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<1>
Accession Number
2012671362
Authors
Mannacio V.A. Di Tommaso L. Antignan A. De Amicis V. Vosa C.
Institution
(Mannacio, Di Tommaso, De Amicis, Vosa) Department of Cardiac Surgery,
University of Naples Federico II, Naples, Italy
(Antignan) Department of Cardiology, Azienda Ospedaliera
Santobono-Pausillipon, Naples, Italy
Title
Aspirin plus clopidogrel for optimal platelet inhibition following
off-pump coronary artery bypass surgery: Results from the CRYSSA
(prevention of Coronary arteRY bypaSS occlusion after off-pump procedures)
randomised study.
Source
Heart. 98 (23) (pp 1710-1715), 2012. Date of Publication: December 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To determine the individual variability in the response to
aspirin and/or clopidogrel and its impact on graft patency after off-pump
coronary artery bypass grafting. Design: A single-centre prospective
randomised controlled study designed according to the Consolidated
Standards of Reporting Trials statement. Randomisation was obtained by a
computer-generated algorithm. Setting: University medical school in Italy.
Patients: 300 patients who underwent off-pump coronary artery bypass
grafting were randomised to receive aspirin (n=150) or aspirin plus
clopidogrel (n=150). Intervention: Aspirin 100 mg or aspirin 100 mg plus
clopidogrel 75 mg daily was initiated when postoperative chest tube
drainage was <=50 ml/h for 2 h and patients were followed up for 12
months. Main outcome measures: Qualitative and quantitative assessment of
platelet function, angiographic evaluation of coronary revascularisation
by 64-slice CT and clinical outcome. Results: In the aspirin group, 49
patients (32.6%) were aspirin resistant and, in the aspirin-clopidogrel
group, 19 patients (12.6%) were aspirin and clopidogrel resistant. The
platelet response to aspirin was similar in all aspirin responders despite
the study arm (Aspirin Reaction Units 313.2644.8 vs 323.6653.6; p=0.07).
The platelet response to clopidogrel was enhanced by aspirin in patients
responsive to both aspirin and clopidogrel (synergistic effect) compared
with responders to clopidogrel only (P2Y12 Reaction Units 139.9+/-15.5 vs
179.4+/-18.5; p<0.001). Combined therapy was associated with a reduced
vein graft occlusion rate (7.4% vs 13.1%; p=0.04). Antiplatelet resistance
was a predictor of graft occlusion (RR 3.6, 95% CI 2.5 to 6.9; p<0.001).
Synergistic aspirin and clopidogrel activity was a strong predictor of
vein graft patency (RR 5.1, 95% CI 1.4 to 16.3; p<0.01). Conclusions:
Combined clopidogrel and aspirin overcome single drug resistances, are
safe for bleeding and improve venous graft patency.

<2>
Accession Number
2012676428
Authors
Mirhosseini S.J. Sayegh S.A.H.
Institution
(Mirhosseini) Department of Cardiovascular Surgery, Afshar Hospital,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Sayegh) Medical Student and Researcher of Cardiac Surgery, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
Title
Effect of preoperative anemia on short term clinical outcomes in diabetic
patients after elective off-pump CABG surgery.
Source
Acta Medica Iranica. 50 (9) (pp 615-618), 2012. Date of Publication: 2012.
Publisher
Medical Sciences University of Teheran (Poursina St, Teheran 14-174, Iran,
Islamic Republic of)
Abstract
Diabetic mellitus (DM) is a major risk factor of morbidity, mortality and
economic cost to society. Diabetic patients are at risk of having
microvascular or macrovascular disorders of diabetes. Postoperative anemia
have wide spectrum of some early complications that require more care in
hospitalization stays. Therefore, this study was designed to evaluate
effect of preoperative anemia on shortterm clinical outcomes in diabetic
patients undergoing elective off-pump CABG. This study conducted on 86
diabetic patients underwent elective off-pump CABG surgery from August to
October 2011, in Afshar Cardiovascular Center, Yazd, Iran. The patients
had hemoglobin concentration between 10-12 mg/dl, patients with
preoperative atrial fibrillation and renal and respiratory dysfunction
were excluded from this study. Participants were randomly assigned into
two groups; the normal group (n=42) that had hemoglobin concentration ~
12-15 g/dl and the anemic group (n=44) had hemoglobin concentration~7-10
g/dl. We evaluated post-CABG variables including incidence of atrial
fibrillation and early morbidity such as infection, vomiting, renal and
respiratory dysfunctions, ICU or hospital stay and early mortality. Data
were analyzed by ANOVA, Chi-square and Fisher's exact test for
quantitative and qualitative variables. The mean age of the patients was
52.51+/-6.9 years, from all of patients 64 cases (74.4%) were male and 22
cases (445.6%) were female. Postoperative atrial fibrillation was observed
in 17 cases (19.8%), 7 cases (16.7%) of whom were in normal group and 10
cases (22.7%) of whom were in anemia group. anemia could significantly
increase hospital stay (P=0.0001) but no ICU stay. Preoperative anemia did
not affect the incidence of atrial fibrillation and early complications
and mortality in patients undergoing off-pump CABG. However, anemia could
increase postoperative hospital stay and renal dysfunction significantly.
2012 Tehran University of Medical Sciences. All rights reserved.

