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<1>
Accession Number
2012713809
Authors
Zipes D.P. Svorkdal N. Berman D. Boortz-Marx R. Henry T. Lerman A. Ross E.
Turner M. Irwin C.
Institution
(Zipes) Indiana University School of Medicine, Krannert Institute of
Cardiology, 1800 North Capitol Ave., Indianapolis, IN 46202-4800, United
States
(Svorkdal) Vancouver Island Pain Program, Royal Jubilee Hospital,
Victoria, BC, Canada
(Berman) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Boortz-Marx) Gundersen Lutheran Medical Center, LaCrosse, WI, United
States
(Boortz-Marx) University of North Carolina, Chapel Hill, NC, United States
(Henry) Minneapolis Heart Institute Foundation, Abbott Northwestern
Hospital, Minneapolis, MN, United States
(Lerman) Mayo Clinic, Rochester, MN, United States
(Ross) Brigham and Women's Hospital, Chestnut Hill, MA, United States
(Turner) Indianapolis Neurosurgical Group, Indianapolis, IN, United States
(Irwin) Medtronic, Inc., Minneapolis, MN, United States
Title
Spinal cord stimulation therapy for patients with refractory angina who
are not candidates for revascularization.
Source
Neuromodulation. 15 (6) (pp 550-558), 2012. Date of Publication:
November-December 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objectives: The aim of this study was to evaluate the safety and efficacy
of spinal cord stimulation (SCS) for refractory angina. Materials and
Methods: This multicenter, randomized, single-blind, controlled trial
evaluated SCS in two patient groups: high stimulation (HS) (treatment) and
low stimulation (LS) (control). The HS group controlled SCS with a
programmer for a minimum of two hours four times daily. The LS group
received SCS therapy above the paresthesia threshold for one min once
daily. The primary efficacy endpoint was number of angina attacks recorded
by patients at six months. The primary safety endpoint was the major
adverse cardiac event (MACE) rate at six months. Results: Due to slow
enrollment, a futility analysis was performed, resulting in early
termination of the study. Sixty-eight patients were randomized after
implantation. Mean change in angina attacks per day from baseline to six
months was -1.19 +/- 2.13 (HS) and -1.29 +/- 1.66 (LS). The difference
from baseline was significant within each group (both p < 0.001) but not
between groups (p = 0.45). Total exercise time and time to angina onset
increased significantly from baseline to six months within each group
(both p = 0.02 and 0.002) but not between groups (p = 0.52 and 0.51). MACE
was similar between groups. Conclusion: Although this study was terminated
early, the results obtained at six months suggest that SCS (HS) is not
more effective than the control (LS) in patients with refractory angina.
2012 International Neuromodulation Society.

<2>
Accession Number
2012719866
Authors
Lysgaard C. Nielsen M.S. Christensen J.H. Lundbye-Christensen S. Riahi S.
Schmidt E.B.
Institution
(Lysgaard, Nielsen, Lundbye-Christensen, Schmidt) Department of
Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aarhus
University Hospital, Sondre Skovvej 15, Aalborg 9000, Denmark
(Christensen, Riahi) Department of Nephrology, Center for Cardiovascular
Research, Aalborg Hospital, Aarhus University Hospital, Sondre Skovvej 15,
Aalborg 9000, Denmark
(Riahi) Department of Health Science and Technology, Faculty of Medicine,
Aalborg University, Sondre Skovvej 15, Aalborg 9000, Denmark
Title
No effect of high-dose atorvastatin on leukotriene B4 formation from
neutrophils in patients treated with coronary bypass surgery: A randomized
placebo-controlled double-blinded trial with a crossover design.
Source
Prostaglandins Leukotrienes and Essential Fatty Acids. 87 (6) (pp
185-188), 2012. Date of Publication: December 2012.
Publisher
Churchill Livingstone (1-3 Baxter's Place, Leith Walk, Edinburgh EH1 3AF,
United Kingdom)
Abstract
Inflammation plays a pivotal role in the pathophysiology of cardiovascular
disease, (CVD) and leukotrienes may play a role in atherogenesis. Statins
reduce mortality from CVD by reducing LDL cholesterol and potentially by
other (pleiotropic) mechanisms. The aim of this study was to investigate
if atorvastatin exerts an anti-inflammatory effect by reducing leukotriene
B₄ (LTB₄) formation from stimulated neutrophils in
patients treated with coronary artery bypass grafting. The study was a
randomized, placebo-controlled, double-blinded crossover study. Patients
(n=80) were allocated to 80mg atorvastatin or placebo for 6 weeks before
crossing over to the opposite treatment for another 6 weeks. There was no
significant correlation between baseline LDL cholesterol levels on
formation of LTB₄, and atorvastatin had no effect on
LTB₄ formation. Hence, this study does not support any effect
of atorvastatin on LTB₄ formation as part of the explanation
for its beneficial effect on CVD. 2012 Elsevier Ltd.

<3>
Accession Number
2012709469
Authors
Mathew J. Katz R. St. John Sutton M. Dixit S. Gerstenfeld E.P. Ghio S.
Gold M.R. Linde C. Shlipak M.G. Deo R.
Institution
(Mathew, St. John Sutton, Dixit, Deo) Division of Cardiovascular Medicine,
University of Pennsylvania, Philadelphia, PA, United States
(Katz) Collaborative Health Studies Coordinating Center, University of
Washington, Seattle, WA, United States
(Gerstenfeld) Section of Electrophysiology, Division of Cardiology,
University of California, San Francisco, CA, United States
(Ghio) Cardiac, Thoracic and Vascular Department, Fondazione IRCCS
Policlinico S. Matteo, Pavia, Italy
(Gold) Division of Cardiology, Medical University of South Carolina,
Charleston, SC, United States
(Linde) Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
(Shlipak) Division of General Internal Medicine Section, Veterans Affairs
Medical Center, San Francisco, CA, University of California, San
Francisco, CA, United States
Title
Chronic kidney disease and cardiac remodelling in patients with mild heart
failure: Results from the REsynchronization reVErses Remodeling in
Systolic Left vEntricular Dysfunction (REVERSE) study.
Source
European Journal of Heart Failure. 14 (12) (pp 1420-1428), 2012. Date of
Publication: December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsChronic kidney disease (CKD) is a risk factor for left ventricular
hypertrophy (LVH) and heart failure. We evaluated the effect of CKD on
left ventricular (LV) remodelling among patients with mild heart
failure.Methods and resultsREVERSE was a randomized, controlled trial
evaluating cardiac resynchronization therapy (CRT) in patients with New
York Heart Association (NYHA) class I/II heart failure. CKD was defined as
an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73
m². We compared changes in LV function and size over the course
of 12 months by CKD status using linear mixed models adjusted for
demographics, co-morbidities, medications, cardiomyopathy aetiology, and
CRT status. Finally, we evaluated the effect of CKD on cardiac remodelling
among patients randomized to CRT on or off. CKD was associated with
worsening LV function and dilation compared with the non-CKD group
adjusted, 12-month beta coefficients for the CKD group compared with the
non-CKD referent group: LV ejection fraction (%) [-1.80, 95 confidence
interval (CI)-3.36 to-0.24], LV end-systolic volume (mL) (14.16, 95 CI
3.96-24.36), LV end-diastolic volume (mL) (14.88, 95 CI 2.88-26.76), LV
end-systolic diameter (cm) (0.36, 95 CI 0.12-0.48), LV end-diastolic
diameter (cm) (0.24, 95 CI 0.012-0.36), mitral regurgitation () (3.12, 95
CI 0.48-5.76), and LV shape (0.036, 95 CI 0.012-0.060). In participants
assigned to CRT, those without CKD had significantly greater improvements
in LV structural parameters compared with the CKD group.ConclusionsIn
comparison with participants with normal kidney function, CKD is an
independent risk factor for ventricular dysfunction and dilation. CRT
improves LV function and structure to a lesser extent in patients with CKD
than in those with normal kidney function. 2012 The Author.

<4>
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Accession Number
2012708389
Authors
Horvath S.A. Xu K. Nwanyanwu F. Chan R. Correa L. Nass N. Jaraki A.-R.
Jurkovich D. Kennedy R. Andrzejewski L. Vignola P.A. Cubeddu R.J.
Institution
(Horvath, Nwanyanwu, Chan, Correa, Nass, Jaraki, Jurkovich, Kennedy,
Andrzejewski, Vignola, Cubeddu) Interventional Cardiology, Division of
Cardiology, Aventura Hospital and Medical Center, 21097 NE 27th Court,
Aventura, FL 33180, United States
(Xu) Clinical Trial Center, Cardiovascular Research Foundation, New York,
NY, United States
Title
Impact of the prehospital activation strategy in patients with
ST-elevation myocardial infarction undergoing primary percutaneous
revascularization: A single center community hospital experience.
Source
Critical Pathways in Cardiology. 11 (4) (pp 186-192), 2012. Date of
Publication: December 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
The strategy of prehospital activation by the emergency medical system
(EMS) in patients with ST-elevation myocardial infarction (STEMI) has been
poorly adopted among the US hospitals that currently offer 24/7 primary
percutaneous coronary intervention. In this study, we report a single
center experience after the implementation of this strategy. From 2008 to
2011, we identified a total 188 STEMI patients (age 65 +/- 15 years)
presenting via EMS for primary percutaneous coronary intervention. Of
these, 112 (59.6%) underwent prehospital activation (EMS group), whereas
the remaining 76 (40.4%) underwent emergency department activation
[emergency department (ED) group]. Baseline demographic characteristics
were similar between both groups. The overall median door-to-balloon (DTB)
time was 49 +/- 14 minutes. Patients undergoing prehospital activation had
on average significantly lower overall DTB times (EMS 44 +/- 11 minutes
vs. ED 57 +/- 15 minutes; P < 0.001). Concordantly, DTB times <60 minutes
were much more commonly achieved with this strategy (EMS 95.5% vs. ED
64.5%; P < 0.001). Fallouts beyond the recommended 90-minute DTB time were
seen among ED patients only. No difference in in-hospital death (EMS 5.4%
vs. ED 6.6%; P = 0.75) or cumulative 30-day mortality (EMS 6.3% vs. ED
7.9%; P = 0.68) was observed between both groups. However, on average, EMS
patients had higher postinfarct left ventricular ejection fraction (EMS 48
+/- 9.5% vs. ED 39 +/- 14.6%; P = 0.004). Differences in DTB time and left
ventricular ejection fraction remained significant after adjusting for
differences in baseline characteristics. In conclusion, the prehospital
activation strategy is largely effective and should be systematically
adopted in the treatment scheme of STEMI patients to lower mechanical
reperfusion times and reduce the potential for untoward clinical outcomes.
