) both have been
linked to decompensated hypertrophy and arrhythmias. CaMKII is also
believed to be involved in acute modulation of ion channels. Objective:
The purpose of this study was to determine the role of calcineurin and
CaMKII in a dog model of compensated hypertrophy and a long QT phenotype.
Methods: AV block was created in dogs to induce ventricular remodeling,
including enhanced susceptibility to dofetilide-induced torsades de
pointes arrhythmias. Dogs were treated with cyclosporin A for 3 weeks,
which reduced calcineurin activity, as determined by mRNA expression
levels of regulator of calcineurin 1 exon 4, but which was unable to
prevent structural, contractile, or electrical remodeling and arrhythmias.
Biopsies were taken before and at 2 or 9 weeks after AV block. Western
blots were performed against phosphorylated and total CaMKII,
phospholamban, Akt, and histone deacetylase 4 (HDAC4). Results: Chronic AV
block showed an increase in Akt, CaMKII and phospholamban phosphorylation
levels, but HDAC4 phosphorylation remained unaltered. Dofetilide induced
torsades de pointes in vivo and early afterdepolarizations in
cardiomyocytes, and increased [Ca²⁺]_i and CaMKII
autophosphorylation. Both W-7 and KN-93 treatment counteracted this.
Conclusion: The calcineurin pathway seems not to be involved in long-term
cardiac remodeling of the chronic AV block dog. Although CaMKII is
chronically activated, this does not translate to HDAC4 phosphorylation.
However, acute CaMKII overactivation is able to initiate arrhythmias based
on triggered activity. 2012 Heart Rhythm Society.

<3>
Accession Number
2012613863
Authors
Ayhan B. Pamuk A.G. Kantar B. Kanbak M. Celebioglu B. Aypar U.
Institution
(Ayhan, Pamuk, Kantar, Kanbak, Celebioglu, Aypar) Hacettepe Universitesi
Tip Fakudiltesi, Anesteziyoloji ve Reanimasyon Anabilim Dali, 06100
Sihhiye / Ankara, Turkey
Title
Renal functional effects of using N-Acetyl-Cysteine (NAC) in cardiac
surgery.
Source
Anestezi Dergisi. 20 (3) (pp 159-167), 2012. Date of Publication: 2012.
Publisher
Anestezi Dergisi (P.O. Box 133, Cebeci, Ankara 06591, Turkey)
Abstract
Objective: Acute renal failure following cardiac surgery is a very
important cause of morbidity and mortality. The risk has been reduced with
a variety of some practises. In this study we investigated the effects of
two different methods of using N-Acetylcystein (NAC) during cardiac
surgery on renal function. Method: 60 patients with normal renal function
were randomly allocated to three groups. Group I had 50 mg kg^-1
NAC added to pump priming solution; Group II received 50 mg
kg^-1 NAC i.v. after induction and had an infusion of 20 mg
kg^-1 h^-1 throughout the operation; Group III was the
control group. Demographic and perioperative data, fluid balance, urine
output and drainage amounts, haemodynamic data, BUN, creatinine, blood and
urine electrolytes, and beta-2 globulin, creatinine clearance and
fractional sodium excreation (FeNa) were obtained after induction(T1),
before CardioPulmonaryBypass (T2), 30^th minutes of
Cardiopulmonary Bypass (T3), after CardioPulmonaryBypass (T4), at the end
of the operation (T5), at postoperative 24^th h(T6), and at
postoperative 48^th h (T7). Results: There were no difference
among the demographic and perioperative data, total amount of fluid given,
urine outputs and drainage. Urinary albumine/creatinine ratios inceased in
Group III at T2 (p<0.05), in Group I at T3, whereas no significant
difference was found in Group II. Creatinine values showed a statistically
significant increase postoperatively (T6-T7) in all groups (p<0.05). Beta
-2 globuline increased in the control group at T6, whereas in Group I and
II at T7. Conclusion: Two different regiments of N-Acetylcystein in
coronary artery bypass grafting have some benefical effects, but failed to
demonstrate preventive effect after 24 hr operation.