<3>
Accession Number
2012673763
Authors
Nilsson J. Scicluna S. Malmkvist G. Pierre L. Algotsson L. Paulsson P.
Bjursten H. Johnsson P.
Institution
(Nilsson, Scicluna, Malmkvist, Pierre, Algotsson, Paulsson, Bjursten,
Johnsson) Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia
and Intensive Care, Skane University Hospital, Lund University, SE 221 85
Lund, Sweden
Title
A randomized study of coronary artery bypass surgery performed with the
Resting Heart System utilizing a low vs a standard dosage of heparin.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (5) (pp 834-839),
2012. Date of Publication: November 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: Allogeneic blood transfusion and reoperation for postoperative
bleeding after the coronary artery bypass grafting have a negative impact
on the patient outcome. This study aimed at evaluating the effects of
reduced doses of heparin and protamine on the patient outcome, using a
heparin-coated mini-cardiopulmonary bypass (CPB) system.METHODS: Sixty
patients undergoing elective first-time CPB were prospectively randomized
either to have a reduced systemic heparinization [activated clotting time
(ACT) = 250 s] or to a control group perfused with a full heparin dose
(ACT = 420 s). Blood transfusions, ventilation time, early postoperative
bleeding, ICU stay, reoperations for bleeding, postoperative cognitive
status and the level of mobilization were registered.RESULTS: Twenty-nine
patients were randomized to the control group, 27 patients to the low-dose
group and 4 patients were excluded because of protocol violations. Four
patients in the control group received a total of 10 units of packed red
blood cells, and in the low-dose group, no transfusions were given, P =
0.046. No patient was reoperated because of bleeding. The ICU stay was
significantly shorter in the low-dose group (8.4 vs 13.7 h, P = 0.020),
less dependent on oxygen on the first postoperative day (78 vs 97%, P =
0.034), better mobilized (89 vs 59%, P = 0.006) and had less pain (visual
analogue scale 2.0 vs 3.5, P = 0.019) compared with the control
group.CONCLUSIONS: The use of a mini-CPB system combined with a low dose
of heparin reduced the need for blood transfusions and may facilitate the
faster mobilization of the patients. 2012 The Author 2012. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<4>
Accession Number
2012673749
Authors
Giglio M. Dalfino L. Puntillo F. Rubino G. Marucci M. Brienza N.
Institution
(Giglio, Dalfino, Puntillo, Rubino, Marucci, Brienza) Anesthesia and
Critical Care Division, Department of Emergency and Organ Transplantation,
University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Title
Haemodynamic goal-directed therapy in cardiac and vascular surgery. A
systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (5) (pp 878-887),
2012. Date of Publication: November 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
In cardiovascular surgery, reduced organ perfusion and oxygen delivery
contribute to increased postoperative morbidity and prolonged intensive
care unit stay. Goal-directed therapy (GDT), a perioperative haemodynamic
strategy aiming to increase cardiac output, is helpful in preventing
postoperative complications, but studies in the context of cardiovascular
surgery have produced conflicting results. The purpose of the present
meta-analysis is to determine the effects of perioperative haemodynamic
goal-directed therapy on mortality and morbidity in cardiac and vascular
surgery. MEDLINE, EMBASE, The Cochrane Library and the DARE databases were
searched until July 2011. Randomized controlled trials reporting on adult
cardiac or vascular surgical patients managed with perioperative GDT or
according to routine haemodynamic practice were included. Primary outcome
measures were mortality and morbidity. Data synthesis was obtained by
using odds ratio (OR) with 95% confidence interval (CI) by a random
effects model. An OR <1 favoured GDT. Statistical heterogeneity was
assessed by Q and I² statistics. Eleven articles (five cardiac
surgery and six vascular procedures), enrolling a total sample of 1179
patients, were included in the analysis. As compared with routine
haemodynamic practice, perioperative GDT did not reduce mortality in
either cardiac or vascular surgery (pooled OR 0.87; 95% CI 0.37-2.02;
statistical power 64%). GDT significantly reduced the number of cardiac
patients with complications (OR 0.34; 95% CI 0.18-0.63; P = 0.0006), but
no effect was observed in vascular patients (OR, 0.84; 95% CI 0.45-1.56; P
= 0.58). Perioperative GDT prevents postoperative complications in cardiac
surgery patients, while it has no effect in vascular surgery. The
different characteristics and comorbidities of the population enrolled
could explain these conflicting results. More trials conforming to the
characteristics of low-risk-of-bias studies and enrolling a larger and
well-defined population of patients are needed to better clarify the
effect of GDT in the specific setting of cardiovascular surgery. 2012 The
Author 2012. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<5>
Accession Number
2012648130
Authors
Han Y.-L. Zhang Q.-Y. Li Y. Guan S.-Y. Jing Q.-M. Wang Z.-L. Zhao X. Wang
X.-Z. Ma Y.-Y. Wang B. Deng J. Wang G. Kim Y.-H.
Institution
(Han, Zhang, Li, Guan, Jing, Wang, Zhao, Wang, Ma, Wang, Deng, Wang)
Department of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning,
China
(Kim) Cardiology Department, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Title
Clinical Presentations, Antiplatelet Strategies and Prognosis of Patients
with Stent Thrombosis: An Observational Study of 140 Patients.
Source
PLoS ONE. 7 (10) , 2012. Article Number: e48520. Date of Publication: 31
Oct 2012.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: Until now there has been scarce evidence regarding an optimal
antiplatelet strategy and clinical outcomes for patients who had suffered
from stent thrombosis (ST). Methods and Results: 140 patients who suffered
from stent thrombosis were prospectively registered. Patients received
dual (aspirin and 150 mg clopidogrel, N = 66) or triple (additional
cilostazol, N = 74) antiplatelet therapy at the physician's discretion.
Thereafter platelet reactivity and one year clinical outcomes were
analyzed. The primary outcome included the composite of cardiac death,
non-fatal myocardial infarction (MI) or stroke at one year,which developed
in 41 (29.3%) patients, consisting of 31 (22.1%) cardiac death, 9 (6.4%)
non-fatal MI and 1 (1.4%) stroke. Recurrent definite and probable ST
according to ARC definition was observed in 8 (5.7%) and 14 (10.0%)
patients, respectively. Triple therapy was associated with significantly
lower platelet reactivities (50.2+/-17.8, % vs. 59.6+/-17.2, %, P = 0.002)
compared to high dose dual antiplatelet therapy. However, the incidence of
primary events (24.3% vs. 34.8%, P = 0.172) did not differ between triple
and dual antiplatelet therapies. High on-treatment platelet reactivity
(HR: 8.35, 95% CI: 2.234~30.867, P = 0.002) and diabetes (HR: 3.732, 95%
CI: 1.353~10.298, P = 0.011) were independent predictors of primary
events. Conclusions: Patients who suffered from stent thrombosis have a
poor prognosis even after revascularization with intensive antiplatelet
therapy. Triple antiplatelet therapy was more effective in reducing
on-treatment platelet reactivity, compared to high dose dual antiplatelet
therapy. 2012 Han et al.

<6>
Accession Number
2012646696
Authors
Dieleman J.M. Nierich A.P. Rosseel P.M. Van Der Maaten J.M. Hofland J.
Diephuis J.C. Schepp R.M. Boer C. Moons K.G. Van Herwerden L.A. Tijssen
J.G. Numan S.C. Kalkman C.J. Van Dijk D.
Institution
(Dieleman, Moons, Van Herwerden, Numan, Kalkman, Van Dijk) Division of
Anesthesiology, Intensive Care, and Emergency Medicine, University Medical
Center Utrecht, PO Box 85500, 3508 GA, Utrecht, Netherlands
(Nierich) Isala Klinieken, Zwolle, Netherlands
(Rosseel) Amphia Ziekenhuis, Breda, Netherlands
(Van Der Maaten) University Medical Center, Groningen, Netherlands
(Hofland) Erasmus Medical Center, Rotterdam, Netherlands
(Diephuis) Medisch Spectrum Twente, Enschede, Netherlands
(Schepp) Medical Center, Leeuwarden, Netherlands
(Boer) Vrije Universiteit Medical Center, Amsterdam, Netherlands
(Tijssen) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
Title
Intraoperative high-dose dexamethasone for cardiac surgery: A randomized
controlled trial.
Source
JAMA - Journal of the American Medical Association. 308 (17) (pp
1761-1767), 2012. Date of Publication: 07 Nov 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Prophylactic corticosteroids are often administered during
cardiac surgery to attenuate the inflammatory response to cardiopulmonary
bypass and surgical trauma; however, evidence that routine corticosteroid
use can prevent major adverse events is lacking. Objective: To quantify
the effect of intraoperative high-dose dexamethasone on the incidence of
major adverse events in patients undergoing cardiac surgery. Design,
Setting, and Participants: A multicenter, randomized, double-blind,
placebocontrolled trial of 4494 patients aged 18 years or older undergoing
cardiac surgery with cardiopulmonary bypass at 8 cardiac surgical centers
in the Netherlands enrolled between April 13, 2006, and November 23, 2011.
Intervention: Patients were randomly assigned to receive a single
intraoperative dose of 1 mg/kg dexamethasone (n=2239) or placebo (n=2255).
Main Outcome Measures: A composite of death, myocardial infarction,
stroke, renal failure, or respiratory failure, within 30 days of
randomization. Results: Of the 4494 patients who underwent randomization,
4482 (99.7%) could be evaluated for the primary outcome. A total of 157
patients (7.0%) in the dexamethasone group and 191 patients (8.5%) in the
placebo group reached the primary study end point (relative risk, 0.83;
95% CI, 0.67-1.01; absolute risk reduction, -1.5%; 95% CI, -3.0% to 0.1%;
P=.07). Dexamethasone was associated with reductions in postoperative
infection, duration of postoperative mechanical ventilation, and lengths
of intensive care unit and hospital stays. In contrast, dexamethasone was
associated with higher postoperative glucose levels. Conclusion: In our
trial of adults undergoing cardiac surgery, the use of intraoperative
dexamethasone did not reduce the 30-day incidence of major adverse events
compared with placebo. Trial Registration: clinicaltrials.gov Identifier:
NCT00293592 2012 American Medical Association. All rights reserved.