Copyright 2012 by Lippincott Williams & Wilkins.

<5>
Accession Number
2012709755
Authors
Angeli F. Reboldi G. Poltronieri C. Mazzotta G. Garofoli M. Ramundo E.
Biadetti A. Verdecchia P.
Institution
(Angeli, Poltronieri) Section of Cardiology, Hospital Media Valle Del
Tevere, ASL 2 Umbria, Perugia, Italy
(Reboldi) Department of Internal Medicine, University of Perugia, Italy
(Mazzotta, Garofoli, Ramundo, Biadetti, Verdecchia) Department of Internal
Medicine, Hospital of Assisi, Italy
Title
Aggressive blood pressure reduction in patients at high vascular risk: Is
it dangerous?.
Source
Italian Journal of Medicine. 6 (4) (pp 302-306), 2012. Date of
Publication: December 2012.
Publisher
Elsevier Masson s.r.l. (Via P. Paleocapa 7, Milan 20121, Italy)
Abstract
Introduction: The aim of this review was to summarize the current state of
evidence regarding the optimal blood pressure goals in patients with high
vascular risk. In particular, this review critically addresses the issue
of the "J-curve" paradox - a hypothesis indicating that low
treatment-induced blood pressure values are characterized by an increase,
rather than a decrease, in the incidence of cardiovascular events.
Materials and methods: We reviewed evidence from studies published in
peer-reviewed journals indexed in Medline, EMBASE and CINAHL that compared
different BP goals. Results: Post-hoc analyses of randomized trials
specifically conducted to test the hypothesis of the "J-shaped curve"
yielded conflicting results. However, trials directly comparing different
blood pressure goals and meta-analyses showed that in-treatment blood
pressure values below the usual goal of less than 140/90 mmHg improve
outcomes in patients at increased vascular risk. Discussion: The fear that
an excessive reduction in blood pressure may be dangerous is inconsistent
with the available data and probably conditioned by the adverse impact of
other risk factors that may be more frequent in patients with low values
of achieved blood pressure. The association between blood pressure
reduction and cardiovascular risk seems to be linear and not J-shaped.
2012 Elsevier Srl. All rights reserved.

<6>
Accession Number
2012677048
Authors
Steingrimsson S. Gottfredsson M. Gudmundsdottir I. Sjogren J. Gudbjartsson
T.
Institution
(Steingrimsson, Gudbjartsson) Department of Cardiothoracic Surgery,
Landspitali University Hospital, IS 101 Reykjavik, Iceland
(Steingrimsson, Gottfredsson, Gudbjartsson) Faculty of Medicine,
University of Iceland, Reykjavik, Iceland
(Gottfredsson) Department of Infectious Diseases, Landspitali University
Hospital, Reykjavik, Iceland
(Gudmundsdottir) Department of Vascular Surgery, Landspitali University
Hospital, Reykjavik, Iceland
(Sjogren) Department of Cardiothoracic Surgery, Skane University Hospital,
Lund University, Lund, Sweden
Title
Negative-pressure wound therapy for deep sternal wound infections reduces
the rate of surgical interventions for early re-infections.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 406-410),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESTo evaluate the outcome of treatment for deep sternal wound
infection (DSWI) in a nationwide patient cohort, before and after the
introduction of negative-pressure wound therapy (NPWT).METHODSThis was a
population-based cohort of all patients treated for DSWI in Iceland out of
2446 open heart operations performed between 2000 and 2010. Length of
hospital stay, survival and reoperations were compared in (i) 23 patients
treated with open and/or closed irrigation before August 2005
(conventional treatment, CvT group) and in (ii) 20 patients treated after
this time with NPWT as a first-line therapy (NPWT group).RESULTSThe DSWI
rate was 1.8% and did not change during the study period. Demographics
were similar for both groups, except for peripheral arterial disease which
was less common in the NPWT group. Coagulase-negative staphylococci were
also more common (as the only pathogen identified) in the NPWT group (70%
vs 30%, P = 0.01). The median length of hospital stay was 43 days in both
groups and the sternum could be closed with delayed primary closure in all
except 2 patients, one in each group. Eight patients in the CvT group
required surgical revision for re-infections, including debridement and
rewiring, when compared with 1 patient in the NPWT group (P = 0.02).
Furthermore, 6 patients in the CvT group developed late chronic infections
of the sternum requiring surgical revision, compared with one in the NPWT
group (P = 0.10). The 30-day mortality was not significantly different
between groups (4% vs 0%, P > 0.1) and the same was true for 1-year
mortality (17% vs 0%, P = 0.11).CONCLUSIONSNPWT significantly reduces the
risk of early re-infections in patients with DSWI. There was a lower rate
of late chronic sternal infections and lower mortality in the NPWT group,
but the difference was not statistically significant. We conclude that
NPWT should be considered as a first-line treatment for most DSWIs. 2012
The Author 2012. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
2012677040
Authors
Gazala S. Hunt I. Bedard E.L.R.
Institution
(Gazala, Bedard) Division of Thoracic Surgery, Royal Alexandra Hospital,
University of Alberta, 10240 Kingsway Ave., Edmonton, AB T6G 2B7, Canada
(Hunt) Department of Thoracic Surgery, St George's Hospital, London,
United Kingdom
Title
Diaphragmatic plication offers functional improvement in dyspnoea and
better pulmonary function with low morbidity.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 505-508),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was as follows: In adults with
unilateral diaphragmatic paralysis, does diaphragmatic plication offer
functional improvement in dyspnoea, better pulmonary function tests (PFTs)
and return to activity? A total of 126 papers were found using the
reported search, of which 13 represented the best evidence to answer the
clinical question. The authors, date and country of publication, patient
group studied, surgical approach, study type, relevant outcomes and
results of these articles are tabulated. Those articles reporting
improvement in PFTs following plication, documented this benefit in the
following parameters: mean forced vital capacity (range 17-40%), forced
expiratory volume at 1 sec (range 21-27%), functional residual capacity
(range 20-21%) and total lung capacity (range 16-19%). The percentage of
postoperative improvement in shortness of breath as measured by a dyspnoea
score was reported to be between 90 and 96% in the thoracotomy group and
100% in the Video Assisted Thoracoscopic Surgery (VATS) group, the
dyspnoea score that was used in all the studies was a visual analogue
scale between 0 and 10 where 0 is no dyspnoea and 10 is the worst dyspnoea
a patient can have. One of the studies reported postoperative
normalization in ventilation perfusion scan (VQ) scan parameters when
compared with the preoperative mismatch. Complication rate was similar
between the two groups, while the mortality rate was 4% in the thoracotomy
group and 0% in the VATS group. The total number of patients included in
all the studies combined was 161. All reports included in this review are
observational studies (one cohort study and the remainder being case
series); therefore, the risk of selection, information and publication
biases are high and conclusions should be implemented with caution. We
conclude that diaphragmatic plication can improve the functional status,
shortness of breath and PFTs of patients with unilateral diaphragm
paralysis. Patients undergoing a VATS approach appear to have more
advantages in objective and subjective measures (including PFTs, dyspnoea
score, length of hospital stay and postoperative complications). Further
research with high-quality study designs is advised, focussing mainly on
the long-term benefits and assessment of health-related quality of life.
2012 The Author 2012. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<8>
Accession Number
2012677038
Authors
Bianchi G. Solinas M. Bevilacqua S. Glauber M.
Institution
(Bianchi, Solinas, Bevilacqua, Glauber) Ospedale Del Cuore Fondazione
Toscana Gabriele Monasterio, Department of Adult Cardiac Surgery, Heart
Hospital 'G. Monasterio' Foundation, Massa, Italy
Title
Are bioprostheses associated with better outcome than mechanical valves in
patients with chronic kidney disease requiring dialysis who undergo valve
surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 473-483),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether patients with
chronic kidney disease who required dialysis that undergo valve surgery
have better surgical recovery rates with bioprostheses than with
mechanical valves. Altogether more than 96 papers were found using the
reported search, of which 12 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. Patients with end stage renal disease (ESRD)
undergoing cardiac surgery are very fragile, with high in-hospital
mortality rates (13-36%) and limited life expectancy (15-42 months in
selected studies). Two studies outlined that diabetic ESRD, neurological
impairment, age at the operation and poor ventricular function are the
strongest predictors of early and late morbidity and mortality. Based on
American Heart Association/American College of Cardiology (AHA/ACC) 1998
valvular guidelines, bioprostheses were considered a contraindication in
dialysis patients; this statement derived from anecdotal reports of
accelerated valve degeneration. Structural valve deterioration was
reported in only 5 of 1347 patients who received bioprosthesis through the
studies and independent from implantation site. Likelihood of degeneration
is low, with a calculated valve-excision rate of 7%, and occurred in a
broad range of time (from 10 to 156 months). The AHA/ACC 2006 valvular
revised guidelines removed the previous statement (1998) of class IIa
recommendation for mechanical valves and class III for tissue valves; in
the focus update of 2008, there is still no specific indication for valve
selection in dialysis patients, but difficulties in maintaining
anticoagulation in these patients was noted. Stroke, haemorrhage and
gastro-intestinal bleeding events occurred in almost 15% of patients with
mechanical valves during the follow-up, while bioprostheses showed an
average event rate of 3.9%. All but one of the selected studies reported
no differences in survival between mechanical and biological valves; in
five of seven studies, the patients who received bioprostheses were older
(mechanical vs biological average 53 years vs 61.4 years), in one study,
patients had undergone dialysis for longer period of time, and, in another
study, they had suffered from more previous myocardial infarction
(mechanical vs biological 9.1% vs 36.2%). Therefore, survivals have been
biased in favour of mechanical valves. Taking together these data,
biological valves are a suitable treatment for dialysis-dependent patients
and, while not superior to mechanical valves in survival due to the
aforementioned study biases, exhibit lower valve-related and
anti-coagulation related events. 2012 The Author 2012. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<9>
Accession Number
2012677025
Authors
Mabvuure N. Cumberworth A. Hindocha S.