<4>
Accession Number
2012622373
Authors
Wohrle J. Zadura M. Mobius-Winkler S. Leschke M. Opitz C. Ahmed W.
Barragan P. Simon J.-P. Cassel G. Scheller B.
Institution
(Wohrle) Department of Internal Medicine II - Cardiology, University of
Ulm, Ulm, 89081, Germany
(Zadura) Department of Cardiology, Heart and Diabetes Center, MVP,
Karlsburg, Germany
(Mobius-Winkler) Department of Internal Medicine-Cardiology, University of
Leipzig, Heart Center, Leipzig, Germany
(Leschke) Department of Cardiology, Pneumology and Angiology, Clinic
Esslingen, Esslingen, Germany
(Opitz) Department of Internal Medicine, DRK Kliniken Berlin, Berlin,
Germany
(Opitz) Department of Internal Medicine B, University of Greifswald,
Greifswald, Germany
(Ahmed) Department of Cardiology, Shifa International Hospital, Islamabad,
Pakistan
(Barragan) Department of Cardiology, Polyclinique les Fleurs, Ollioules,
France
(Simon) Department of Cardiology, Polyclinique Pasteur, Essey les Nancy,
France
(Cassel) Milpark Hospital, Johannesburg, South Africa
(Scheller) Department of Internal Medicine III, University Hospital of
Saarland, Homburg/Saar, Germany
Title
SeQuent please world wide registry: Clinical results of SeQuent please
paclitaxel-coated balloon angioplasty in a large-scale, prospective
registry study.
Source
Journal of the American College of Cardiology. 60 (18) (pp 1733-1738),
2012. Date of Publication: 30 Oct 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to assess the safety and efficacy of
paclitaxel-coated balloon (PCB) angioplasty in an international,
multicenter, prospective, large-scale registry study. Background: In small
randomized trials, PCB angioplasty was superior to uncoated balloon
angioplasty for treatment of bare-metal stent (BMS) and drug-eluting stent
(DES) restenosis. Methods: Patients treated with SeQuent Please PCBs were
included. The primary outcome measure was the clinically driven target
lesion revascularization (TLR) rate at 9 months. Results: At 75 centers,
2,095 patients with 2,234 lesions were included. The TLR rate was 5.2%
after 9.4 months. Definite vessel thrombosis occurred in 0.1%. PCB
angioplasty was performed in 1,523 patients (72.7%) with DES or BMS
restenosis and 572 patients (27.3%) with de novo lesions. The TLR rate was
significantly lower in patients with PCB angioplasty for BMS restenosis
compared with DES restenosis (3.8% vs. 9.6%, p < 0.001). The TLR rate did
not differ for PCB angioplasty of paclitaxel-eluting stent and
non-paclitaxel-eluting sten restenosis (8.3% vs. 10.8%, p = 0.46). In de
novo lesions (small vessels), the TLR rate was low and did not differ
between PCB angioplasty with and without additional BMS implantation (p =
0.31). Conclusions: PCB angioplasty in an all-comers, prospective,
multicenter registry was safe and confirmed in a large population the low
TLR rates seen in randomized clinical trials. PCB angioplasty was more
effective in BMS restenosis compared with DES restenosis, with no
difference regarding the type of DES. 2012 American College of Cardiology
Foundation.

<5>
Accession Number
22951500
Authors
Gilfraguas L. Guadalix S. Martinez G. Jodar E. Vara J. Gomez-Sanchez M.A.
Delgado J. De La Cruz J. Lora D. Hawkins F.
Institution
(Gilfraguas) University Hospital, 12 de Octubre, Madrid, Spain.
Title
Bone loss after heart transplant: effect of alendronate, etidronate,
calcitonin, and calcium plus vitamin D3.
