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<1>
Accession Number
2012725266
Authors
Pan M. Medina A. Romero M. Segura J. Martin P. Suarez De Lezo J. Hernandez
E. Mazuelos F. Ojeda S.
Institution
(Pan, Suarez De Lezo, Romero, Segura, Suarez De Lezo, Mazuelos, Ojeda)
Reina Sofia Hospital, Department of Cardiology, University of Cordoba
(IMIBIC), Avenida Melendez Pidal 1, 14001 Cordoba, Spain
(Medina, Martin, Hernandez) Dr. Negrin Hospital, Department of Cardiology,
University of Las Palmas, Las Palmas de Gran Canaria, Spain
Title
Randomized study comparing everolimus- and sirolimus-eluting stents in
patients with bifurcation lesions treated by provisional side-branch
stenting.
Source
Catheterization and Cardiovascular Interventions. 80 (7) (pp 1165-1170),
2012. Date of Publication: 01 Dec 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives To compare the efficacy of sirolimus- and everolimus-eluting
stents in patients with bifurcation lesions treated with provisional
side-branch stenting. Background The efficacy of everolimus-eluting stents
in bifurcation lesions has been poorly tested. Methods Patients with all
types of Medina bifurcation lesions were randomly assigned to treatment
with either a sirolimus- (n = 145) or everolimus-eluting stent (n = 148).
We included patients with main vessel diameter over 2.5 mm and side
branches over 2.25 mm. Patients with diffuse side-branch stenosis were
excluded. Results There were no significant differences between patients
from the sirolimus and everolimus groups in terms of age, risk factors,
clinical status, location of the bifurcation lesions or angiographic
variables. Immediate results and in-hospital outcome were also similar in
both groups of patients. In-hospital death occurred in two patients, one
from each group. Target lesion revascularization was required in nine
patients: four patients (2.7%) from the sirolimus group and five patients
(3.4%) from the everolimus group. Late cardiac mortality occurred in two
patients from the sirolimus group and in one patient from the everolimus
group. Major cardiac event rates at 1 year were similar in both groups:
nine patients (6.2%) in the sirolimus group and nine patients (6.1%) from
the everolimus group (p: ns). Conclusions In patients with bifurcation
lesions, no significant differences in clinical outcome at 1-year
follow-up were observed between sirolimus- and everolimus-eluting stent
groups. Copyright 2012 Wiley Periodicals, Inc.

<2>
Accession Number
2012725262
Authors
Stella P.R. Belkacemi A. Dubois C. Nathoe H. Dens J. Naber C. Adriaenssens
T. Van Belle E. Doevendans P. Agostoni P.
Institution
(Stella, Belkacemi, Nathoe, Van Belle, Doevendans, Agostoni) Department of
Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584
CX, Utrecht, Netherlands
(Dubois, Adriaenssens) Department of Cardiovascular Medicine, University
Hospital Leuven, Belgium
(Dens) Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
(Naber) Department of Cardiology, Elisabeth Hospital Essen, Germany
Title
A multicenter randomized comparison of drug-eluting balloon plus
bare-metal stent versus bare-metal stent versus drug-eluting stent in
bifurcation lesions treated with a single-stenting technique: Six-month
angiographic and 12-month clinical results of the drug-eluting balloon in
bifurcations trial.
Source
Catheterization and Cardiovascular Interventions. 80 (7) (pp 1138-1146),
2012. Date of Publication: 01 Dec 2012.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background Percutaneous treatment of coronary bifurcation lesions remains
hampered by suboptimal results, mainly in the side branch (SB), even with
the use of drug-eluting stents (DES). Paclitaxel drug-eluting balloons
(DEB) could provide an attractive alternative to treat bifurcations in
combination with a provisional T-stenting technique in order to minimize
SB restenosis. We compared angiographic and clinical outcomes of a
provisional T-stenting technique with a DEB plus bare-metal stent (BMS)
versus BMS versus paclitaxel DES. Methods In this randomized,
international, multicenter, single-blinded 3-arm study, 117 patients with
coronary bifurcation lesions underwent treatment with: (A) DEB in both
main branch (MB) and SB and BMS in MB; (B) BMS in MB and regular balloon
angioplasty in SB; or (C) paclitaxel DES in MB and regular balloon in SB.