<7>
Accession Number
2012646695
Authors
Sesso H.D. Christen W.G. Bubes V. Smith J.P. MacFadyen J. Schvartz M.
Manson J.E. Glynn R.J. Buring J.E. Gaziano J.M.
Institution
(Sesso, Christen, Bubes, Smith, MacFadyen, Schvartz, Manson, Glynn,
Buring, Gaziano) Division of Preventive Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Sesso, Buring, Gaziano) Division of Aging, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Gaziano) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Sesso, Manson, Buring) Department of Epidemiology, Harvard School of
Public Health, Boston, MA, United States
(Glynn) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
(Buring) Department of Ambulatory Care and Prevention, Harvard Medical
School, Boston, MA, United States
(Gaziano) Harvard Medical School, VA Boston Healthcare Center, Boston, MA,
United States
Title
Multivitamins in the prevention of cardiovascular disease in men: The
physicians' health study II randomized controlled trial.
Source
JAMA - Journal of the American Medical Association. 308 (17) (pp
1751-1760), 2012. Date of Publication: 07 Nov 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Although multivitamins are used to prevent vitamin and mineral
deficiency, there is a perception that multivitamins may prevent
cardiovascular disease (CVD). Observational studies have shown
inconsistent associations between regular multivitamin use and CVD, with
no long-term clinical trials of multivitamin use. Objective: To determine
whether long-term multivitamin supplementation decreases the risk of major
cardiovascular events among men. Design, Setting, and Participants: The
Physicians' Health Study II, a randomized, double-blind,
placebo-controlled trial of a common daily multivitamin, began in 1997
with continued treatment and follow-up through June 1, 2011. A total of 14
641 male US physicians initially aged 50 years or older (mean, 64.3 [SD,
9.2] years), including 754 men with a history of CVD at randomization,
were enrolled. Intervention: Daily multivitamin or placebo. Main Outcome
Measures: Composite end point of major cardiovascular events, including
nonfatal myocardial infarction (MI), nonfatal stroke, and CVD mortality.
Secondary outcomes included MI and stroke individually. Results: During a
median follow-up of 11.2 (interquartile range, 10.7-13.3) years, there
were 1732 confirmed major cardiovascular events. Compared with placebo,
there was no significant effect of a daily multivitamin on major
cardiovascular events (11.0 and 10.8 events per 1000 person-years for
multivitamin vs placebo, respectively; hazard ratio [HR], 1.01; 95% CI,
0.91-1.10; P=.91). Further, a daily multivitamin had no effect on total MI
(3.9 and 4.2 events per 1000 person-years; HR, 0.93; 95% CI, 0.80-1.09;
P=.39), total stroke (4.1 and 3.9 events per 1000 person-years; HR, 1.06;
95% CI, 0.91-1.23; P=.48), or CVD mortality (5.0 and 5.1 events per 1000
person-years; HR, 0.95; 95% CI, 0.83-1.09; P=.47). A daily multivitamin
was also not significantly associated with total mortality (HR, 0.94; 95%
CI, 0.88-1.02; P=.13). The effect of a daily multivitamin on major
cardiovascular events did not differ between men with or without a
baseline history of CVD (P=.62 for interaction). Conclusion: Among this
population of US male physicians, taking a daily multivitamin did not
reduce major cardiovascular events, MI, stroke, and CVD mortality after
more than a decade of treatment and follow-up. Trial Registration:
clinicaltrials.gov Identifier: NCT00270647 2012 American Medical
Association. All rights reserved.

<8>
Accession Number
2012672151
Authors
Wiesner G. Braun S.L. Gruber M. Gertler R. Lange R. Tassani P. Martin K.
Institution
(Wiesner, Gertler, Tassani, Martin) Institute of Anaesthesiology, German
Heart Centre Munich, Lazarettstr.36, D-80636 Munich, Germany
(Braun) Institute of Laboratory Medicine, German Heart Centre Munich,
Lazarettstr. 36, D-80636 Munich, Germany
(Gruber) Department of Anaesthesiology, University of Regensburg,
Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
(Lange) Department of Cardiovascular Surgery, German Heart Centre Munich,
Lazarettstr 36, D-80636 Munich, Germany
Title
Neither moxifloxacin nor cefuroxime produces significant attenuation of
inflammatory mediator release in patients exposed to cardiopulmonary
bypass: A randomized controlled trial.
Source
Journal of Antimicrobial Chemotherapy. 67 (1) (pp 230-233), 2012. Date of
Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: In vitro and experimental studies in animals have established
the anti-inflammatory effects of moxifloxacin. Cardiopulmonary bypass
(CPB) leads to an inflammatory response. The aim of this study was to
assess whether the inflammatory cytokine response to CPB is reduced with a
perioperative antibiotic prophylaxis, either moxifloxacin or cefuroxime
(the standard prophylaxis). Patients and methods: Twenty-eight patients
scheduled for elective coronary artery bypass grafting with CPB were
randomly assigned to receive either moxifloxacin or cefuroxime as the
perioperative antibiotic prophylaxis. Interleukin (IL)-6, -8, -10 and
tumour necrosis factor-alpha (TNF-alpha) serum concentrations were
determined at eight time points before and after CPB. Results: In both
groups, all cytokine concentrations significantly increased after the
start of CPB. There were no statistically significant differences between
the moxifloxacin and cefuroxime groups at any point; IL-6 concentrations
[median (interquartile range)] 240 min after CPB, the primary endpoint,
were 364 (192-598) and 465 (325-906) pg/mL (P=0.323), respectively.
Conclusions: Neither moxifloxacin nor cefuroxime produced significant
attenuation of the inflammatory cytokine response to CPB. The reasons why
moxifloxacin did not have significant anti-inflammatory effects in this
unique clinical situation may be: (i) the inflammatory response to CPB may
be different from that of infectious disease states that were used to
establish the immunomodulatory effects of moxifloxacin; and (ii) a single
intravenous dose, which was used in this investigation, may not lead to
high enough plasma and intracellular concentrations. The Author 2011.
Published by Oxford University Press on behalf of the British Society for
Antimicrobial Chemotherapy. All rights reserved.

<9>
Accession Number
2012668237
Authors
Piccolo R. Cassese S. Galasso G. Niglio T. De Rosa R. De Biase C. Piscione
F.
Institution
(Piccolo, Cassese, Galasso, Niglio, De Rosa, De Biase, Piscione)
Department of Clinical Medicine, Cardiovascular Sciences and Immunology,
Federico II University, Via S. Pansini 5, 80131 Naples, Italy
Title
Long-term clinical outcomes following sirolimus-eluting stent implantation
in patients with acute myocardial infarction. A meta-analysis of
randomized trials.
Source
Clinical Research in Cardiology. 101 (11) (pp 885-893), 2012. Date of
Publication: November 2012.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Objectives The aim of this study was to perform a metaanalysis of
randomized trials, evaluating the long-term outcomes of sirolimus-eluting
stents (SES) versus baremetal stents (BMS) in patients with ST-segment
elevation myocardial infarction (STEMI). Background Despite short-term
outcomes of patients with STEMI undergoing primary percutaneous coronary
intervention indicate a benefit of SES in terms of reintervention, several
concerns remain on the long-term safety and efficacy of SES. Methods A
systematic literature search of electronic resources, through October
2011, was performed using specific search terms. Included trials were
randomized studies comparing SES to BMS in STEMI patients, with a
follow-up C3 years. Results Seven trials were included, with a total of
2,364 patients. At a median follow-up of 3 years, SES significantly
reduced the risk of target-vessel revascularization when compared with BMS
[odds ratio (OR), 0.44; 95 % confidence interval (CI), 0.34-0.57;
p<0.0001], without increasing the risk of mortality (OR 0.78; 95 % CI,
0.57-1.08; p = 0.14), reinfarction (OR 0.91; 95 % CI, 0.61-1.35, p = 0.64)
and early to late stent thrombosis (OR 0.77; 95 % CI, 0.49-1.20; p =
0.25). However after the first year, SES did not further reduce
target-vessel revascularization (OR 1.06; 95 % CI, 0.64-1.74; p = 0.83)
and increased the risk of very late stent thrombosis (OR 2.81; 95 % CI,
1.33-5.92; p = 0.007). Conclusions At long-term follow-up, SES compared to
BMS use in STEMI patients reduces the risk of targetvessel
revascularization, without increasing the risk of death and reinfarction.
However, the strong SES efficacy is counterbalanced by a significant risk
of very late stent thrombosis. Springer-Verlag 2012.