Source
Progress in transplantation (Aliso Viejo, Calif.). 22 (3) (pp 237-243),
2012. Date of Publication: Sep 2012.
Abstract
To compare the effects of calcitonin, etidronate, and alendronate in
preventing bone loss during the first 2 years after heart transplant. A
total of 222 heart transplant recipients (mean [SD] age, 52.4 [10] years,
85% male) were evaluated. Patients with normal bone mineral density
(reference group, n = 102) received 1000 mg/d calcium plus 800 IU/d
vitamin D3. The rest were assigned to 200 IU/d of calcitonin (n=42), 400
mg/d etidronate orally for 14 days quarterly (n = 33), or 10 mg/d
alendronate (n = 45). All patients received calcium and vitamin D. Bone
mineral density was assessed by dual-energy x-ray absorptiometry in the
lumbar spine, the entire femur, and the femoral neck at baseline and 6,
12, and 24 months after transplant. At 2 years after transplant, bone
mineral density in the lumbar spine had decreased in the reference group
(-3.07%), calcitonin group (-0.93%), and etidronate group (-1.87%) but not
in the alendronate group (+4.9%; P <.001). After 2 years, bone mineral
density in the entire femur decreased in all groups (-3.2% in the
reference group, -3.6% in the calcitonin group, -4.6% in the etidronate
group, and -0.5% in the alendronate group) but bone loss was significantly
lower in the alendronate group (P <.001). Bone mineral density in the
femoral neck also decreased in all groups. The incidence of vertebral
fractures did not differ among groups. Adverse events were similar between
groups. Alendronate therapy in heart transplant recipients was associated
with a significant increase in bone mineral density in the lumbar spine
and less bone loss at the hip.

<6>
Accession Number
2012626436
Authors
Yetgin T. Manintveld O.C. Boersma E. Kappetein A.P. van Geuns R.-J.
Zijlstra F. Duncker D.J. van der Giessen W.J.
Institution
(Yetgin, Manintveld, Boersma, van Geuns, Zijlstra, Duncker, van der
Giessen) Department of Cardiology, Thoraxcenter, Erasmus University
Medical Center, Dr. Molewaterplein 50-60, Rm Ee-2351A, 3015 GE Rotterdam,
Netherlands
(Kappetein) Department of Cardio-Thoracic Surgery, Thoraxcenter, Erasmus
University Medical Center, Rotterdam, Netherlands
(Yetgin, van der Giessen) Interuniversity Cardiology, Institute of the
Netherlands, ICIN-KNAW, Utrecht, Netherlands
Title
Remote Ischemic Conditioning in Percutaneous Coronary Intervention and
Coronary Artery Bypass Grafting - Meta-Analysis of Randomized Trials -.
Source
Circulation Journal. 76 (10) (pp 2392-2404), 2012. Date of Publication:
2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Although remote ischemic conditioning (RIC) by transient limb
ischemia in percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) has shown favorable effects on myocardial
(ischemiareperfusion) injury, recent trials provide inconsistent results.
The aim of the present study was to assess the effect of RIC in PCI or
CABG. Methods and Results: Medline/Embase/conference reports were searched
for randomized RIC trials and were included if they reported on biomarkers
of myocardial injury (CK-MB/troponin T/I), after which, standardized mean
differences (SMDs) were calculated (Hedges g statistic). Meta-analysis of
4 studies on PCI, involving 557 patients, indicated reduced biomarkers for
myocardial injury with RIC compared to control (random effects model:
SMD,-0.21; 95% confidence interval [CI]:-0.66 to 0.24). Analysis of
primary PCI studies, involving 314 patients, indicated a highly
significant positive effect of RIC on myocardial injury (SMD,-0.55; 95%
CI:-0.77 to-0.32). The 13 CABG studies taken together, involving 891
patients, indicated a significant effect of RIC on myocardial injury
(SMD,-0.34; 95% CI:-0.59 to-0.08). The statistical tests indicated
moderate to high heterogeneity across the studies (Q-statistic: PCI,
P=0.0006, I2=83%; CABG, P<0.0001, I²=69%). Conclusions: In
patients undergoing PCI or CABG, RIC with transient episodes of limb
ischemia is associated with lower biomarkers of myocardial injury compared
to control, but this effect failed to reach statistical significance in
the overall PCI analysis.

<7>
Accession Number
2012621751
Authors
Sinha L.M. Yunus A. Hussain S. Hussain M.