Institution
(Mabvuure, Cumberworth) Brighton and Sussex Medical School, Audrey Emerton
Building, Eastern Road, Brighton BN2 5BE, United Kingdom
(Hindocha) Department of Plastic Surgery, Whiston Hospital, Liverpool,
United Kingdom
Title
In patients with carcinoid syndrome undergoing valve replacement: Will a
biological valve have acceptable durability?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 467-471),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'In patients with
carcinoid syndrome undergoing valve replacement, will a biological valve
have acceptable durability?' Altogether, more than 130 papers were found
using the reported search, of which 17 represented the best evidence to
answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. The pooled data from all papers
represent 51 patients with carcinoid right heart disease who underwent
tricuspid valve replacement. Two 'outcomes' studies reported a 30-day
postoperative mortality of 16.7-18% and 2-year survival rates of 44 and
50%, respectively. Seventeen patients were detailed in case reports. Of
these 17 patients, 7 died during the follow-up period. All but one of
these patients had a normal bioprosthesis at echocardiography or at
post-mortem. One patient with a plaque-covered valve had a functionally
normal valve. We conclude that at present, the best available evidence
suggests that although 30-day mortality approaches 20%, approximately half
of patients with carcinoid syndrome undergoing tricuspid valve replacement
can be expected to survive 2 years. Some patients survive considerably
longer than this, beyond 10 years in some cases. Importantly, at autopsy,
many replacement valves have been shown to be normal, with a few patients
reported as having died of cardiac causes. This should be taken as
cautious evidence that biological valves have an acceptable lifespan in
patients with carcinoid syndrome and that the process of valve destruction
seen in carcinoid patients does not continue to a significant level in the
bioprosthesis. Caveats to this include the lack of any directly
comparative trial and the predominance of case reports as opposed to
higher-level evidence. 2012 The Author 2012. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<10>
Accession Number
2012677020
Authors
Patatas K. Ling L. Dunning J. Shrivastava V.
Institution
(Patatas, Ling, Shrivastava) Department of Vascular Radiology, Hull Royal
Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom
(Dunning) Department of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom
Title
Static sac size with a type II endoleak post-endovascular abdominal aortic
aneurysm repair: Surveillance or embolization?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 462-466),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether embolization is superior to surveillance
for a type II endoleak associated with a static sac size post-endovascular
abdominal aortic aneurysm repair (EVAR). Four hundred and sixty-one papers
were identified, of which 10 papers presented the best evidence to answer
the clinical question. The author, journal, date and country of
publication, patient group studied, study type, and relevant outcomes and
results are tabulated. A review of the available literature suggests that
most type II endoleaks are innocuous and will seal spontaneously during
the long-term follow-up, even when they persist for more than 6 months. An
analysis of the large European Collaborators on Stent-Graft Techniques for
Aortic Aneurysm Repair (EUROSTAR) registry that includes prospective data
on 2463 patients from 87 European hospitals showed that type II endoleaks
were not associated with an increased risk of rupture; this correlates
well with the large single-centre studies included in this review. Based
on the available evidence, we conclude that the management of most
isolated type II endoleaks should be conservative-with close radiological
follow-up-even when persistent, with intervention restricted to theoese
associated with sac enlargement >5 mm over a 6-month period or >10 mm when
compared with pre-EVAR diameter. 2012 The Author 2012. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<11>
Accession Number
2012677019
Authors
Okonta K.E. Kesieme E.B.
Institution
(Okonta) Division of Cardiothoracic Surgery, Department of Surgery,
University College Hospital, PMB 5116, Ibadan, Nigeria
(Kesieme) Department of Surgery, Irrua Specialist Teaching Hospital, PMB8,
Irrua, Edo State, Nigeria
Title
Is oesophagectomy or conservative treatment for delayed benign oesophageal
perforation the better option?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 509-511),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was, 'Is oesophagectomy or conservative treatment for
delayed benign oesophageal perforation the better option?' Seven papers
were identified that provided the best evidence to answer the question.
The authors, journal, date and country of publication, patient group
studied, study type, relevant outcomes and results of these studies were
tabulated. A total of 147 patients from the studies had oesophageal
perforation, while 86 had oesophagectomies for delayed oesophageal
perforation (DOP; defined as a perforation diagnosed after 24 h) and 57
had conservative procedures. The mortality rate ranged from 0 to 18% for
patients with oesophagectomies, increasing to 50% with double exclusion
and reaching as high as 68% in primary repair. In one report, it was found
that conservative procedures inflicted higher morbidity than
oesophagectomy, which eliminated the perforation, the source of sepsis and
the underlying oesophageal disease; another study came to the same
conclusion. One study concurred that oesophageal perforation was a
surgical disease and only a few cases qualified for conservative
procedures. In a review of 34 patients who had DOP, 19 were treated with
conservative procedures and 15 oesophagectomy; the mortality rate for
patients treated by conservative procedures was 68%, whereas it was 13.3%
for patients treated by oesophagectomy. In another study, among the
patients treated with conservative procedures, at least one required an
additional operation and about 33.3% of patients who survived had
continued difficulty with swallowing. In four of the studies, the authors
observed that oesophagectomy for DOP was a better surgical option, which
decreased mortality, and one study compared the treatment outcome between
conservative procedures and oesophagectomy. The primary end-point in all
the studies was elimination of the source of sepsis by extirpating the
perforated oesophagus in comparison with conservative procedures. However,
the consensus of opinion in all the presented evidence was in support of
the theory that oesophagectomy was safer and better than conservative
procedures. In conclusion, oesophagectomy for DOP was superior to
conservative procedures. The limitation of the present review was the lack
of many randomized controlled trials. 2012 The Author 2012. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<12>
Accession Number
2012677015
Authors
Malik H.T. Sepehripour A.H. Shipolini A.R. McCormack D.J.
Institution
(Malik, Shipolini, McCormack) Department of Cardiothoracic Surgery, London
Chest Hospital, Bonner Road, London E2 9JX, United Kingdom
(Sepehripour) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Manchester, United Kingdom
Title
Is there a suitable method of anticoagulation in pregnant patients with
mechanical prosthetic heart valves?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 484-488),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol in
order to identify the mode of anticoagulation that has the best safety
profile for both the mother and the foetus in pregnant patients with
mechanical prosthetic heart valves. A total of 281 papers were identified
using the reported search, of which eight represented the best evidence to
answer the clinical question. The authors, date, journal, study type,
population, main outcome measures and results are tabulated. The reported
measures were foetal mortality, maternal mortality, congenital
abnormalities and embryopathy, and maternal thromboembolic and
haemorrhagic complications. The medical orthodoxy has warned of the
combination of oral anticoagulation and pregnancy due to the
well-documented warfarin embryopathy. Yet only one of the reported papers
identified a greater incidence of foetal aberrations among warfarin use,
with the highest reported rate being 6.4% and two of the assessed papers
reporting no embryopathy at all. Foetal mortality with oral
anticoagulation use ranged from 1.52 to 76%. All reported publications
demonstrated a superior maternal outcome with warfarin use, with a range
of thromboembolic events from 0 to 10% in comparison with 4 to 48% where
heparin was used. Thus, it is concluded that warfarin is a more durable
anticoagulant with a better maternal outcome despite it carrying a greater
foetal risk. Although, in contrast to previous teaching, the risks of
embryopathy are not the major drawback of oral anticoagulation. Heparin is
consistently less effective, but may be preferred for the superior foetal
outcome. Heparin usage during the first trimester reduces the foetal risk
but is still associated with an adverse maternal outcome. While the focus
for clinicians looking after pregnant women with mechanical heart valves
may be to prevent maternal thromboembolic complications, the overriding
concern for many women is to avoid any harm to their unborn child, even
when this places their health at risk. Thus women with mechanical heart
valves must be fully informed of the risks involved with different
anticoagulation for an informed decision to be made. 2012 The Author
2012. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<13>
Accession Number
2012677014
Authors
Evans R.G. Naidu B.
Institution
(Evans, Naidu) Department of Thoracic Surgery, Heart of England NHS
Foundation Trust, Bordesley Green East, B9 5SS, United Kingdom
(Evans, Naidu) University of Warwick, Coventry, United Kingdom
Title
Does a conservative fluid management strategy in the perioperative
management of lung resection patients reduce the risk of acute lung
injury?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 498-504),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether a conservative
fluid management strategy in the perioperative management of lung
resection patients is associated with a reduced incidence of postoperative
acute lung injury (PALI) and/or acute respiratory distress syndrome (ARDS)
in the recovery period. Sixty-seven papers were found using the reported
search, of which 13 level III and 1 level IV evidence studies represented
the best evidence to answer the question. Two retrospective case-control
studies demonstrated a direct association between liberal fluid intake and
the incidence of PALI/ARDS following lung resection on multivariate
analysis (MVA) with odds ratios (ORs) of 1.42 (95% CI 1.09-4.32, P =
0.011) and 2.91 (1.9-7.4, P = 0.001). In non-PALI/ARDS cases, the mean
intraoperative fluid infusion volume was significantly less [1.22 l
(1.17-1.26) vs 1.68 l (1.46-1.9) P = 0.005], the fluid balance over the
first 24 postoperative hours was significantly less [1.52 l positive
(1.44-1.60) vs 2.0 l positive (1.6-2.4) P = 0.026] and cumulated intra-and
postoperative fluid infusion was significantly less [2.0 ml/kg/h (1.7-2.3)
vs 2.6 ml/kg/h (2.3-2.9) P = 0.003]. These data show that the difference
between fluid regimes associated with an increased incidence of PALI/ARDS
(i.e. 'liberal') and those which are not (i.e. 'conservative') is narrow
but significant. However, this does not prove a causative role for liberal
fluid in the multifactorial development of PALI/ARDS. On this best
evidence, we recommend intra-and postoperative maintenance fluid to be
administered at 1-2 ml/kg/h and that a positive fluid balance of 1.5 l
should not be exceeded in the perioperative period with caution being
exercised with regard to the adequacy of oxygen delivery. If the fluid
balance exceeds this threshold, a high index of suspicion for PALI/ARDS
should be adopted and escalation of the level of care should be
considered. If a patient develops signs of hypoperfusion after these
thresholds are exceeded, inotropic/ vasopressor support should be
considered. 2012 The Author 2012. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<14>
Accession Number
2012677013
Authors
Szlubowski A. Soja J. Kocon P. Talar P. Czajkowski W. Rudnicka-Sosin L.