<10>
Accession Number
2012670746
Authors
Lin Y.Y. He B. Chen J. Wang Z.N.
Institution
(Lin, Chen, Wang) Department of Cardiothoracic Surgery, Changzheng
Hospital, The Second Military Medical University, Fengyang road 415#,
Shanghai, 200003, China
(He) Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai
Jiaotong University School of Medicine, Kongjiang road 1665#, Shanghai,
200092, China
Title
Can dexmedetomidine be a safe and efficacious sedative agent in
post-cardiac surgery patients? A meta-analysis.
Source
Critical Care. 16 (5) , 2012. Article Number: R169. Date of Publication:
27 Sep 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: The aim of this study was to explore the use of
dexmedetomidine as a safe and efficacious sedative agent in post-cardiac
surgery patients.Methods: A systematic literature search of MEDLINE,
EMBASE, the Cochrane Library and Science Citation Index until January 2012
and review of studies was conducted. Eligible studies were of randomized
controlled trials or cohort studies, comparing dexmedetomidine with a
placebo or an alternative sedative agent in elective cardiac surgery,
using dexmedetomidine for postoperative sedation and available in full
text. Two reviewers independently performed study selection, quality
assessment, and data extraction.Results: The search identified 530
potentially relevant publications; 11 met selection criteria in this
meta-analysis. Our results revealed that dexmedetomidine was associated
with a shorter length of mechanical ventilation (mean difference -2.70
[-5.05, -0.35]), a lower risk of delirium (risk ratio 0.36 [0.21, 0.64]),
ventricular tachycardia (risk ratio 0.27 [0.08, 0.97]) and hyperglycemia
(risk ratio 0.78 [0.61, 0.99]), but may increase the risk of bradycardia
(risk ratio 2.08 [1.16, 3.74]). But there was no significant difference in
ICU stay, hospital stay, and morphine equivalents between the included
studies. Dexmedetomidine may not increase the risk of hypotension, atrial
fibrillation, postoperative nausea and vomiting, reintubation within 5
days, cardiovascular complications, postoperative infection or hospital
mortality.Conclusions: Dexmedetomidine was associated with shorter length
of mechanical ventilation and lower risk of delirium following cardiac
surgery. Although the risk of bradycardia was significantly higher
compared with traditional sedatives, it may not increase length of
hospital stay and hospital mortality. Moreover, dexmedetomidine may
decrease the risk of ventricular tachycardia and hyperglycemia. Thus,
dexmedetomidine could be a safe and efficacious sedative agent in cardiac
surgical patients. 2012 Lin et al.; licensee BioMed Central Ltd.

<11>
Accession Number
2012667277
Authors
Uhlemann M. Adams V. Lenk K. Linke A. Erbs S. Adam J. Thiele H. Hilberg T.
Gutberlet M. Grunze M. Schuler G.C. Mobius-Winkler S.
Institution
(Hilberg) Sports medicine, University Wuppertal, Wuppertal, Germany
(Gutberlet) Department for Radiology, Heart Centre, University of Leipzig,
Leipzig, Germany
(Grunze) MediClin-Klinikum Trassenheide, Trassenheide, Germany
(Uhlemann, Adams, Lenk, Linke, Erbs, Adam, Thiele, Schuler,
Mobius-Winkler) Department of Internal Medicine/Cardiology, Heart Centre,
University of Leipzig, Strumpellstrasse 39, Leipzig, 04289, Germany
Title
Impact of different exercise training modalities on the coronary
collateral circulation and plaque composition in patients with significant
coronary artery disease (EXCITE trial): study protocol for a randomized
controlled trial.
Source
Trials. 13 , 2012. Article Number: 167. Date of Publication: 14 Sep 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Exercise training (ET) in addition to optimal medical therapy
(OMT) in patients with stable coronary artery disease (CAD) has been
demonstrated to be superior to percutaneous coronary interventions (PCI)
with respect to the composite endpoint of death, myocardial infarction,
stroke, revascularization and hospitalization due to worsening of angina.
One mechanism leading to this superiority discussed in the literature is
the increase in coronary collateral blood flow due to ET. Until now, data
demonstrating the positive effect of ET on the collateral blood flow and
the functional capacity of the coronary collateral circulation are still
lacking.Methods/design: The EXCITE trial is a three-armed randomized,
prospective, single-center, open-label, controlled study enrolling 60
patients with stable CAD and at least one significant coronary stenosis
(fractional flow reserve <=0.75). The study is designed to compare the
influence and efficacy of two different 4-week ET programs [high-intensity
interval trainings (IT) versus moderate-intensity exercise training (MT)
in addition to OMT] versus OMT only on collateral blood flow (CBF). The
primary efficacy endpoint is the change of the CBF of the target vessel
after 4 weeks as assessed by coronary catheterization with a pressure wire
during interruption of the antegrade flow of the target vessel by balloon
occlusion. Secondary endpoints include the change in plaque composition as
assessed by intravascular ultrasound (IVUS) after 4 weeks, myocardial
perfusion as analyzed in MRI after 4 weeks and 12 months, peak oxygen
uptake (V02 peak), change in endothelial function and biomarkers after 4
weeks, 3, 6 and 12 months. The safety endpoint addresses major adverse
cardiovascular events (death from cardiovascular cause, myocardial
infarction, stroke, TIA, target vessel revascularization or
hospitalization) after 12 months.Discussion: The trial investigates
whether ET for 4 weeks increases the CBF in patients with significant CAD
compared to a sedentary control group. It also examines the impact of two
intensities of ET on the CBF as well as the histological plaque
composition. The trial started recruitment in June 2009 and will complete
recruitment until June 2012. First results are expected in December 2012
(4-week follow-up), final results (12-month long-term secondary endpoint)
in December 2013.Trial registration: Clinical trial registration
information-URL: http://www.clinicaltrials.gov.Unique identifier:
NCT01209637. 2012 Uhlemann et al.; licensee BioMed Central Ltd.