Institution
(Sinha, Yunus) Department of Cardiac Surgery, Mayo Hospital, King Edward
Medical University, Lahore, Pakistan
(Hussain) Department of Cardiac Surgery, CPE Institute of Cardiology,
Multan, Pakistan
(Hussain) Department of Pathology, Mayo Hospital, King Edward Medical
University, Lahore, Pakistan
Title
Antibiotic prophylaxis for preventing surgical site infection after
coronary artery bypass graft: Prospective randomized comparative study.
Source
Pakistan Journal of Medical and Health Sciences. 6 (3) (pp 742-745), 2012.
Date of Publication: July-September 2012.
Publisher
Pakistan Journal of Medical and Health Sciences (Nila Gumbad, Lahore,
Pakistan)
Abstract
Objectives: To compare the outcome of short-term (>24 hours) versus
longer-term (<24 hours) antibiotic prophylaxis in patients undergoing
coronary artery bypass graft (CABG) surgery and its impact on deep Sternal
Wound Infection (DSWI) / Mediastinitis. Patients and methods: To compare
the effect of short (>24 hours) versus prolonged (<24 hours) ABP on
surgical site infections (SSIs) and acquired antimicrobial resistance,
Cross sectional comparative study was conducted. Prospective surveillance
of 200 patients undergoing isolated CABG surgery (on pump/off pump)
fulfilling the inclusion and exclusion criteria were included in the
study. Comparison were made between 100 patients receiving less than 24
hours of prophylactic antibiotics with another 100 patients receiving more
than 24 hours of prophylactic antibiotics. Surgical Site infection (SSI)
was assessed on a daily basis during the patient's stay in the Department
of Cardiac Surgery, Mayo Hospital/KEMU, Lahore. Diagnosis of identified
SSI were based on positive cultures, clear dehiscence of the sternotomy
wound, fever, pain, redness, secretion, purulent drainage, and sternal
instability. The main exposure was the duration of ABP, and the primary
outcome measure was DSWI (Mediastinitis). Results: During the study period
9 patients developed DSWI/Mediastinitis, the infection rates were 4% in
the group > 24 h of ABP and 5% in the group receiving <24 h of ABP
therapy, and the difference was statistically non-significant (P=0. 774).
The proportion of patients with deep-organ-space involvement
(mediastinitis) and sepsis requiring rewiring were 3 patients (3%) for >24
hours and 4 patients (4%) in <24 hours of ABP (P=0.700). There were no
differences between groups for mortality or duration of hospitalization
(preoperative hospitalization, intensive care unit stay, and
hospitalization after surgical intervention). The microorganisms isolated
showed a similar distribution in both groups. Test of proportion was
applied and it was found that there was no difference in the proportion of
infection in the two groups (p value 0.05). Conclusion: Findings confirm
that a prophylactic Antibiotic combination using Vancomycin and an
aminoglycoside of 24 hours duration is as effective as prophylaxis
administered for longer than 24 hours regimen for preventing surgical site
infection in patients undergoing isolated CABG.

<8>
Accession Number
22729307
Authors
Cancio A.S.A. Guizilini S. Bolzan D.W. Dauar R.B. Succi J.E. de Paola
A.A.V. de Camargo Carvalho A.C. Gomes W.J.
Institution
(Cancio, Guizilini, Bolzan, de Paola, de Camargo Carvalho, Gomes) Sao
Paulo Hospital, Cardiology Discipline, Escola Paulista de Medicina,
Federal University of Sao Paulo, Sao Paulo, SP, Brazil
(Guizilini) Department of Human Movement Sciences, Physical Therapy
School, Federal University of Sao Paulo, Santos, SP, Brazil
(Dauar, Succi) Hospital Bandeirantes, Sao Paulo, SP, Brazil
Title
Subxyphoid pleural drain confers lesser impairment in respiratory muscle
strength, oxygenation and lower chest pain after off-pump coronary artery
bypass grafting: A randomized controlled trial.
Source
Brazilian Journal of Cardiovascular Surgery. 27 (1) (pp 103-109), 2012.
Date of Publication: March 2012.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Objective: To evaluate respiratory muscle strength, oxygenation and chest
pain in patients undergoing off-pump coronary artery bypass (OPCAB) using
internal thoracic artery grafts comparing pleural drain insertion site at
the subxyphoid region versus the lateral region. Methods: Forty patients
were randomized into two groups in accordance with the pleural drain site.