Cmiel A. Kuzdzal J.
Institution
(Szlubowski) Endoscopy Unit, John Paul II Hospital, ul. Pradnicka 80,
31-202 Krakow, Poland
(Soja) Department of Medicine, Jagiellonian University, Krakow, Poland
(Kocon, Talar, Czajkowski, Kuzdzal) Department of Thoracic Surgery,
Jagiellonian University, John Paul II Hospital, Krakow, Poland
(Rudnicka-Sosin) Department of Pathology, John Paul II Hospital, Krakow,
Poland
(Cmiel) Department of Applied Mathematics, AGH University of Science and
Technology, Krakow, Poland
Title
A comparison of the combined ultrasound of the mediastinum by use of a
single ultrasound bronchoscope versus ultrasound bronchoscope plus
ultrasound gastroscope in lung cancer staging: A prospective trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 442-446),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESThe aim of the study was to compare diagnostic utility of
combined (i.e. transbronchial and transoesophageal) ultrasound imaging
with needle biopsy of the mediastinum in lung cancer (LC) staging, (a) by
use of a single ultrasound bronchoscope (CUSb) and (b) by using two scopes
(CUS).METHODSIn consecutive LC patients, clinical stage IA-IIIB the CUS or
CUSb was performed under mild sedation and, if negative, underwent lung
resection with confirmatory systematic lymph node dissection.RESULTSFrom
214 LC patients, 110 underwent CUS and 104 underwent CUSb (618 biopsies);
both revealed metastases in 50% of cases. There was 'minimal N2' in 11 of
14 false negative patients. Diagnostic sensitivity, specificity, accuracy,
positive predictive value (PPV) and negative predictive value (NPV) of CUS
was 91.7%, 98%, 94.6%, 98.2% and 90.7% respectively and of CUSb was 85%,
93.2%, 88.5%, 94.4%, 82%, respectively with no significant difference in
yield of CUS vs CUSb (P = 0.255 and P = 0.192). The mean time of CUS (25
+/- 4.4 min) was significantly longer as compared to CUSb (14.9 +/- 2.3
min) (P < 0.001). No severe complications of either method were
observed.CONCLUSIONSThe combined ultrasound imaging of the mediastinum by
use of CUSb is significantly less time-consuming and equally as effective
and safe as the use of CUS for LC staging. 2012 The Author 2012.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<15>
Accession Number
2012677007
Authors
Khorsandi M. Muhammad I. Shaikhrezai K. Pessotto R.
Institution
(Khorsandi, Muhammad, Shaikhrezai, Pessotto) Department of Cardio-Thoracic
Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old
Dalkeith Road, Edinburgh EH16 4SA, United Kingdom
Title
Is it worth placing ventricular pacing wires in all patients post-coronary
artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 489-493),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether ventricular pacing
wires should be placed routinely in all patients undergoing coronary
artery bypass grafting (CABG) regardless of immediate post-cardiopulmonary
bypass (CPB) rhythm status. Using the reported search, 142 papers were
found, from which 10 papers represented the best evidence on the subject.
The author, date and country of 10 publications, study type, patient group
studied, relevant outcomes and results are tabulated. Complete
atrio-ventricular (AV) block is the main reason for inserting ventricular
pacing wires upon conclusion of CABG. Eight studies found complete AV
block to be a rare entity post-CABG. The rate of complete AV block in CABG
in our review ranged from 0.3 to 24%. The calculated average rate of AV
block in all studies was 2.4%. The number needed to treat with ventricular
wires to support a patient who develops AV block is 42. One randomized
controlled trial found 3% risk of complete AV block post-CABG. Another
cohort of 222 patients revealed a rate of 1.8% for complete AV block. For
one cohort of 770 patients, post-CABG the rate of complete AV block was
found to be 0.3%. In one cohort of 25 patients, there was a rate of 4% for
complete AV block post-CABG. Another study of 564 patients revealed a rate
of 0.7% for complete AV block. A study of 4999 patients post-CABG reported
a rate of 1.2% for complete AV block. In one cohort of 93 patients, there
was a 4% risk of complete AV block. Another cohort of 62 patients showed a
rate of 1.6% for complete AV block. Only two papers found the rate of
complete AV block post-CABG to be as high as 24 and 16%. Both studies were
limited by sample size. In conclusion, routine ventricular pacing wire
insertion post-CABG is unnecessary given that routine use of ventricular
wires can occasionally cause complications such as bleeding and cardiac
tamponade and thus is not risk free. We also found that the incidence of
complete AV block is probably higher in on-CPB CABG than off-CPB CABG and
that AV pacing may be haemodynamically beneficial for some patients
postoperatively. 2012 The Author 2012. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<16>
Accession Number
2012676982
Authors
Okonta K.E. Edwin F. Falase B.
Institution
(Okonta) Division of Cardiothoracic Surgery, Department of Surgery,
University College Hospital, PMB 5116, Ibadan, Nigeria
(Edwin) National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra,
Ghana
(Falase) Cardiothoracic Surgery Unit, Lagos State University Teaching
Hospital, Ikeja, Nigeria
Title
Is recombinant activated factor VII effective in the treatment of
excessive bleeding after paediatric cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (4) (pp 690-695),
2012. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in paediatric cardiac surgery was written according
to a structured protocol. The question addressed was whether recombinant
activated factor VII was effective for the treatment of excessive bleeding
after paediatric cardiac surgery. Altogether 150 papers were found using
the reported search; 13 papers were identified that provided the best
evidence to answer the question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these studies were tabulated. A total of 311 children
experienced excessive bleeding following cardiac surgery that was
refractory to the conventional methods of achieving haemostasis. One
hundred and ninety-two patients received the rFVIIa while 116 were in
control arm from five studies. The primary end-point was on chest tube
drainage, the plasma prothrombin time, the activated partial
thromboplastin time after the administration of rFVIIa and the secondary
end-point was reduction of blood products transfusion. Thrombosis was a
complication in 8 patients (4.2%); three deaths (1.6%) but not
attributable to thromboembolic events following the use of rFVIIa. Most of
the studies failed to clearly state the doses but the extracted doses
ranged between 30 and 180 mug/kg/dose, the interval between doses ranged
between 15 and 120 min with a maximum of four doses. However, most of the
patients had 180 mug/kg/dose with interval between dose of 2 h and maximum
of two doses with dosage moderated with respect to weight, prior
coagulopathy and responsiveness. There were two randomized studies with
good sample size. One showed no significant differences in the secondary
end points between the two arms and noted no adverse complications.
However, the rFVIIa was used prophylactically. The other observed that
there were no increase in thromboembolic events rather rFVIIa was
effective in decreasing excessive bleeding that may complicate cardiac
surgery in children. In conclusion, the studies were in support of the
notion that the use of rFVIIa was effective in decreasing excessive
bleeding which may complicate paediatric cardiac surgery, and care should
be exercised when using it in the children on ECMO circuit. 2012 The
Author 2012. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<17>
Accession Number
2012676976
Authors
Rossi M. Serraino G.F. Jiritano F. Renzulli A.
Institution
(Rossi, Serraino, Jiritano, Renzulli) Department of Cardiac Surgery, Magna
Graecia University, Viale Europa. Germaneto, 88100 Catanzaro, Italy
Title
What is the optimal anticoagulation in patients with a left ventricular
assist device?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (4) (pp 733-740),
2012. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether there is an
optimal antithrombotic management for patients supported with axial-flow
left ventricular assist devices (LVADs). Altogether, more than 758 papers
were found using the reported search, of which 17 represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. These included seven
prospective and three retrospective cohort studies with a total of 538
patients with axial-flow left ventricular assist device (LVAD) (HeartMate
II, Jarvik 2000, INCOR, Thoratec assist device) implanted across the world
as destination therapy or bridge to transplantation. We conclude that
there is a substantial alteration of the prothrombotic profile in patients
with axial-flow LVADs. These abnormalities appeared to be reversible with
the removal of the device and are likely to be responsible for the high
incidence of non-surgical bleeding episodes reported. Warfarin seems to
offer a lower thromboembolic risk compared with unfractioned heparin or
low molecular weight heparin. There are reports that suggest that managing
axial-flow LVAD without anticoagulation, after major bleeding
complications, is possible but in all probability, these papers are
subject to publication bias as poor outcomes are unlikely to have been
reported. All patients with axial-flow LVAD, showed severely impaired
platelet function at point of care tests. The use of warfarin (INR target
2.5), in association with aspirin at 100 mg/day, or with point-of-care
tests titrated antiplatelet therapy to inhibit 70%, seems to have the best
bleeding-thrombosis, and in many cases a very small dose of aspirin of 25
mg twice a day and a dose of clopidogrel of 35 mg/day, were sufficient to
achieve a reduction of the maximum aggregation to less than 30%. Finally,
we would like to emphasize that such recommendations are addressed only to
patients with axial-flow LVAD. 2012 The Author 2012. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<18>
Accession Number
2012676968
Authors
Bilal H. O'neill B. Mahmood S. Waterworth P.
Institution
(Bilal, Waterworth) Department of Cardiothoracic Surgery, University
Hospital of South Manchester, Manchester M23 9LT, United Kingdom
(O'neill) School of Medicine, University of Manchester, Manchester, United
Kingdom
(Mahmood) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
Title
Is cerebrospinal fluid drainage of benefit to neuroprotection in patients
undergoing surgery on the descending thoracic aorta or thoracoabdominal
aorta?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (4) (pp 702-708),
2012. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Is cerebrospinal fluid
(CSF) drainage of benefit in patients undergoing surgery on the descending
thoracic aorta or thoracoabdominal aorta?' Altogether 1177 papers were
found using the reported search, of which 17 represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. Ten of 13 studies demonstrate
significant neurological protection from CSF drainage (+/-additional
adjuncts), with two further papers showing no significant difference
between patients who had or had not had CSF drainage and one study unable
to provide any conclusions. For patients having surgery on the thoracic
aorta or thoracoabdominal aorta CSF drainage, maintaining pressures <10
mmHg (P < 0.03), in conjunction with other neuroprotective strategies,
minimizes the risk of neurological sequelae when compared with patients
treated with similar adjuncts but without CSF drainage. The majority of
studies used additional neuroprotective strategies, including cooling and
reattachment of the intercostal arteries as adjuncts to CSF drainage.