<12>
Accession Number
2012661383
Authors
Hammoudeh A. Saleh A. Hamam I. Alhaddad I. Bakri M. Nammas A. Alnaquib A.
Izraiq M. Tarawneh H. Harassis A. Tabbalat R. Khader Y. Al-Mousa E.
Institution
(Hammoudeh, Izraiq, Al-Mousa) Cardiology Department, Istishari Hospital,
Amman, Jordan
(Saleh, Hamam) Cardiology Division, Internal Medicine Department, Jordan
University Hospital, Amman, Jordan
(Alhaddad, Bakri) Cardiology Department, Jordan Hospital Medical Center,
Amman, Jordan
(Nammas, Alnaquib) Cardiology Division, Internal Medicine Department,
Islamic Hospital, Amman, Jordan
(Tarawneh, Harassis, Tabbalat) Cardiology Department, Khalidi Hospital
Medical Center, Amman, Jordan
(Khader) Department of Community Medicine, Public Health and Family
Medicine, School of Medicine Jordan University of Science and Technology,
Irbid, Jordan
Title
The prognostic implications of TIMI risk scores in Jordanian patients with
acute coronary syndrome. Results from the glucometabolic abnormalities in
acute coronary syndrome in Jordan (GLORY) study.
Source
Jordan Medical Journal. 46 (3) (pp 237-245), 2012. Date of Publication:
September 2012.
Publisher
Jordan Medical Association (P.O. Box 915, Amman, Jordan)
Abstract
Background and Aims: Western studies have shown that TIMI (Thrombolysis In
Myocardial Infarction) risk scores predict adverse events in patients with
non ST-elevation acute coronary syndrome (NSTEACS) and ST-elevation
myocardial infarction (STEMI). Whether this also applies to Jordanian
patients is largely unknown. Materials and Methods: We prospectively
followed up 656 patients with ACS for total mortality, combined events of
death, nonfatal MI or urgent coronary revascularization up to one year
after admission. Results: Of the whole group, 472 patients (72%) had
NSTEACS, and 184 patients (28%) had STEMI. Among NSTEACS patients, 31.0%
had a low risk score (total points 0-2 of 7), 43.5% had an intermediate
risk score (total points 3-4), and 25.5% had a high risk score (total
points 5-7). In-hospital mortality was not different in the respective
risk score groups (1.4%, 0.5%, and 3.4%, p = 0.123). At 1 year, mortality
was significantly higher in the high risk score group (12.8%) compared
with the intermediate (4%) and low (1.4%) risk groups (p = 0.001). Among
STEMI patients, 58.6% had a low risk score (total points 0-3 of 13-14),
31.0% had a low intermediate risk score (total points 4-6), 8.0% had a
high intermediate score (total points 7-9), and 2.4% had a high risk score
(total points > 10). In-hospital mortality rate was significantly higher
in the two intermediate risk score groups (7.4%, 14.3%, respectively) and
the high risk score group (50%) compared with the low risk score group
(1.0%, p = 0.001). The high risk and the two intermediate risk groups also
had higher one-year mortality (75%, 28.6% and 16.7%, respectively) than
the low risk group (3.9%, p = 0.001). Similarly, composite events occurred
at a significantly higher rate in patients with high risk scores than
intermediate or low risk scores among NSTEACS and STEMI patients.
Conclusions: In Jordanian ACS patients, high TIMI risk scores were
associated with a high risk of cardiovascular events. Such patients are
candidates for early aggressive therapeutic strategies. 2012 DAR
Publishers/University of Jordan. All Rights Reserved.

<13>
Accession Number
2012663794
Authors
Jensen L.O. Thayssen P. Junker A. Maeng M. Tilsted H.-H. Kaltoft A. Hansen
K.N. Christiansen E.H. Kristensen S.D. Ravkilde J. Madsen M. Sorensen H.T.
Thuesen L. Lassen J.F.
Institution
(Jensen, Thayssen, Junker, Hansen) Department of Cardiology, Odense
University Hospital, Odense, Denmark
(Maeng, Kaltoft, Christiansen, Kristensen, Thuesen, Lassen) Department of
Cardiology, Aarhus University Hospital, Skejby, Denmark
(Tilsted, Ravkilde) Department of Cardiology, Aarhus University Hospital,
Aalborg, Denmark
(Madsen, Sorensen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
Title
Comparison of outcomes in patients with versus without diabetes mellitus
after revascularization with everolimus- and sirolimus-eluting stents
(from the SORT OUT IV Trial).
Source
American Journal of Cardiology. 110 (11) (pp 1585-1591), 2012. Date of
Publication: 01 Dec 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Diabetes is associated with increased risk of major adverse cardiac events
(MACEs) after percutaneous coronary intervention. The purpose of this
substudy of the SORT OUT IV trial was to compare clinical outcomes in
patients with and without diabetes mellitus treated with
everolimus-eluting stents (EESs) or sirolimus-eluting stents (SESs). In
total 2,774 patients (390 with diabetes, 14.1%) were randomized to stent
implantation with EESs (n = 1,390, diabetes in 14.0%) or SESs (n = 1,384,
diabetes in 14.2%). Randomization was stratified by presence/absence of
diabetes. The primary end point was MACEs, a composite of cardiac death,
myocardial infarction, definite stent thrombosis, or target vessel
revascularization within 18 months. MACEs were higher in diabetic than in
nondiabetic patients (13.1% vs 6.4%, hazard ratio [HR] 2.08, 95%
confidence interval [CI] 1.51 to 2.86). In diabetic patients, MACEs were
seen in 10.3% of those treated with EESs and in 15.8% of those treated
with SESs (HR 0.63, 95% CI 0.36 to 1.11). In nondiabetic patients, MACEs
occurred in 6.6% of EES-treated and in 6.3% SES-treated patients (HR 1.06,
95% CI 0.77 to 1.46). In diabetics, cardiac death occurred in 3.1% of
EES-treated and in 4.6% of SES-treated patients (HR 0.67, 95% CI 0.24 to
1.89), myocardial infarction occurred in 0.5% of EES-treated and in 3.6%
of SES-treated patients (HR 0.14, 95% CI 0.02 to 1.16), and clinically
driven target lesion revascularization was needed in 3.1% of EES-treated
and in 7.7% of SES-treated patients (HR 0.40, 95% CI 0.15 to 1.02). No
interaction between diabetes status and type of drug-eluting stent was
found for the end points. In conclusion, patients with diabetes have
higher MACE rates than nondiabetics. No significant differences in safety
or efficacy outcomes after EES or SES implantation were present in
nondiabetic or diabetic patients. 2012 Elsevier Inc. All rights reserved.

<14>
Accession Number
2012657623
Authors
Szczeklik W. Devereaux P.J.
Institution
(Szczeklik) 2nd Department of Medicine, Jagiellonian University Medical
College, Krakow, Poland
(Devereaux) Departments of Clinical Epidemiology and Biostatistics and
Medicine, McMaster University, Hamilton, ON, Canada
Title
Troponin T level and mortality risk after noncardiac surgery: Practical
implications of the VISION study.
Source
Polskie Archiwum Medycyny Wewnetrznej. 122 (10) (pp 499-503), 2012. Date
of Publication: 2012.
Publisher
Medycyna Praktyczna (31-066 Krakow31-066Poland)
Abstract
This review article presents the current state of knowledge about major
perioperative cardiovascular complications in noncardiac surgery patients
and the role of the currently available stratification models and
biomarkers in risk prediction. The authors discuss a recent paper
presented by the VISION Investigators in the June edition of the Journal
of the American Medical Association and its practical implications in
day-to-day perioperative practice. According to this study, the authors
conclude that troponin (Tn) measurement up to 3 days after noncardiac
surgery substantially improves perioperative risk estimation, and peak Tn
values (even the levels previously considered as normal) strongly predict
30-day mortality. One in 25 patients with a peak fourth generation
troponin T (TnT) measurement of 0.02 mug/l, 1 in 11 patients with a peak
TnT measurement of 0.03 to 0.29 mug/l, and 1 in 6 patients with a peak TnT
measurement of 0.30 mug/l or higher will die within 30 days of surgery.
Postoperative monitoring of TnT measurements substantially improves risk
stratification after noncardiac surgery and may help identify patients
requiring further therapeutic interventions. Copyright by Medycyna
Praktyczna, 2012.