Group II (n = 19) - pleural drain exteriorized in the intercostal space;
group (SI) (n = 21) chest tube exteriorized at the subxyphoid region. All
patients underwent assessment of respiratory muscle strength (inspiratory
and expiratory) on the pre, 1, 3 and 5 postoperative days (POD). Arterial
blood gas analysis was collected on the pre and POD1. The chest pain
sensation was measured 1, 3 and 5 POD. Results: A significant decrease in
respiratory muscle strength (inspiratory and expiratory) was seen in both
groups until POD5 (P <0.05). When compared, the difference between groups
remained significant with greater decrease in the II (P <0.05). The blood
arterial oxygenation fell in both groups (P <0.05), but the oxygenation
was lower in the II (P <0.05). Referred chest pain was higher 1, 3 and 5
POD in the II group (P <0.05). The orotracheal intubation time and
postoperative length of hospital stay were higher in the II group (P
<0.05). Conclusion: Patients submitted to subxyphoid pleural drainage
showed less decrease in respiratory muscle strength, better preservation
of blood oxygenation and reduced thoracic pain compared to patients with
intercostal drain on early OPCAB postoperative.

<9>
Accession Number
22729304
Authors
Sbruzzi G. Silveira S.A. Silva D.V. Coronel C.C. Plentz R.D.M.
Institution
(Sbruzzi, Coronel) Instituto de Cardiologia do Rio Grande do Sul, Fundacao
Universitaria de Cardiologia, Porto Alegre, Brazil
(Plentz) Universidade Federal de Ciencias da Saude de Porto Alegre, Brazil
Title
Transcutaneous electrical nerve stimulation after thoracic surgery:
Systematic review and metaanalysis of randomized trials.
Source
Brazilian Journal of Cardiovascular Surgery. 27 (1) (pp 75-87), 2012. Date
of Publication: March 2012.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Objectives: To evaluate the effects of transcutaneous electric nerve
stimulation (TENS) on pain and pulmonary function during the postoperative
period after thoracic surgery by performing a systematic review and
meta-analysis of randomized trials. Methods: The search strategy included
MEDLINE, PEDro, Cochrane CENTRAL, EMBASE and LILACS, in addition to a
manual search, from inception to August, 2011. Randomized trials were
included, comparing TENS associated or not with pharmacological analgesia
vs. placebo TENS associated or not with pharmacological analgesia or vs.
pharmacological analgesia alone to assess pain (visual analog scale - VAS)
and/or pulmonary function represented by forced vital capacity (FVC) in
postoperative thoracic surgery patients (pulmonary or cardiac with
approach by thoracotomy or sternotomy). Results: Of the 2.489 articles
identified, 11 studies were included. In the approach by thoracotomy, TENS
associated with pharmacological analgesia reduced pain compared to the
placebo TENS associated with pharmacological analgesia (VAS -1.29; 95%CI:
-1.94 to - 0.65). In the approach by sternotomy, TENS associated with
pharmacological analgesia also reduced pain compared to the placebo TENS
associated with pharmacological analgesia (VAS -1.33; 95%CI: -1.89 to
-0.77) and compared to pharmacological analgesia alone (VAS -1.23; 95%CI:
-1.79 to -0.67). There was no significant improvement in FVC (0.12 L;
95%CI: - 0.27 to 0.51). Conclusion: TENS associated with pharmacological
analgesia provides pain relief compared to the placebo TENS in
postoperative thoracic surgery patients both approached by thoracotomy and
sternotomy. In sternotomy it also provides more effective pain relief
compared to pharmacological analgesia alone, but it has no significant
effect on pulmonary function.

<10>
Accession Number
22729297
Authors
Abbaszadeh M. Khan Z.H. Mehrani F. Jahanmehr H.
Institution
(Abbaszadeh) Anesthesia Technology Department, School of allied Health
Sciences, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Khan) Department of Anesthesiology and Intensive Care, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mehrani) School of allied Health Sciences, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Jahanmehr) Hematology Department, School of allied Health Sciences,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Perioperative intravenous corticosteroids reduce incidence of atrial
fibrillation following cardiac surgery: A randomized study.