Logistic regression curves demonstrated that the longer the ischaemia
time, the greater the benefit from CSF drainage (P < 0.04). Four papers
observed complications of CSF drainage, of which the main complications
were: catheter occlusion or dislodgement, headache, meningitis and
subdural haematoma. Overall, CSF drainage does offer a neuroprotective
benefit; preventing paraplegia if CSF pressures are maintained <10 mmHg.
2012 The Author 2012. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<19>
Accession Number
2012676962
Authors
Linder A. Ertner C. Steger V. Messerschmidt A. Merk J. Cregan I. Timm J.
Walles T.
Institution
(Linder, Ertner) Clinic for Thoracic Surgery, Klinikum Bremen Ost, Bremen,
Germany
(Steger, Walles) Thoracic Surgery Department, Klinik Schillerhoehe,
Gerlingen, Germany
(Messerschmidt) Clinic for Thoracic Surgery, Katholisches Klinikum
Koblenz, Koblenz, Germany
(Merk) Clinic for Thoracic Surgery, Evangelische Lungenklinik Berlin,
Berlin, Germany
(Cregan) Medela AG, Baar, Switzerland
(Timm) Department of Mathematics, Competence Center for Clinical Trials
(KKSB), University of Bremen, Bremen, Germany
(Walles) Department of Cardiac, Thoracic and Vascular Surgery, University
of Wurzburg, Division of Thoracic Surgery, Oberdurrbacher Strasse 6,
D-97080 Wurzburg, Germany
Title
Postoperative chest tube management: Snapshot of German diversity.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (4) (pp 622-626),
2012. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: The management of chest tubes is one of the most critical
aspects in patient care in thoracic surgery, and no consensus exists
regarding the ideal chest tube management strategy.METHODS: Chest tube
management protocols and their effects on chest tube therapy were compared
at four German specialist thoracic surgery units. Altogether, 79 patients
were stratified for underlying disease and type of surgery. A digital
chest drainage system was applied to objectify the presence of air
leakages.RESULTS: In our analysis, the average length of drainage therapy
was 4.9 +/- 2.8 days. Different chest tube management protocols resulted
in a significant degree of scatter between units (P = 0.0348). Higher
arbitrary postoperative suction levels (4 kPa) resulted in earlier chest
tube removal than lower suction levels (2 kPa) (4.2 +/- 2.4 vs 5.4 +/- 3.0
days, P = 0.06). Patient discharge following chest tube removal was
delayed on average by 3.2 +/- 2.9 days. This delay was not correlated with
the previous duration of chest tube therapy (Spearman's =-0.15, P = 0.25)
in contrast to the total length of hospital stay ( = 0.59, P < 0.001).
2012 The Author 2012. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<20>
Accession Number
2012676954
Authors
O'neill B. Bilal H. Mahmood S. Waterworth P.
Institution
(O'neill) School of Medicine, University of Manchester, Manchester, United
Kingdom
(Bilal, Waterworth) Department of Cardiothoracic Surgery, South Manchester
University Hospital, Manchester M23 9LT, United Kingdom
(Mahmood) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
Title
Is it worth packing the head with ice in patients undergoing deep
hypothermic circulatory arrest?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (4) (pp 696-701),
2012. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: Is it worth packing the
head with ice in patients undergoing deep hypothermic circulatory arrest
(DHCA)? Altogether more than 34 papers were found using the reported
search, of which 7 represented the best evidence to answer the clinical
question, 5 of which were animal studies, 1 was a theoretical laboratory
study and 1 study looked at the ability to cool using circulating water
'jackets' in humans. There were no available human studies looking at the
neurological outcome with or without topical head cooling with ice without
further adjunct methods of cerebral protection. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Four papers studied
animals undergoing DHCA for 45 min-2 h depending on the study design, with
or without packing the head with ice. The studies all demonstrated
improved cerebral cooling when the head was packed with ice during DHCA.
They also illustrated an improved neurological outcome, with better
behavioural scores (P < 0.05), and in some, survival, when compared with
animals whose heads were not packed in ice. One study examined selective
head cooling with the use of packing the head with ice during rewarming
after DHCA. However, they demonstrated worse neurological outcomes in
these animals, possibly due to the loss of cerebral vasoregulation and
cerebral oedema. One study involved a laboratory experiment showing
improved cooling using circulating cool water in cryotherapy braces than
by using packed ice. They extrapolated that newer devices to cool the head
may improve cerebral cooling during DHCA. The final study discussed here
demonstrated the use of circulating water to the head in humans undergoing
pulmonary endarterectomy. They found that tympanic membrane temperatures
could be maintained significantly lower than bladder or rectal
temperatures when using circulating water to cool the head. We conclude
that topical head cooling with ice is of use during DHCA but not during
rewarming following DHCA and that it may be possible to advance topical
head cooling techniques using circulating water rather than packed ice.
2012 The Author 2012. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<21>
Accession Number
2012676949
Authors
Wheble G.A.C. Benson R.A. Khan O.A.
Institution
(Wheble, Benson) Department of Surgery, Queen Alexandra Hospital,
Portsmouth, United Kingdom
(Khan) Department of Upper GI Surgery, St. George's Hospital, London SW17
0QT, United Kingdom
Title
Is routine postoperative enteral feeding after oesophagectomy worthwhile?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (4) (pp 709-712),
2012. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in surgery was written according to a structured
protocol. The question addressed was whether, in patients undergoing an
oesophagectomy for cancer, immediate postoperative enteral feeding (via
percutaneous jejunostomy or nasojejunostomy) provides better patient
outcomes as compared to waiting until oral feeding can be instituted. Four
randomized controlled trials represented the best evidence to answer the
clinical question. The first study randomized 25 patients into enteral
feeding via jejunostomy (n = 13) versus a routine diet without jejunostomy
(n = 12). The authors found no statistical difference in outcomes
including length of stay, anastomotic complications and mortality. They
did not report any catheter-related complications. A second study included
patients undergoing an oesophagectomy or a pancreatodudenectomy,
randomized to immediate postoperative jejunostomy feeding (n = 13) or
remaining unfed for 6 days (n = 15). They reported one incident of
detachment of the catheter from the abdominal wall. They also noted a
statistically significant decrease in vital capacity and FEV1 in enterally
fed patients. There was no difference in length of stay or anastomotic
complications. They concluded that there was no indication for routine use
of immediate postoperative enteral feeding in those patients without
significant preoperative malnutrition. A Third report randomized their
post-oesophagectomy patients into enteral feeding via jejunostomy (n = 20)
versus crystalloid only (n = 20). The also found no difference in length
of stay, anastomotic leak rate or mortality. One catheter was removed due
to concerns over respiratory function. They also concluded that there was
no measurable benefit in early enteral feeding. The last of these 4
studies randomized patients into naso-duodenal feeding (n = 71) and
jejunostomy feeding groups (n = 79). As in previous trials, they found no
statistically significant difference between length of stay or anastomotic
leak rates. Mortality was higher in the jejunostomy group, although the
team did not attribute the deaths to the catheter. They found both methods
equally effective in providing postoperative nutrition. In summary, all
the trials concluded that routine postoperative enteral nutrition was
feasible, but there was no evidence suggesting that it conferred any
clinical benefits. 2012 The Author 2012. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<22>
Accession Number
2012676947
Authors
Gandhi A. Husain M. Salhiyyah K. Raja S.G.
Institution
(Gandhi) Homerton University Hospital, London, United Kingdom
(Husain, Salhiyyah, Raja) Department of Cardiac Surgery, Harefield
Hospital, Hill End Road, Harefield UB9 6JH, United Kingdom
Title
Does perioperative furosemide usage reduce the need for renal replacement
therapy in cardiac surgery patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (4) (pp 750-755),
2012. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was 'Does perioperative furosemide usage reduce the
need for renal replacement therapy in cardiac surgery patients?'
Forty-seven papers were found using the reported search, of which 10
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
Current best available evidence to resolve the issue includes a systematic
review and nine randomized controlled trials (RCTs). The systematic review
of seven RCTs and one observational study has demonstrated that in
patients who have undergone cardiac surgery, a more consistent and
sustained diuresis is produced by a continuous infusion of furosemide
compared with intermittent bolus doses of furosemide. However, there does
not appear to be a significant difference in the total urine output or a
change in serum electrolyte levels when furosemide is administered as a
continuous infusion compared with intermittent bolus doses. Three RCTs
recruiting neonatal and paediatric patients after open heart surgery also
validated the safety and efficacy of furosemide infusion as well as
intermittent bolus doses. Two of the five RCTS in adult cardiac surgery
patients showed that furosemide infusion was associated with a reduced
need for renal replacement therapy (RRT), while two RCTs failed to show
any benefit and one reported an increased incidence of renal impairment.
We conclude that continuous furosemide infusion in the perioperative
period promotes a gentle and sustained diuresis in cardiac surgery
patients. The evidence supporting the benefit of this strategy in terms of
reducing the need for RRT is weak. At the same time, current best
available evidence, albeit from small RCTs, suggests that the timely
introduction of continuous furosemide infusion does not increase the
incidence of renal impairment after cardiac surgery. 2012 The Author
2012. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<23>
Accession Number
2012676940
Authors
Sepehripour A.H. Lo T.T. McCormack D.J. Shipolini A.R.