<15>
Accession Number
2012660565
Authors
Ye Z. Zhang B.-L. Zhao X.-X. Qin Y.-W. Wu H. Cao J. Zhang J.-L. Hu J.-Q.
Zheng X. Xu R.-L.
Institution
(Ye, Zhang, Zhao, Qin, Wu, Cao, Zhang, Hu, Zheng, Xu) Department of
Cardiovascular Diseases, Changhai Hospital, Second Military Medical
University, 168 Changhai Road, Shanghai 200433, China
Title
Intracoronary infusion of bone marrow-derived mononuclear cells
contributes to longstanding improvements of left ventricular performance
and remodelling after acute myocardial infarction: A meta-analysis.
Source
Heart Lung and Circulation. 21 (11) (pp 725-733), 2012. Date of
Publication: November 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Conflicting results exist now on the sustained effects of
intracoronary bone marrow-derived mononuclear cells (BMMNCs) infusion in
patients with acute myocardial infarction (AMI). Methods: Systematical
literature search of PubMed, ISI Web of Science, and Cochrane databases
was conducted. We included the randomised controlled trials with at least
12-month follow-up data for AMI patients receiving primary percutaneous
coronary intervention in addition to intracoronary BMMNCs transfer or not
(the control). Summary statistics were calculated using random-effects
models. Results: A total of 10 trials with 757 patients were available for
analysis. The pooled statistics showed intracoronary administration of
BMMNCs significantly improved post-infarction left ventricular ejection
fraction (weight mean differences [WMD]=4.04%, 95% confidence intervals
[CI], 3.01-5.07%; p< 0.01), and attenuated the enlargement of left
ventricular end-diastolic volume (WMD=-6.13. ml, 95%CI, -10.56. ml to
-1.69. ml; p=0.007) as well as infarct size (WMD=-2.47%, 95%CI, -3.79% to
-1.15%; p=0.0002). However, for the major adverse clinical events (MACEs),
there appeared to be neutral results (between-group differences of p>
0.10). Conclusions: Intracoronary BMMNCs infusion leads to longstanding
and moderate improvements of post-infarction left ventricular performance
as well as remodelling. Meanwhile, the procedure did not increase the risk
of MACEs. 2012 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ).

<16>
Accession Number
2012660562
Authors
Dell'Amore A. Caroli G. Nizar A. Cassanelli N. Luciano G. Greco D. Dolci
G. Bini A. Stella F.
Institution
(Dell'Amore, Caroli, Nizar, Cassanelli, Luciano, Greco, Dolci, Bini,
Stella) Thoracic Surgery Operative Unit, S.Orsola Malpighi University
Hospital, Bologna, Italy
Title
Can Topical Application of Tranexamic Acid Reduce Blood Loss in Thoracic
Surgery? A Prospective Randomised Double Blind Investigation.
Source
Heart Lung and Circulation. 21 (11) (pp 706-710), 2012. Date of
Publication: November 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Objective: The systemic or topical use of antifibrinolytic agents is
effective in reducing postoperative bleeding and blood product transfusion
in cardiac surgery. We sought to study the effect of the topical
application of tranexamic acid into the pleural space to reduce
postoperative bleeding after lung surgery. Methods: This was a prospective
randomised double blind placebo controlled investigation. From May-2010 to
February-2012, 89-patients, scheduled for pulmonary resection, were
randomly allocated to one of the two study groups. Group-A received 5. g
of tranexamic-acid in 100. ml of saline solution. Group-B received 100. ml
of saline solution as placebo. Results: The blood loss in the first 12-h
was significantly less in group-A. The same trend was observed in the
first 24-h but without reaching a true statistical significance. The mean
volume of blood transfusion was statistically lower in group-A. The
analysis between post-operative haemoglobin concentration, haematocrit,
platelet-count, international-normalised-ratio, fibrinogen and
partial-thromboplastin-time of both groups was not statistically
significant. Conclusion: In our experience, the topical use of
tranexamic-acid after lung surgery reduces postoperative bleeding and
blood transfusion volume. The topical administration of tranexamic-acid is
safe without increasing the risk of post-operative complications related
to pharmacological side-effects. 2012 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ).

<17>
Accession Number
2012660557
Authors
Dong M.-F. Ma Z.-S. Wang J.-T. Chai S.-D. Tang P.-Z. Wang L.-X.
Institution
(Dong, Ma, Wang, Chai, Tang, Wang) Department of Cardiac Surgery,
Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical
University, Liaocheng, Shandong 252000, China
(Ma, Wang) School of Biomedical Sciences, Charles Sturt University, Wagga
Wagga, NSW 2650, Australia
Title
Effect of Preoperational Mechanical Ventilation on Short-Term
Postoperative Outcomes in Patients with Severe Tetralogy of Fallot.
Source
Heart Lung and Circulation. 21 (11) (pp 679-683), 2012. Date of
Publication: November 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: This study is designed to investigate the effect of
preoperational mechanical ventilation on the short-term postoperative
outcomes following corrective surgery for severe tetralogy of Fallot
(TOF). Methods: Ninety-two patients (58 males, mean age 20.5 +/- 8.5
months) with severe TOF were randomised into study and control groups. In
the study group, mechanical ventilation was performed in PEEP/PRVC mode in
the intensive care unit to correct blood gas imbalances for the corrective
surgery. In the control group, preoperative oxygen supply was provided via
face mask or nasal tubes. Results: The postoperative mechanical
ventilation time (14.3 +/- 1.9 vs 22.5 +/- 2.2. h, p=0.02), intensive care
stay (2.3 +/- 1.2 vs 4.7 +/- 1.1 d, p= 0.03) and duration for positive
inotropic drug administration (2.5 +/- 1.1 vs 4.8 +/- 1.2. d, p=0.04) in
the study group were shorter than those in the control group. The
postoperative capillary leak syndrome in the study group was lower than
that in the control group (4.3% vs 23.9%, p=0.006). There was no
statistically significant difference in the postoperative mortality
between the study and control groups (2.1% vs 6.5%, p=0.606). Conclusions:
Preoperational mechanical ventilation in patients with severe forms of TOF
was associated with improved short-term outcomes following the corrective
surgery. The effect of the preoperational ventilation on postoperative
mortality requires further investigation. 2012.

<18>
Accession Number
2012663902
Authors
Cao P. De Rango P. Czerny M. Evangelista A. Fattori R. Nienaber C.
Rousseau H. Schepens M.
Institution
(Cao) Vascular Surgery, Ospedale San Camillo, Rome, Italy
(De Rango) Vascular Surgery, Ospedale S. Maria della Misericordia,
Perugia, Italy
(Czerny) Cardiovascular Surgery, Basel, Switzerland
(Evangelista) Cardiology, Hospital Val d'Hebron Barcelona, Barcelona,
Spain
(Fattori) Cardiovascular Radiology, San Salvatore Hospital, Pesaro, Italy
(Nienaber) Interventional Cardiology, University of Rostock, Rostock,
Germany
(Rousseau) Radiology, Toulouse, France
(Schepens) Cardiovascular Surgery, Brugge, Belgium
Title
Systematic review of clinical outcomes in hybrid procedures for aortic
arch dissections and other arch diseases.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (6) (pp 1286-1300.e2),
2012. Date of Publication: December 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Available data on clinical outcomes of hybrid aortic arch
repair are limited, especially for patients with aortic dissection. The
objective of this review was to provide pooled analysis of periprocedural
mortality and neurologic outcomes in hybrid procedures involving the
aortic arch for dissection and other aortic diseases. Methods: Studies
involving hybrid aortic arch procedures (2002-2011) were systematically
searched and reviewed. End points were periprocedural mortality, stroke,
and spinal cord ischemia. Results: A total of 50 studies including 1886
patients were included. Perioperative mortality ranged from 1.6% to 25.0%
with a pooled event ratio of 10.8% (95% confidence intervals [CI],
9.3-12.5). Perioperative stroke, regardless of severity, ranged from 0.8%
to 25.0% (pooled ratio 6.9%; 95% CI, 5.7%-8.4), and spinal cord ischemia,
including permanent and transitory events, ranged from 1.0% to 25.0%
(pooled ratio, 6.8%; 95% CI, 5.6-8.2). Neurologic but no mortality risk
was affected by timing and center volume with decreased rates in more
recent and higher volume studies. In dissected aorta, perioperative
mortality rate was 9.8% (95% CI, 7.7-12.4), stroke 4.3% (95% CI, 3.0-6.3),
and spinal cord ischemia 5.8% (95% CI, 4.2-7.9). Perioperative mortality
was higher in diseases that extended to the ascending aorta (15.1% vs
7.6%; odds ratio, 2.8; 95% CI, 1.17-6.7; P =.021), whereas there were no
significant differences in the neurologic risks of stroke or spinal cord
ischemia. Conclusions: Hybrid repair of the aortic arch carries not
negligible risks of perioperative mortality and neurologic morbidity. Risk
of neurologic complications has decreased with timing and center volume
and may be limited in dissection repairs. However, contemporary
information on aortic hybrid arch procedures is mainly provided by small
case series or retrospective studies with wide range of results. Copyright
2012 by The American Association for Thoracic Surgery.