All patients underwent provisional T-stenting with an identical stent
platform in the MB. Paclitaxel was the drug for elution in groups A and C.
The primary endpoint was 6-month angiographic late luminal loss. Secondary
end points were 6-month binary restenosis and 12-month major adverse
cardiac events (MACE: death, myocardial infarction, target vessel
revascularization). Results The procedure was successful in all cases.
Late luminal loss, measured respectively in the proximal MB, distal MB and
SB was 0.58 +/- 0.65, 0.41 +/- 0.60, and 0.19 +/- 0.66 mm in group A; 0.60
+/- 0.65, 0.49 +/- 0.85, and 0.21 +/- 0.57 mm in group B; and 0.13 +/-
0.45, 0.19 +/- 0.64, and 0.11 +/- 0.43 mm in group C (P = 0.001). Binary
restenosis rates per bifurcation and MACE rates were 24.2%, 28.6%, and 15%
(P = 0.45) and 20%, 29.7%, and 17.5% (P = 0.40) in groups A, B, and C,
respectively. Conclusions Pretreatment of both MB and SB with DEB failed
to show angiographic and clinical superiority over conventional BMS, using
a provisional T-stenting technique. Moreover DES showed superior
angiographic results than DEB and BMS. Copyright 2012 Wiley Periodicals,
Inc.

<3>
Accession Number
2012730128
Authors
Stather D.R. MacEachern P. Chee A. Dumoulin E. Hergott C.A. Tremblay A.
Institution
(Stather, MacEachern, Chee, Tremblay) Department of Medicine, University
of Calgary, Calgary, AB, Canada
(Dumoulin) Department of Medicine, University of Sherbrooke, Sherbrooke,
QC, Canada
(Hergott) Airways Research Group, Division of Respirology, Critical Care
and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada
Title
Wet laboratory versus computer simulation for learning endobronchial
ultrasound: A randomized trial.
Source
Canadian Respiratory Journal. 19 (5) (pp 325-330), 2012. Date of
Publication: September-October 2012.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
Background: Linear endobronchial ultrasound with transbronchial needle
aspiration (EBUS-TBNA) is a revolutionary bronchoscopic procedure that is
challenging to learn. Objectives: To compare two methods used to teach
EBUS-TBNA: wet laboratory (lab) versus computer EBUS-TBNA simulation.
Methods: A prospective, randomized study of respirologists, thoracic
surgeons and trainees learning EBUS-TBNA at a two-day continuing medical
education course. All subjects received education via a series of lectures
and live cases, followed by randomization to learn EBUS-TBNA predominantly
either by wet lab simulation (n=6) or computer simulation (n=6). All
subjects then completed testing of their EBUS-TBNA skills via a previously
validated method using simulated cases on EBUS-TBNA simulators and
questionnaires evaluating learner preferences. Results: There were no
significant differences between the computer EBUS-TBNA simulator group and
the wet lab group in procedure time (25.3+/-6.1 min versus 25.2+/-2.5 min;
P=0.984) and percentage of successful biopsies (81.3+/-14.9% versus
74.0+/-17.3%; P=0.453). The computer simulator group performed
significantly better than the wet lab group in the percentage of lymph
nodes correctly identified (70.4+/-16.7% versus 42.9+/-19.9%; P=0.002).
Wet lab simulation was associated with increased learner confidence with
operating the real EBUS-TBNA bronchoscope. All subjects responded that wet
lab and computer EBUS-TBNA simulation offered important complementary
learning opportunities. Discusion: Computer EBUS-TBNA simulation leads to
improved skill at correctly identifying lymph nodes, while wet lab
simulation provided increased learner confidence due to increased realism.
Conclusion: Computer EBUS-TBNA simulation and wet lab simulation are
effective methods of learning basic EBUS-TBNA skills and appeared to be
complementary. 2012 Pulsus Group Inc. All rights reserved.

<4>
Accession Number
2012724297
Authors
Hare J.M. Fishman J.E. Gerstenblith G. DiFede Velazquez D.L. Zambrano J.P.