Source
Brazilian Journal of Cardiovascular Surgery. 27 (1) (pp 18-23), 2012. Date
of Publication: March 2012.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Objective: Corticosteroids decrease side effects after noncardiac elective
surgery. A randomized, double blinded, placebo-controlled study was plan
to test the hypothesis that standard doses of dexamethasone (6X2) would
decrease the incidence of atrial fibrillation (AF) following cardiac
surgery. Methods: A total of 185 patients undergoing coronary
revascularization surgery were enrolled in this clinical study. The
anesthetic management was standardized in all patients. Dexamethasone (6
mg/ml) or saline (1 ml) was administered after the induction of anesthesia
and a second dose of the same study drug was given on the morning after
surgery. The incidence of AF was determined by analyzing the first 72
hours of continuously recorded electrocardiogram records after cardiac
surgery, to determine the incidence and severity of postoperative side
effects. Results: The incidence of 48 hours postoperative AF was
significantly lower in the Dexamethasone group (21/ 92[37.5%]) than in the
placebo group (35/92 [62.5%], adjusted hazard ratio, 2.07; 95% confidence
interval, 1.09-3.95 (P<0.05). Compared with placebo, patients receiving
dexamethasone did not have higher rates of superficial or deep wound
infections, or other major complications. Conclusions: Prophylactic
short-term dexamethasone administration in patients undergoing coronary
artery bypasses grafting significantly reduced postoperative atrial
fibrillation.

<11>
Accession Number
22729296
Authors
Feguri G.R. Lima P.R.L. Lopes A.M. Roledo A. Marchese M. Trevisan M. Ahmad
H. de Freitas B.B. de Aguilar-Nascimento J.E.
Institution
(Feguri, Lopes, Roledo, Marchese) Brazilian Society of Cardiovascular
Surgery, DECA, Brazil
(Lima) Brazilian Society of Cardiovascular Surgery, ECCOR, Brazil
(de Aguilar-Nascimento) Surgical Clinics Department, UFMT Medical College,
Brazilian College of Surgeons, International Association for Surgical
Metabolism and Nutrition (IASMEN), Brazil
Title
Clinical and metabolic results of fasting abbreviation with carbohydrates
in coronary artery bypass graft surgery.
Source
Brazilian Journal of Cardiovascular Surgery. 27 (1) (pp 7-17), 2012. Date
of Publication: March 2012.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Introduction: Limited information is available about preoperative fasting
abbreviation with administration of liquid enriched with carboidrates
(CHO) in cardiovascular surgeries. Objectives: To assess clinical
variables, security of the method and effects on the metabolism of
patients undergoing fasting abbreviation in coronary artery bypass graft
(CABG) surgery. Methods: Forty patients undergoing CABG were randomized to
receive 400ml (6h before) and 200ml (2h before) of maltodextrin at 12.5%
(Group I, n=20) or only water (Group II, n=20) before anesthetic
induction. Perioperative clinical variables were assessed. Insulin
resistance (IR) was assessed by Homa-IR index and also by the need of
exogenous insulin; pancreatic beta-cell excretory function by Homa-Beta
index and glycemic control by tests of capillary glucose. Results: Deaths,
bronchoaspiration, mediastinitis, stroke and AMI did not occur. Atrial
fibrillation occurred in two patients of each group and infectious
complications did not differ among groups (P=0.611). Patients of Group I
presented two days less of hospital stay (P=0.025) and one day less in the
ICU (P<0.001). The length of time using dobutamine was shorter in Group I
(P=0.034). Glycemic control in the first 6h after surgery was worse for
Group II (P=0.012). IR was verified and did not differ among groups
(P>0.05). A decline in the endogenous production of insulin was observed
in both groups (P<0.001). Conclusion: Preoperative fasting abbreviation
with the administration of CHO in the CABG was safe. The glycemic control
improved in the ICU; there was less time in the use of dobutamine and
length of hospital and ICU stay was reduced. However, neither IR nor
morbimortality during hospital phase were influenced.