<19>
Accession Number
2012663937
Authors
Suri R.M. Michelena H.I. Burkhart H.M. Greason K.L. Daly R.C. Dearani J.A.
Park S.J. Joyce L.D. Stulak J.M. Sundt III T.M. Li Z. Schaff H.V.
Institution
(Suri, Burkhart, Greason, Daly, Dearani, Park, Joyce, Stulak, Schaff)
Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW,
Rochester, MN 55905, United States
(Michelena) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Li) Division of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Sundt III) Division of Cardiac Surgery, Massachusetts General Hospital,
Boston, MA, United States
Title
A prospective, randomized comparison of 3 contemporary bioprosthetic
aortic valves: Should hemodynamic performance influence device selection?.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (6) (pp 1387-1398),
2012. Date of Publication: December 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Latest generation biologic aortic valve prostheses were
designed to improve hemodynamic performance. We sought to determine
whether there are clinically important early differences among these
devices. Methods: Three hundred adults with severe aortic valve stenosis
undergoing aortic valve replacement were randomized to receive the Edwards
Magna, Sorin Mitroflow, or St. Jude Epic bioprostheses (n = 100, n = 101,
n = 99, respectively). Early hemodynamic performance was studied by
echocardiography. Results: Mean patient age was 76 +/- 8 years and there
were 203 men (68%). There were no significant differences in baseline
characteristics among implant groups. Early mortality was 1.7%, and there
were no differences in early adverse events. Postoperative
echocardiography showed small but statistically significant differences
overall between the Magna, Mitroflow, and Epic valves in mean gradient
(14.2 mm Hg, 16.3 mm Hg, 16.5 mm Hg, respectively; P = .011), aortic valve
area (2.05 cm², 1.88 cm², 1.86 cm²,
respectively; P = .012), and indexed aortic valve area (1.05 cm
²/m², 0.97 cm²/m², 0.95 cm
²/m², respectively; P = .012). Prosthetic
performance was similar among all with a small (<=21 mm) aortic annulus.
Patients who received the Magna device with a 23-mm annulus had slightly
greater indexed aortic valve area; those with >23 mm had a slightly lower
transprosthetic gradient. Analogous trends were found when data were
stratified by either commercial implant size or
echocardiography-determined aortic annulus size. Severe patient-prosthesis
mismatch was infrequent overall and was similarly low among devices (P
value not significant). Conclusions: This prospective, randomized
comparison reveals that there are small but consistent early postoperative
hemodynamic differences among current third-generation porcine and
pericardial aortic valve prostheses. The 3 valves studied performed
equally well in patients with a small (<=21 mm) aortic annulus. The Magna
valve had a slightly lower mean gradient in those with larger annular size
(>23 mm). Longitudinal follow-up of these randomized cohorts is essential
to determine late clinical implications of these early postoperative
findings. Copyright 2012 by The American Association for Thoracic
Surgery.

<20>
Accession Number
2012655569
Authors
Li J.-H. Aikebaer Inamdar K.Y. Mula-Ti
Institution
(Li, Aikebaer, Inamdar, Mula-Ti) Department of Cardiac Surgery Division
One, The First Affiliated Hospital of Xinjiang Medical University, Urumqi
830054, China
Title
Effectiveness and safety of coronary artery bypass grafting versus
percutaneous coronary intervention for coronary heart disease combined
with diabetic mellitus: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 12 (9) (pp 1116-1121), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To evaluate the effectiveness and security through meta-analysis
of a comprehensive study of efficacy of coronary artery bypass grafting
(CABG) versus drug-eluting stent percutaneous coronary intervention
(DESPCI), for diabetes mellitus with multi-vessel coronary disease.
Methods Databases including The Cochrane Library, PubMed, MEDLINE, EMbase,
CBM, CNKI, WanFang Data and VIP were searched from their establishment
dates to 2010. Published information and conference papers including
references were handsearched. Relevant randomized controlled trials (RCTs)
on diabetic patients with coronary multi-vessel disease treated with
revascularization were collected and screened by two reviewers
independently. After data extraction and quality assessment of the
included studies, metaanalysis was performed using RevMan 5.0. Results A
total of eight studies involving a total of 3 689 cases (CABG group: 1 814
cases; DES-PCI group: 1 875 cases) were included. Results of meta-analyses
showed that: compared with the DESPCI group, the CABG group could
significantly reduce postoperative repeat revascularization rate (OR=0.27,
95% CI 0.10 to 0.69, P=0.006) and major cardio-cerebral vascular events
(OR=0.49, 95% CI 0.38 to 0.62, P<0.000 01). But in reducing mortality rate
(OR=0.84, 95%CI 0.64 to 1.10, P=0.21), cerebrovascular events (OR=2.00,
95%CI 0.97 to 4.14, P=0.06) and myocardial infarction incidence rate
(OR=0.92, 95%CI 0.53 to 1.59, P=0.75), there were no significant
differences between the two groups. Conclusion CABG is superior to DES-PCI
in the treatment of diabetic patients with multi-vessel disease. However,
due to the limitation of the quality and quantity of the included studies,
the above conclusion should be tested by conducting more large-scale,
multi-center and prospective RCTs in future. 2012 Editorial Board of Chin
J Evid-based Med.

<21>
Accession Number
2012655567
Authors
Wang S.-L. Shi D.-Z. Wang C.-L.
Institution
(Wang, Shi, Wang) Cardiovascular Center, Xiyuan Hospital, China Academy of
Chinese Medical Sciences, Beijing, China
Title
Prognostic effects of obstructive sleep apnea treated with continuous
positive airway pressure or upper airway surgery on coronary heart
disease: A systematic review.
Source
Chinese Journal of Evidence-Based Medicine. 12 (9) (pp 1105-1109), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To evaluate prognostic impact of treatment with Continuous
Positive Airway Pressure (CPAP) or upper airway surgery on the patients
with obstructive sleep apnea (OSA) and coronary heart disease (CHD).
Methods Database search in The Cochrane Library, PubMed, OVID and CBM
(from establishment dates to October 2009) were conducted. Cohort studies
and randomized controlled trials of OSA with CPAP or upper airway surgery
in CHD patients were identified. We assessed the quality of the included
trials and extracted the relevant data. Statistical analysis was performed
using RevMan 4.3.2 software. Results A total of 4 cohort studies involving
945 participants were included. The results of meta-analysis were as
follows: a) there were no significant differences in the rate of late
lumen loss and 10-year mortality between CHD patients with OSA treated by
CPAP and those without OSA (RR=1.84, 95%CI 0.73 to 4.68, P=0.20; RR=0.80,
95%CI 0.24 to 2.64, P=0.71). b) CPAP or uvulopalatopharyngoplasty used in
the treatment of OSA on CHD patients after PCI had a significant decrease
in the rate of 5-year cardiac death when compared with those untreated OSA
patients (RR=0.34, 95%CI 0.14 to 0.82, P=0.02). But there were no
differences in the rate of 5-year allcause mortality, major adverse
cardiac events (MACE) between the two groups respectively (RR=0.66, 95%CI
0.39 to 1.10, P=0.11; RR=0.97, 95%CI 0.81 to 1.15, P=0.69). c) CPAP or
upper airway surgery in treating OSA significantly reduced the risk of
MACE occurrence during the 86.5+/-39 months follow-up period (RR=0.22,
95%CI 0.07 to 0.72, P=0.01). Conclusion Current evidence indicates that
treating OSA with CPAP or upper airway surgery in CHD patients might be
associ ated with a decrease in the risk of cardiac death. But more studies
are necessary to evaluate prognostic impact of treatment with CPAP or
upper airway surgery on the patients with OSA and CHD. However, due to the
limited quantity and quality of the included studies, more high-quality
studies are need. 2012.