Institution
(Sepehripour) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Manchester, United Kingdom
(Lo, McCormack, Shipolini) Department of Cardiothoracic Surgery, London
Chest Hospital, Bonner Road, London E2 9JX, United Kingdom
Title
Is there benefit in smoking cessation prior to cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (4) (pp 726-732),
2012. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether smoking cessation prior to cardiac surgery
would result in a greater freedom from postoperative complications. A
total of 564 papers were found using the reported searches, of which five
represented the best evidence to answer the clinical question. The
authors, date, journal, study type, population, main outcome measures and
results are tabulated. Reported measures were operative mortality,
pulmonary complications, infective complications, neurological
complications, transfusion requirements, duration of ventilation,
intensive care unit and hospital stay, intensive care unit re-admission,
postoperative gas exchange parameters and postoperative pulmonary
function. The largest of the best evidence studies demonstrated a
significant reduction in pulmonary complications in non-smokers (P <
0.001); however, there was an increased requirement for transfusion in
this cohort (P = 0.002). There were non-significant reductions in
neurological complications, infective complications and re-admissions to
intensive care. Another large cohort study demonstrated significant
reductions in non-smokers in mortality (P < 0.0001), pulmonary
complications (P = 0.0002), infection (P < 0.0007), intensive care unit
re-admission (P = 0.0002), duration of mechanical ventilation (P = 0.026)
and intensive care unit stay (P = 0.002). A larger cohort study again
demonstrated significant reductions in non-smokers in pulmonary
complications (P < 0.002), duration of mechanical ventilation (P < 0.012)
and intensive care unit stay (P < 0.005). A smaller prospective cohort
study reported significantly raised PaO₂ (P = 0.0091) and
reduced PaCO₂ (P < 0.0001) levels in the non-smokers as well as
improved FVC and FEV ₁ (P < 0.0001). There were also reductions
in duration of intubation (P < 0.0001), intensive care unit stay (P <
0.0001) and hospital stay (P < 0.0013). Another small cohort study
reporting outcomes of heart transplantation demonstrated significant
improvement in non-smokers in terms of survival (P = 0.031), duration of
intubation (P = 0.05) and intensive care unit stay (P = 0.021). We
conclude that there is strong evidence demonstrating superior outcomes in
non-smokers following cardiac surgery and advocate the necessity of
smoking cessation as soon as possible prior to cardiac surgery. 2012 The
Author 2012. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<24>
Accession Number
2012676937
Authors
Elmistekawy E. Mesana T.G. Ruel M.
Institution
(Elmistekawy, Mesana, Ruel) Division of Cardiac Surgery, University of
Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
Title
Should Jehovah's Witness patients be listed for heart transplantation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (4) (pp 716-719),
2012. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
This best evidence topic in Cardiac Surgery was written according to a
structured protocol. The question addressed was: for [Jehovah's Witness
patients with end-stage heart failure] can these patients undergo a [heart
transplantation] without an increased rate of mortality. Altogether, 133
papers were found using the reported search strategy. Of those, 29 papers
represented the best evidence to answer the clinical question. Five papers
focusing on patients of the Jehovah's Witness (JW) faith who had end-stage
heart failure were published. Successful heart transplantation was
performed in a total of seven patients without mortality, re-exploration
or blood transfusion. One patient had left ventricular reduction surgery
twice and another patient had bypass surgery several years after
transplantation. Other successful organ transplantations were also
reported, including lung, liver, kidney and pancreas in both adult and
paediatric patients of the JW faith, with comparable mortality and
morbidity to non-JW patients. A publication bias is likely; nevertheless,
we conclude that although there are no large studies directly focused on
heart transplantation in JW patients, a multidisciplinary team approach to
such surgery can make it technically feasible and without an increased
mortality risk in suitable candidates. Therefore, such patients may be
considered for heart transplantation under selected and favourable
circumstances. 2012 The Author 2012. Published by Oxford University Press
on behalf of the European Association for Cardio-Thoracic Surgery. All
rights reserved.

<25>
Accession Number
2012690901
Authors
Collet J.-P. Cuisset T. Range G. Cayla G. Elhadad S. Pouillot C. Henry P.
Motreff P. Carrie D. Boueri Z. Belle L. Van Belle E. Rousseau H. Aubry P.
Monsegu J. Sabouret P. O'Connor S.A. Abtan J. Kerneis M. Saint-Etienne C.
Barthelemy O. Beygui F. Silvain J. Vicaut E. Montalescot G.
Institution
(Collet, Sabouret, O'Connor, Abtan, Kerneis, Barthelemy, Beygui, Silvain,
Montalescot) Institut de Cardiologie Hopital Pitie- Salpetriere,
Universite Pierre et Marie Curie, Paris, France
(Henry) Departement de Cardiologie, Hopital Lariboisiere, Paris, France
(Rousseau, Vicaut) Unite de Recherche Clinique-Hopital Lariboisiere,
Paris, France
(Aubry) Universite Denis Diderot, Centre Hospitalier Bichat, Paris, France
(Monsegu) Hopital d'Instruction des Armees du Val de Grace, Paris, France
(Cuisset) Departement de Cardiologie, Centre Hospitalier Universitaire
(CHU) de la Timone, Marseille, France
(Range) Les Hopitaux de Chartres, Le Coudray, France
(Cayla) Departement de Cardiologie, CHU Caremeau, Nimes, France
(Elhadad) Departement de Cardiologie, Centre Hospitalier de Lagny-Marne la
Vallee, Lagny-sur-Marne, France
(Pouillot) Clinique Ste. Clotilde, St. Denis de la Reunion, France
(Motreff) CHU de Clermont-Ferrand, Clermont-Ferrand, France
(Carrie) CHU Rangueil, Toulouse, France
(Boueri) Centre Hospitalier de Bastia, Bastia, France
(Belle) Centre Hospitalier Annecy, Annecy, France
(Van Belle) Centre Hospitalier Regional Universitaire de Lille, Lille,
France
(Saint-Etienne) CHU Trousseau, Tours, France
Title
Bedside Monitoring to Adjust Antiplatelet Therapy for Coronary Stenting.
Source
New England Journal of Medicine. 367 (22) (pp 2100-2109), 2012. Date of
Publication: 29 Nov 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Patients' responses to oral antiplatelet therapy are subject
to variation. Bedside monitoring offers the opportunity to improve
outcomes after coronary stenting by individualizing therapy. METHODS: We
randomly assigned 2440 patients scheduled for coronary stenting at 38
centers to a strategy of platelet-function monitoring, with drug
adjustment in patients who had a poor response to antiplatelet therapy, or
to a conventional strategy without monitoring and drug adjustment. The
primary end point was the composite of death, myocardial infarction, stent
thrombosis, stroke, or urgent revascularization 1 year after stent
implantation. For patients in the monitoring group, the VerifyNow P2Y12
and aspirin point-of-care assays were used in the catheterization
laboratory before stent implantation and in the outpatient clinic 2 to 4
weeks later. RESULTS: In the monitoring group, high platelet reactivity in
patients taking clopidogrel (34.5% of patients) or aspirin (7.6%) led to
the administration of an additional bolus of clopidogrel, prasugrel, or
aspirin along with glycoprotein IIb/IIIa inhibitors during the procedure.
The primary end point occurred in 34.6% of the patients in the monitoring
group, as compared with 31.1% of those in the conventional-treatment group
(hazard ratio, 1.13; 95% confidence interval [CI], 0.98 to 1.29; P =
0.10). The main secondary end point, stent thrombosis or any urgent
revascularization, occurred in 4.9% of the patients in the monitoring
group and 4.6% of those in the conventional-treatment group (hazard ratio,
1.06; 95% CI, 0.74 to 1.52; P = 0.77). The rate of major bleeding events
did not differ significantly between groups. CONCLUSIONS: This study
showed no significant improvements in clinical outcomes with
platelet-function monitoring and treatment adjustment for coronary
stenting, as compared with standard antiplatelet therapy without
monitoring. (Funded by Allies in Cardiovascular Trials Initiatives and
Organized Networks and others; ARCTIC ClinicalTrials.gov number,
NCT00827411.) Copyright 2012 Massachusetts Medical Society.

<26>
Accession Number
2012690900
Authors
Schwartz G.G. Olsson A.G. Abt M. Ballantyne C.M. Barter P.J. Brumm J.
Chaitman B.R. Holme I.M. Kallend D. Leiter L.A. Leitersdorf E. McMurray
J.J.V. Mundl H. Nicholls S.J. Shah P.K. Tardif J.-C. Wright R.S.
Institution
(Schwartz) Veterans Affairs Medical Center, University of Colorado School
of Medicine, Denver, CO, United States
(Olsson) Stockholm Heart Center, Stockholm, Sweden
(Olsson) Linkoping University, Linkoping, Sweden
(Abt, Brumm, Kallend, Mundl) F. Hoffmann-La Roche, Basel, Switzerland
(Ballantyne, Barter) Baylor College of Medicine and Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Chaitman) Heart Research Institute, Sydney, Australia
(Holme) Saint Louis University, St. Louis, United States
(Leiter) Oslo University Hospital, Ulleval, Oslo, Norway
(Leitersdorf) Keenan Research Centre, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, University of Toronto, Toronto, Canada
(McMurray) Hadassah Hebrew University Medical Center, Jerusalem, Israel
(Nicholls) British Heart Foundation Cardiovascular Research Centre,
University of Glasgow, Glasgow, United Kingdom
(Shah) South Australian Health and Medical Research Institute, University
of Adelaide, Adelaide, SA, Australia
(Tardif) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Wright) Montreal Heart Institute, Universitede Montreal, Montreal, Canada
(Wright) Mayo Clinic, Rochester, MN, United States
Title
Effects of dalcetrapib in patients with a recent acute coronary syndrome.
Source
New England Journal of Medicine. 367 (22) (pp 2089-2099), 2012. Date of
Publication: 29 Nov 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND:In observational analyses, higher levels of high-density
lipoprotein (HDL) cholesterol have been associated with a lower risk of
coronary heart disease events. However, whether raising HDL cholesterol
levels therapeutically reduces cardiovascular risk remains uncertain.
Inhibition of cholesteryl ester transfer protein (CETP) raises HDL
cholesterol levels and might therefore improve cardiovascular outcomes.
METHODS:We randomly assigned 15,871 patients who had had a recent acute
coronary syndrome to receive the CETP inhibitor dalcetrapib, at a dose of
600 mg daily, or placebo, in addition to the best available evidence-based
care. The primary efficacy end point was a composite of death from
coronary heart disease, nonfatal myocardial infarction, ischemic stroke,
unstable angina, or cardiac arrest with resuscitation. RESULTS:At the time
of randomization, the mean HDL cholesterol level was 42 mg per deciliter
(1.1 mmol per liter), and the mean low-density lipoprotein (LDL)
cholesterol level was 76 mg per deciliter (2.0 mmol per liter). Over the
course of the trial, HDL cholesterol levels increased from baseline by 4
to 11% in the placebo group and by 31 to 40% in the dalcetrapib group.