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Accession Number
2012622668
Authors
Brackbill M.L. Rahman A. Sandy J.S. Stam M.D. Harralson A.F.
Institution
(Brackbill, Rahman, Sandy, Stam, Harralson) Winchester Medical Center,
Heart and Vascular Center, Winchester, VA 22601, United States
(Brackbill) Department of Pharmacy Practice, Bernard J. Dunn School of
Pharmacy, Shenandoah University, 1775 North Sector Court, Winchester, VA
22601, United States
Title
Adjunctive sitagliptin therapy in postoperative cardiac surgery patients:
A pilot study.
Source
International Journal of Endocrinology. 2012 , 2012. Article Number:
810926. Date of Publication: 2012.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Aim. We aimed to determine if sitagliptin added to standard postoperative
standardized sliding-scale insulin regimens improved blood glucose.
Methods. A prospective, randomized, double-blind, placebo-controlled pilot
study was conducted in diabetic cardiac surgery patients. Patients
received sitagliptin or placebo after surgery for 4 days. The primary
endpoint was to estimate the effect of adjunctive sitagliptin versus
placebo on overall mean blood glucose in the 4-day period after surgery.
Results. Sixty-two patients participated. Repeated measures tests
indicated no significant difference between the groups in the overall mean
blood glucose level with a mean of 147.2 +/- 4.8 mg/dL and 153.0 +/- 4.6
mg/dL for the test and the control group, respectively (P = 0.388).
Conclusions. Sitagliptin added to normal postoperative glucose management
practices did not improve overall mean blood glucose control in diabetic
patients in the postoperative setting. 2012 Marcia L. Brackbill et al.

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[Use Link to view the full text]
Accession Number
2012621536
Authors
Brooks M.M. Chaitman B.R. Nesto R.W. Hardison R.M. Feit F. Gersh B.J.
Krone R.J. Sako E.Y. Rogers W.J. Garber A.J. King S.B. Davidson C.J. Ikeno
F. Frye R.L.
Institution
(Brooks, Hardison) Department of Epidemiology, University of Pittsburgh,
130 DeSoto St, Pittsburgh, PA 15261, United States
(Chaitman) St. Louis University School of Medicine, St. Louis, MO, United
States
(Nesto) Lahey Clinic, Burlington, MA, United States
(Feit) NYU School of Medicine, New York, NY, United States
(Gersh, Frye) Mayo Clinic, Rochester, MN, United States
(Krone) Washington University, St. Louis, MO, United States
(Sako) University of Texas Health Science Center at San Antonio, San
Antonio, United States
(Rogers) University of Alabama at Birmingham, Birmingham, United States
(Garber) Baylor College of Medicine, Houston, TX, United States
(King) St. Josephs Heart and Vascular Institute, Atlanta, GA, United
States
(Davidson) Northwestern University, Chicago, IL, United States
(Ikeno) Stanford University, Stanford, CA, United States
Title
Clinical and angiographic risk stratification and differential impact on
treatment outcomes in the bypass angioplasty revascularization
investigation 2 diabetes (BARI 2D) trial.
Source
Circulation. 126 (17) (pp 2115-2124), 2012. Date of Publication: 23 Oct
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND-: The Bypass Angioplasty Revascularization Investigation 2
Diabetes (BARI 2D) trial assigned patients with type 2 diabetes mellitus
to prompt coronary revascularization plus intensive medical therapy versus
intensive medical therapy alone and reported no significant difference in
mortality. Among patients selected for coronary artery bypass graft
surgery, prompt coronary revascularization was associated with a
significant reduction in death/myocardial infarction/stroke compared with
intensive medical therapy. We hypothesized that clinical and angiographic
risk stratification would affect the effectiveness of the treatments
overall and within revascularization strata. METHODS AND RESULTS-: An
angiographic risk score was developed from variables assessed at
randomization; independent prognostic factors were myocardial jeopardy
index, total number of coronary lesions, prior coronary revascularization,
and left ventricular ejection fraction. The Framingham Risk Score for
patients with coronary disease was used to summarize clinical risk.