<22>
Accession Number
2012653008
Authors
Budera P. Straka Z. Osmancik P. Vanek T. Jelinek S. Hlavicka J. Fojt R.
Cervinka P. Hulman M. Smid M. Mal M. Widimsk P.
Institution
(Budera, Straka, Osmancik, Vanek, Jelinek, Hlavicka, Fojt, Widimsk)
Cardiocenter, Third Faculty of Medicine, Charles University Prague, Czech
Republic
(Cervinka) Cardiology Department, Masaryk Hospital, Usti nad Labem, Czech
Republic
(Hulman) National Institute of Cardiovascular Diseases, Bratislava,
Slovakia
(Smid) Cardiocenter, Faculty of Medicine in Pilsen, Charles University
Prague, Czech Republic
(Mal) National Institute of Public Health, Prague, Czech Republic
Title
Comparison of cardiac surgery with left atrial surgical ablation vs.
cardiac surgery without atrial ablation in patients with coronary and/or
valvular heart disease plus atrial fibrillation: Final results of the
PRAGUE-12 randomized multicentre study.
Source
European Heart Journal. 33 (21) (pp 2644-2652), 2012. Date of Publication:
November 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsSurgical ablation procedure can restore sinus rhythm (SR) in patients
with atrial fibrillation (AF) undergoing cardiac surgery. However, it is
not known whether it has any impact on long-term clinical outcomes.Methods
and resultsThis multicentre study randomized 224 patients with AF
scheduled for valve and/or coronary surgery: group A (left atrial surgical
ablation, n 117) vs. group B (no ablation, n 107). The primary efficacy
outcome was the SR presence (without any AF episode) during a 24 h
electrocardiogram (ECG) after 1 year. The primary safety outcome was the
combined endpoint of death/myocardial infarction/stroke/renal failure at
30 days. A Holter-ECG after 1 year revealed SR in 60.2 of group A patients
vs. 35.5 in group B (P = 0.002). The combined safety endpoint at 30 days
occurred in 10.3 (group A) vs. 14.7 (group B, P = 0.411). All-cause 1-year
mortality was 16.2 (A) vs. 17.4 (B, P = 0.800). Stroke occurred in 2.7 (A)
vs. 4.3 (B) patients (P = 0.319). No difference (A vs. B) in SR was found
among patients with paroxysmal (61.9 vs. 58.3) or persistent (72 vs. 50)
AF, but ablation significantly increased SR prevalence in patients with
longstanding persistent AF (53.2 vs. 13.9, P < 0.001).ConclusionSurgical
ablation improves the likelihood of SR presence post-operatively without
increasing peri-operative complications. However, the higher prevalence of
SR did not translate to improved clinical outcomes at 1 year. Further
follow-ups (e.g. 5-year) are warranted to show any potential clinical
benefit which might occur later. 2012 The Author.

<23>
Accession Number
2012653001
Authors
Hara H. Oyenuga O.A. Tanaka H. Adelstein E.C. Onishi T. McNamara D.M.
Schwartzman D. Saba S. Gorcsan J.
Institution
(Hara, Oyenuga, Tanaka, Adelstein, Onishi, McNamara, Schwartzman, Saba,
Gorcsan) Cardiovascular Institute, University of Pittsburgh, Scaife 564,
200 Lothrop Street, Pittsburgh, PA 15213-2582, United States
Title
The relationship of QRS morphology and mechanical dyssynchrony to
long-term outcome following cardiac resynchronization therapy.
Source
European Heart Journal. 33 (21) (pp 2680-2691), 2012. Date of Publication:
November 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsBecause benefits of cardiac resynchronization therapy (CRT) appear to
be less favourable in non-left bundle branch block (LBBB) patients, this
prospective longitudinal study tested the hypothesis that QRS morphology
and echocardiographic mechanical dyssynchrony were associated with
long-term outcome after CRT.Methods and resultsTwo-hundred and
seventy-eight consecutive New York Heart Association class III and IV CRT
patients with QRS <120 ms and ejection fraction <=35 were studied. The
pre-specified primary endpoint was death, heart transplant, or left
ventricular assist device over 4 years. Dyssynchrony assessed before CRT
included interventricular mechanical delay (IVMD) and speckle-tracking
radial strain using pre-specified cut-offs for each. Of 254 with baseline
quantitative echocardiographic data available, 128 had LBBB, 81 had
intraventricular conduction delay (IVCD), and 45 had right bundle branch
block (RBBB). Radial dyssynchrony was observed in 85 of the patients with
LBBB, 59 with IVCD (*), and 40 with RBBB (*) ( (*)P < 0.01 vs. LBBB). Of
248 (98) with follow-up, LBBB patients had a significantly more favourable
long-term survival than non-LBBB patients. However, non-LBBB patients with
dyssynchrony had a more favourable event-free survival than those without
dyssynchrony: radial dyssynchrony hazard ratio 2.6, 95 confidence interval
(CI) 1.47-4.53 (P = 0.0008) and IVMD hazard ratio 4.9, 95 CI 2.60-9.16 (P
= 0.0007). Right bundle branch block patients who lacked dyssynchrony had
the least favourable outcome.ConclusionNon-LBBB patients with dyssynchrony
had a more favourable long-term survival than non-LBBB patients who lacked
dyssynchrony. Mechanical dyssynchrony and QRS morphology are associated
with outcome following CRT. 2012 The Author.

<24>
Accession Number
70925380
Authors
Moraca R.J. Wanamaker K. Nitzberg D. Bailey S.H. Benckart D. McGregor W.
Maher T. Magovern G.
Institution
(Moraca, Wanamaker, Nitzberg, Bailey, Benckart, McGregor, Maher, Magovern)
Allegheny General Hosp, Pittsburgh, PA, United States
Title
The role of routine carotid artery duplex in patients referred for
coronary artery bypass grafting.
Source
Stroke. Conference: 2012 International Stroke Conference and Nursing
Symposium New Orleans, LA United States. Conference Start: 20120201
Conference End: 20120203. Conference Publication: (var.pagings). 43 (2
Meeting Abstracts) , 2012. Date of Publication: February, 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction In the past decade, there has been an increase in the amount
of patients with medical co-morbidities referred for coronary artery
bypass surgery (CABG). Cerebrovascular accident (CVA) after CABG is a
devastating and multi-factorial problem. Carotid artery disease in
patients undergoing cardiopulmonary bypass procedures may increase the
risk of significant neurological complication. We review the results of
carotid screening, management and outcome of carotid disease in patients
referred for CABG. Methods Between 2008 through 2010, 673 patients were
referred for isolated coronary artery bypass surgery at a single
institution. Patients were identified through a systematic review of The
Department of Cardiothoracic Surgery Society of Thoracic Surgery Outcomes
Database. A retrospective analysis of prospectively collected demographic,
clinical data and outcomes were preformed. All patients with screening
preoperative carotid duplex were reviewed. We defined the degree of
carotid disease as: none to mild stenosis (<50%), moderate stenosis
(50-69%), severe stenosis (70-99%). Results 559 (83%) patients underwent
screening preoperative carotid ultrasonography prior to surgery. Patient
demographics and clinical variable are listed in Table 1. Severity of
carotid disease on preoperative imaging was none/mild (68%), unilateral
moderate disease (17%), bilateral moderate (7%) and severe (8%). 12 (2.1
%) of patients underwent a preoperative carotid endarterectomy and
subsequent CABG, with no peri-operative cardiac events or CVAs. Only 4
(0.7%) patients in the entire series had a peri-operative CVA. Conclusions
Routine use of carotid ultrasound in patients referred for CABG with
aggressive management may reduce the incidence of peri-operative CVA.