Dalcetrapib had a minimal effect on LDL cholesterol levels. Patients were
followed for a median of 31 months. At a prespecified interim analysis
that included 1135 primary end-point events (71% of the projected total
number), the independent data and safety monitoring board recommended
termination of the trial for futility. As compared with placebo,
dalcetrapib did not alter the risk of the primary end point (cumulative
event rate, 8.0% and 8.3%, respectively; hazard ratio with dalcetrapib,
1.04; 95% confidence interval, 0.93 to 1.16; P = 0.52) and did not have a
significant effect on any component of the primary end point or total
mortality. The median C-reactive protein level was 0.2 mg per liter higher
and the mean systolic blood pressure was 0.6 mm Hg higher with dalcetrapib
as compared with placebo (P<0.001 for both comparisons). CONCLUSIONS:In
patients who had had a recent acute coronary syndrome, dalcetrapib
increased HDL cholesterol levels but did not reduce the risk of recurrent
cardiovascular events. (Funded by F. Hoffmann-La Roche; dal-OUTCOMES
ClinicalTrials.gov number, NCT00658515.) Copyright 2012 Massachusetts
Medical Society.

<27>
Accession Number
2012714237
Authors
Adams T.D. Davidson L.E. Litwin S.E. Hunt S.C.
Institution
(Adams, Davidson, Hunt) Division of Cardiovascular Genetics, Department of
Internal Medicine, University of Utah School of Medicine, Salt Lake City,
UT, United States
(Adams) Intermountain Health and Fitness Institute, Intermountain
Healthcare, Salt Lake City, UT, United States
(Litwin) Department of Medicine, Georgia Health Sciences University, 1120
15th Avenue, BBR 6513B, Augusta, GA 30912, United States
(Adams, Davidson, Hunt) Division of Cardiovascular Genetics, University of
Utah School of Medicine, 420 Chipeta Way, Salt Lake City, UT 84108, United
States
Title
Gastrointestinal surgery: Cardiovascular risk reduction and improved
long-term survival in patients with obesity and diabetes.
Source
Current Atherosclerosis Reports. 14 (6) (pp 606-615), 2012. Date of
Publication: December 2012.
Publisher
Current Medicine Group LLC (400 Market St, Ste 700 Philadelphia PA 19106,
United States)
Abstract
Whereas the initial focus of bariatric surgery primarily focused on weight
loss and was considered by many clinicians and the public as a
cosmetic-driven procedure, this surgical therapy is now recognized as a
successful approach to reducing cardiovascular disease risk and the only
substantial and sustainable weight loss treatment for most severely obese
patients. In addition, as a result of the multiple metabolicrelated
benefits associated with bariatric surgery, efforts to understand
physiologic and biochemical mechanisms have led to a dramatic increase in
scientific discovery. This review focuses on bariatric research conducted
during the past two decades in relation to cardiovascular disease risk and
the effects of this surgical therapy on diabetes. Cardiovascular and
diabetes mortality and morbidity associated with bariatric surgery are
reviewed. The opportunity for bariatric (and/or metabolic) surgery to
provide a preventive strategy for cardiovascular disease and diabetes as
well as treatment therapy is presented for clinical consideration.
Springer Science+Business Media New York 2012.

<28>
Accession Number
2012710097
Authors
Vest A.R. Heneghan H.M. Agarwal S. Schauer P.R. Young J.B.
Institution
(Vest, Agarwal, Young) Heart and Vascular Institute, Cleveland Clinic,
Cleveland, OH, United States
(Heneghan, Schauer) Bariatric and Metabolic Institute, Cleveland Clinic,
Cleveland, OH, United States
(Schauer, Young) Endocrinology and Metabolism Institute, Cleveland Clinic,
Cleveland, OH, United States
Title
Bariatric surgery and cardiovascular outcomes: A systematic review.
Source
Heart. 98 (24) (pp 1763-1777), 2012. Date of Publication: December 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Purpose: To quantify the impact of bariatric surgery on cardiovascular
(CV) risk factors, and on cardiac structure and function. Data sources:
Three major databases (PubMed, Medline and Cochrane) were searched for
original studies written in English. Study selection: Original articles
reporting CV risk factors or non-invasive imaging parameters for patients
undergoing bariatric surgery, from January 1950 to June 2012. Data
extraction: Data extraction from selected studies was based on
protocol-defined criteria that included study design, methods, patient
characteristics, surgical procedures, weight loss, changes in CV risk
factors, cardiac structure and cardiac function postoperatively. Data
synthesis: 73 CV risk factor studies involving 19 543 subjects were
included (mean age 42 years, 76% female). Baseline prevalence of
hypertension, diabetes and hyperlipidaemia were 44%, 24%, and 44%,
respectively. Mean follow-up was 57.8 months (range 3-176) and average
excess weight loss was 54% (range 16-87%). Postoperative
resolution/improvement of hypertension occurred in 63% of subjects, of
diabetes in 73% and of hyperlipidaemia in 65%. Echocardiographic data from
713 subjects demonstrated statistically significant improvements in left
ventricular mass, E/A ratio, and isovolumic relaxation time
postoperatively. Limitations: Diagnostic criteria, CV risk factor
reporting, and imaging parameters were not uniform across all studies.
Study groups were heterogeneous in their demographics, operative technique
and follow-up period. Conclusions: This systematic review highlights the
benefits of bariatric surgery in reducing risk factors for CV disease.
There is also evidence for left ventricular hypertrophy regression and
improved diastolic function. These observations provide further evidence
that bariatric surgery enhances future CV health for obese individuals.

<29>
Accession Number
2012703721
Authors
Bellieni C.V. Tei M. Stazzoni G. Bertrando S. Cornacchione S. Buonocore G.
Institution
(Bellieni, Tei, Stazzoni, Bertrando, Cornacchione, Buonocore) Department
of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena,
Italy
Title
Use of fetal analgesia during prenatal surgery.
Source
Journal of Maternal-Fetal and Neonatal Medicine. 26 (1) (pp 90-95), 2013.
Date of Publication: January 2013.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objective: Recent progresses in fetal surgery have raised concern on fetal
pain, its long-term consequences and the risks of sudden fetal movements
induced by pain. In several studies, surgeons have directly administered
opioids to the fetus, while others have considered sufficient the
maternally administered analgesics. We performed a review of the
literature to assess the state of the art. Methods: We performed a PubMed
search to retrieve the papers that in the last 10 years reported studies
of human fetal surgery and that described whether any fetal analgesia was
administered. Results: We retrieved 34 papers. In three papers, the
procedure did not hurt the fetus, being performed on fetal annexes, in two
papers, it was performed in the first half of pregnancy, when pain
perception is unlikely. In 10 of the 29 remaining papers, fetal surgery
was performed using direct fetal analgesia, while in 19, analgesia was
administered only to the mother. In most cases, fetal direct analgesia was
obtained using i.m. opioids, and muscle relaxant. Rare drawbacks on either
fetuses or mothers due to fetal analgesia were reported. Conclusion: Fetal
direct analgesia is performed only in a minority of cases and no study
gives details about fetal reactions to pain. More research is needed to
assess or exclude its possible long-term drawbacks, as well as the actual
consequences of pain during surgery. 2013 Informa UK, Ltd.

<30>
Accession Number
2012706949
Authors
Sher-i-Murtaza M. Zubair M. Jalal A.
Institution
(Sher-i-Murtaza, Zubair, Jalal) CPE Institute of Cardiology, Multan,
Pakistan
Title
Is there any benefit of preoperative oral trimetazidine in coronary artery
bypass graft?.
Source
Journal of the Pakistan Medical Association. 62 (12) (pp 1271-1276), 2012.
Date of Publication: December 2012.
Publisher
Pakistan Medical Association (Garden Road, Karachi - 3, Pakistan)
Abstract
Objective: To evaluate the impact of preoperative oral trimetazidine on
myocardial protection in coronary bypass surgery. Methods: We conducted a
prospective double blind randomized study in the Department of Cardiac
Surgery, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan,
Pakistan. One hundred and seventy (170) patients of isolated CABG were
included in the study. All operations were done by conventional technique
of CABG using cardiopulmonary bypass, moderate systemic hypothermia and
cold antegrade blood cardioplegia. The patients were randomized into 2
groups i.e. Group 1 (n=85), who received and Group 2 (n=85), who did not
receive Trimetazidine. Trimetazidine (20mg) was given orally, at 10:00 pm
the night before operation and also at 7.00 am on the day of surgery. The
CPK and CK-MB levels were determined before operation, immediately after
shifting to the ICU, 12 hours and 36 hours after the operation. The
comparison of CPK and CK-MB levels was carried out using analysis of
variance with repeated measures. The peri-operative clinical and
laboratory data were compared using Student's t-test for numeric variables
and Chi-square test for categoric varaibles. The difference was considered
statistically significant if the p-value was < 0.05. Results: The
pre-operative variables i.e. age, gender, Canadian Cardiovascular Society
(CCS) class, ejection fraction, diabetes, history of smoking, haemoglobin
level, serum creatinine etc had no differences in both group. Both groups
showed no significant difference in Cardiopulmonary Bypass time (BPT),
Aortic cross Clamp Time (CxT), prevalence of intra-operative arrhythmia
and need for inotropic support. The analysis did not show any within group
or between groups differences in the CPK and CKMB levels. Conclusion: This
study showed that oral Trimetazidine given before coronary bypass grafting
did not provide any benefit in myocardial protection.

<31>
Accession Number
2012700978
Authors
Chen-Scarabelli C. Saravolatz II L. Murad Y. Shieh W.-S. Qureshi W. Di
Rezze J. Abrencillo R. Gardin T. Gidwani U.K. Saravolatz L. Faggian G.
Scarabelli T.M.
Institution
(Chen-Scarabelli, Scarabelli) Department of Internal Medicine and
Pharmacology, Wayne State University, St John Hospital and Medical Center,
22201 Moross Road, Detroit, MI 48236, United States
(Chen-Scarabelli, Saravolatz II, Murad, Shieh, Qureshi, Di Rezze,
Abrencillo, Gardin, Saravolatz) Division of Cardiology, VA Ann Arbor,
University of Michigan, Ann Arbor, MI, United States
(Gidwani) Cardiovascular Institute, Mount Sinai Hospital, New York, NY,
United States
(Faggian) Department of Cardiac Surgery, University of Verona Medical
School, Verona, Italy
Title
A critical review of the use of carvedilol in ischemic heart disease.