Cardiovascular event rates were compared by assigned treatment within
high-risk and low-risk subgroups. Overall, no outcome differences between
the intensive medical therapy and prompt coronary revascularization groups
were seen in any risk stratum. The 5-year risk of death/myocardial
infarction/stroke was 36.8% for intensive medical therapy compared with
24.8% for prompt coronary revascularization among the 381 coronary artery
bypass graft surgery-selected patients in the highest angiographic risk
tertile (P=0.005); this treatment effect was amplified in patients with
both high angiographic and high Framingham risk (47.3% intensive medical
therapy versus 27.1% prompt coronary revascularization; P=0.010; hazard
ratio=2.10; P=0.009). Treatment group differences were not significant in
other clinical-angiographic risk groups within the coronary artery bypass
graft surgery stratum, or in any subgroups within the percutaneous
coronary intervention stratum. CONCLUSION-: Among patients with diabetes
mellitus and stable ischemic heart disease, a strategy of prompt coronary
artery bypass graft surgery significantly reduces the rate of
death/myocardial infarction MI/stroke in those with extensive coronary
artery disease or impaired left ventricular function. CLINICAL TRIAL
REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00006305. 2012 American Heart Association, Inc..

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Accession Number
70908866
Authors
Di Niro V. Costanzo S. Gianfagna F. Donati M.B. De Gaetano G. Iacoviello
L.
Institution
(Di Niro, Costanzo, Gianfagna, Donati, De Gaetano, Iacoviello) Laboratorio
di Epidemiologia Genetica ed Ambientale, Laboratori di Ricerca, Fondazione
di Ricerca e Cura Giovanni Paolo II, Campobasso, Italy
Title
Prevention of post-operative atrial fibrillation in cardiac surgery by
pre-operative supplementation of N-3 polyunsatured fatty acids. A
meta-analysis.
Source
Blood Transfusion. Conference: 22nd National Congress of the Italian
Society for Thrombosis and Hemostasis - SISET Vicenza Italy. Conference
Start: 20121004 Conference End: 20121006. Conference Publication:
(var.pagings). 10 (pp s32), 2012. Date of Publication: September 2012.
Publisher
SIMTI Servizi Sri
Abstract
Background Several clinical trials have evaluated whether preoperative
supplementation of omega-3 (N-3) polyunsaturated fatty acids (PUFA)
protects against post-operative atrial fibrillation (POAF) in patients
undergoing cardiac surgery. Despite the anti-inflammatory and
anti-arrhythmic properties of N-3 PUFA, there are still doubts about their
real efficacy in POAF reduction. A meta analysis of randomized trials was
performed to investigate if pre-operative N-3 PUFA supplementation would
prevent POAF after cardiac surgery. Materials and Methods Articles were
searched through April 2012, screening electronic databases and cross
references. Six randomized controlled clinical trials were retrieved. For
each study, the incidence of POAF in both the intervention and placebo
groups were extracted to calculate risk ratios (RRs) and 95% CIs, if not
reported. Study-specific estimates were combined using inverse
variance-weighed methods in both fixed- and random-effects models. When
statistically significant heterogeneity was identified, the random-effect
estimate was preferentially used as summary measure. Results This meta
analysis includes a total of 928 patients (459 in the intervention group)
undergoing cardiac surgery (coronary artery bypass graft (CABG) and/or
valvular surgery). Pooled analysis showed a non-significant reduction in
POAF with N-3 PUFA pre-operative supplementation using random effects
models (RR 0.77, CI 95% 0.56-1.05; p=0.1). However, despite a significant
heterogeneity (p=0.01), a significant reduction in 21% in POAF (RR 0.79,
95% CI 0.67-0.94; p=0.01) was found using a fixed effects model. Moreover,
considering CABG patients only (N=813), a significant protection was
observed in fixed (RR 0.79, CI 95% 0.64-0.96; p=0.02) but not in
random-effects model (RR 0.77, CI 95% 0.55-1.08; p=0.1). Conclusions When
using fixed effects models, a weak significant, protective effect of N-3
PUFA supplementation in POAF after cardiac surgery and in CABG procedures
was observed. Further studies are necessary to fully evaluate the efficacy
of N-3 PUFA supplementation in POAF.