Source
American Journal of Cardiovascular Drugs. 12 (6) (pp 391-401), 2012. Date
of Publication: 2012.
Publisher
Adis International Ltd (41 Centorian Drive, Private Bag 65901, Mairangi
Bay, Auckland 10 1311, New Zealand)
Abstract
beta-Adrenergic receptor antagonists (beta-blockers) have been recognized
for their cardioprotective properties, prompting use of these
pharmacologic agents to become more mainstream in acute myocardial
infarction (AMI) and congestive heart failure (CHF). Despite their
popularity as a class, the ability to protect the myocardium varies
significantly between different agents. Carvedilol is a non-selective
beta-blocker with alpha1-adrenergic receptor antagonism properties. It is
unique among beta-blockers because in addition to improving exercise
tolerance and its anti-ischemic properties secondary to a reduction in
heart rate and myocardial contractility, carvedilol exerts other
beneficial effects including: antioxidant effects; reduction in neutrophil
infiltration; apoptosis inhibition; reduction of vascular smooth muscle
migration; and improvement of myocardial remodeling post-AMI. These
properties, documented in animal models and subsequent clinical trials,
are consistent with established evidence demonstrating decreased morbidity
and mortality in patients with CHF and post-AMI. This article reviews the
role of carvedilol compared with other beta-blockers in the treatment of
CHF and post-AMI management. Adis 2012 Springer International Publishing
AG. All rights reserved.

<32>
Accession Number
70937201
Authors
Wu Y.-L.
Institution
(Wu) Guangdong Lung Cancer Institute, Guangdong General Hospital,
Guangdong Academy of Medical Sciences, Guangzhou, China
Title
Minimally invasive surgery.
Source
Journal of Thoracic Oncology. Conference: 5th Asia Pacific Lung Cancer
Conference, APLCC and 3rd International Thymic Malignancy Interest Group,
ITMIG Annual Meeting Fukuoka Japan. Conference Start: 20121125 Conference
End: 20121128. Conference Publication: (var.pagings). 7 (11 SUPPL. 5) (pp
S443), 2012. Date of Publication: November 2012.
Publisher
International Association for the Study of Lung Cancer
Abstract
Over the last 20 years thoracic surgeons developed a minimally invasive
technique to provide the best treatment with minimal risk. VATS lung
resection is slowly becoming the standard of care for patients with early
stage lung cancer. A standardized definition of VATS was provided by the
Cancer and Leukemia Group B, which conducted a prospective
multi-institutional feasibility study of VATS lobectomy (CALGB 39802). The
true VATS lobectomy was defined as a lobectomy performed with videoscopic
guidance and anatomic hilar vascular, bronchial, and lymphatic dissection
using two or three ports and without rib spreading. Advantages to the VATS
approach compared with traditional open lobectomy are less morbidity and
shorter hospitalization. The advantage was due to advances in anesthesia
and technology. VATS provided both excellent exposure and superior
visualization of the thoracic cavity. In 2009 Yan et al reported a meta
analysis that showed there were no significant statistical differences
between VATS and open lobectomy in terms of postoperative prolonged air
leak (P = .71), arrhythmia (P = .86), pneumonia (P = .09), and mortality
(P = .49). VATS did not demonstrate any significant difference in
locoregional recurrence (P = .24), as compared with the open lobectomy
arm, but the data suggested a reduced systemic recurrence rate (P = .03)
and an improved 5-year mortality rate of VATS (P = .04).In our
hospital-Guangdong Lung Cancer Institute from 2007 to 2012-Thoracic
surgical technique was developed from traditional open thoracic surgery to
muscle-sparing minithoracotomy, then VATS to complete thoracoscopic
surgery and now single hole thoracoscope operation. Our experiences also
showed that several advantages of VATS or complete thoracoscopic surgery
as below: less pain; little scarring; minimal blood loss; no cutting of
the ribs; faster recovery and return to normal activities; shorter
hospital stay; and possible improved cure rates for lung cancer.

<33>
Accession Number
70937180
Authors
Van Meerbeeck J.
Institution
(Van Meerbeeck) Universitair Ziekenhuis Gent, Gent, Belgium
Title
Treatment of malignant mesothelioma.
Source
Journal of Thoracic Oncology. Conference: 5th Asia Pacific Lung Cancer
Conference, APLCC and 3rd International Thymic Malignancy Interest Group,
ITMIG Annual Meeting Fukuoka Japan. Conference Start: 20121125 Conference
End: 20121128. Conference Publication: (var.pagings). 7 (11 SUPPL. 5) (pp
S435-S436), 2012. Date of Publication: November 2012.
Publisher
International Association for the Study of Lung Cancer
Abstract
Investigational drug approaches Recent progress has reshaped the clinical
landscape in the treatment of MPM. We have now more effective chemotherapy
and from current evidence, it is clear that histone deacetylase inhibitors
represent a potentially new treatment modality in MPM. Among current
investigational drugs, mesothelin targeted therapies, dendritic cell based
immunotherapy and gene therapy hold promise and should be further
explored. Despite these, actual treatment is still amenable to
improvement. Several factors have hampered the development of more
effective regimens for mesothelioma. MPM is uncommon, is heterogeneous,
staging is unreliable, response assessement is difficult and most drugs do
not work. For the staging, the International Mesothelioma Interest Group
are actually collaborating with the IASLC to include malignant pleural
mesothelioma in its proposals for the 8th edition of TNM classification.
The ability to measure reproducibly tumour response to treatment is vital
in the development of new drugs and therapeutic combinations, particularly
for the conducting of phase II studies. Conventional response criteria
have always been difficult to apply to malignant mesothelioma due to its
unique pattern of growth. Because the selection of measurement sites in
mesothelioma is difficult, RECIST criteria could be applied differently by
different investigators and that's why the Modified RECIST criteria have
been developed. Based on the complex growth pattern of MPM, response
evaluation in this cancer entity is still challenging. Results on value of
fluoro-2-deoxy-D-glucose and positron emission tomography imaging
((SUVmean, tumor lesion glycolysis (TLG) and tumor volume (PETvol)) in
response assessment in MPM are promising. Where do we go from here with
the systemic therapy for MPM? We need better drugs, probably by more
accurate preclinical investigation and we have to use better the drugs we
have: in maintenance therapy, in special populations, in multimodality
setting. More selectivity regarding the "promising" drug we choose to move
from the bence to the clinic and fewer "me too" trials are warranted.
Better designed trials that are adequately powered, multicenter,
preferable with randomized phase II design to balance for heterogeneity,
with appropriate endpoints (PFS, OS, QoL) and with correlative studies
built in, are mandatory. Methods to assay individual tumor characteristics
are warranted in order to avoid toxicity in patients who may not respond
to treatment and losing precious time in a disease associated with a short
survival. Drug resistance profiles have been reported to various malignant
diseases including NSCLC, SCLC, breast, ovarian, colon, esophageal and
carcinoid tumours. Recently the feasibility of performing off-site in
vitro drug resistance assays on resected mesothelioma specimens is
reported. For clinical implementation, a chemoresistance test applicable
to pemetrexed should be useful. The effectiveness of assay-directed
therapy is promising and need to be addressed in prospective trials.
Multiple biologicals have been studied or are still under investigation,
however a lot of them seems to fail. It is of great importance that the
molecular biologic research should focus more on mesothelioma-specific
pathways and biomarkers, instead of copying mechanisms and treatments that
were successful in other tumour types. Looking at the list of new
VEGFR-inhibitors being tested in MPM, one can question if it is a wise use
of the limited patient resources to perform so many "me too" trials in
this uncommon disease? One can question whether trials with so-called
targeted agents in an unselected population of mesothelioma patients are
appropriate. Investigational surgical approaches The role of surgery
remains controversial and should be further explored. Although the
multimodality treatment procedure seems feasible, overall treatment time
is long and psychological distress is considerable. Subgroup analysis of a
large Scandinavian phase 2 combination chemotherapy trial shows a median
overall survival of 22 months in patients with good performance status,
epithelioid subtype, stage I-II and aged 70 years or less, equivalent to
survival in patients subjected to multimodality treatment. These findings
stress the importance of a large prospective multicentre, in which
operable patients with early stage resectable MPM are randomly assigned to
a surgical and a non-surgical management. The feasibility of this approach
has been explored in the UK MARS 1 trial, in which the randomisation is
between EPP followed by PORT and any palliative treatment, including
pleurodesis, following an induction treatment with chemotherapy. The
results of the feasibility part of this trial have recently been released
and show no difference in survival between both treatment arms. A large
retrospective uncontrolled series reports that P/D might prolong survival
as compared to EPP and that a less invasive procedure might hence be
preferable in selected patients, provided it is standardised. In a
systematic review of 1270 patients who had undergone lung-sparing surgery
for mesothelioma, overall survival was comparable with the outcome
reported in historical series including EPP. It is expected that a large
European multicentre randomised trial will be conducted in the coming
years, addressing the role of any tumour resection in MPM. Whether the
latter will include EPP remains to be determined. Investigational
radiotherapy approaches The role of PORT in MPM is controversial and based
on a single uncontrolled retrospective series. This additional value of
PORT is being addressed in an on-going Swiss study, in which eligible
patients are randomised after EPP between observation and hemi-thoracic
PORT. Pleural IMRT allows administering a radical dose of radiotherapy to
a MPM with intact lung. The role of IMRT with chemotherapy is presently
being investigated in patients with unresectable disease. Currently a
study that looks at whether giving a short intense course of chest
radiation just prior to surgery will sterilize these tumour cells and
thus, avoid or reduce contamination of the areas outside the chest cavity
is ongoing. The investigators hypothesize that short neo-adjuvant
(pre-operative) hemi-thoracic IMRT, followed by immediate planned
extra-pleural pneumonectomy (EPP) (+/- adjuvant chemotherapy) will reduce
the risk of intra-operative seeding and reduce the incidence of distant
metastatic disease. Another trial explores the use of tomotherapy to treat
mesothelioma more aggressively than has been possible before.
Tomotherapy's ability to treat unusual shaped tumours, particularly when
they are wrapped around sensitive normal tissues (the lung), enable higher
doses of radiation to be used and this may improve its effectiveness.