Suncion V.Y. Tracy M. Ghersin E. Johnston P.V. Brinker J.A. Breton E.
Davis-Sproul J. Schulman I.H. Byrnes J. Mendizabal A.M. Lowery M.H. Rouy
D. Altman P. Wong Po Foo C. Ruiz P. Amador A. Da Silva J. McNiece I.K.
Heldman A.W.
Institution
(Hare, DiFede Velazquez, Zambrano, Suncion, Schulman, Da Silva, McNiece,
Heldman) Interdisciplinary Stem Cell Institute, University of Miami Miller
School of Medicine, Biomedical Research Bldg., PO Box 016960 (R-125),
Miami, FL 33101, United States
(Hare, Zambrano, Tracy, Schulman, Byrnes, Lowery, McNiece, Heldman)
Department of Medicine, University of Miami Miller School of Medicine,
Miami, FL, United States
(Fishman, Ghersin) Department of Radiology, University of Miami Miller
School of Medicine, Miami, FL, United States
(Ruiz, Amador) Department of Surgery, University of Miami Miller School of
Medicine, Miami, FL, United States
(Gerstenblith, Johnston, Brinker, Breton, Davis-Sproul) Cardiovascular
Division, Johns Hopkins University School of Medicine, Baltimore, MD,
United States
(Schulman) Miami Veterans Affairs Healthcare System, Miami, FL, United
States
(Mendizabal) EMMES Corporation, Rockville, MD, United States
(Rouy, Altman, Wong Po Foo) Biocardia Inc., San Carlos, CA, United States
(McNiece) Department of Stem Cell Transplantation, University of Texas MD
Anderson Cancer Center, Houston, TX, United States
Title
Comparison of allogeneic vs autologous bone marrow-derived mesenchymal
stem cells delivered by transendocardial injection in patients with
ischemic cardiomyopathy: The POSEIDON randomized trial.
Source
JAMA - Journal of the American Medical Association. 308 (22) (pp
2369-2379), 2012. Date of Publication: 12 Dec 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Mesenchymal stem cells (MSCs) are under evaluation as a therapy
for ischemic cardiomyopathy (ICM). Both autologous and allogeneic MSC
therapies are possible; however, their safety and efficacy have not been
compared. Objective: To test whether allogeneic MSCs are as safe and
effective as autologous MSCs in patients with left ventricular (LV)
dysfunction due to ICM. Design, Setting, and Patients: A phase 1/2
randomized comparison (POSEIDON study) in a US tertiary-care referral
hospital of allogeneic and autologous MSCs in 30 patients with LV
dysfunction due to ICM between April 2, 2010, and September 14, 2011, with
13-month follow-up. Intervention: Twenty million, 100 million, or 200
million cells (5 patients in each cell type per dose level) were delivered
by transendocardial stem cell injection into 10 LV sites. Main Outcome
Measures: Thirty-day postcatheterization incidence of predefined
treatment-emergent serious adverse events (SAEs). Efficacy assessments
included 6-minute walk test, exercise peak VO₂, Minnesota
Living with Heart Failure Questionnaire (MLHFQ), New York Heart
Association class, LV volumes, ejection fraction (EF), early enhancement
defect (EED; infarct size), and sphericity index. Results: Within 30 days,
1 patient in each group (treatment-emergent SAE rate, 6.7%) was
hospitalized for heart failure, less than the prespecified stopping event
rate of 25%. The 1-year incidence of SAEs was 33.3% (n=5) in the
allogeneic group and 53.3% (n=8) in the autologous group (P=.46). At 1
year, there were no ventricular arrhythmia SAEs observed among allogeneic
recipients compared with 4 patients (26.7%) in the autologous group
(P=.10). Relative to baseline, autologous but not allogeneic MSC therapy
was associated with an improvement in the 6-minute walk test and the MLHFQ
score, but neither improved exercise VO₂ max. Allogeneic and
autologous MSCs reduced mean EED by -33.21% (95% CI, -43.61% to -22.81%;
P<.001) and sphericity index but did not increase EF. Allogeneic MSCs
reduced LV end-diastolic volumes. Low-dose concentration MSCs (20 million
cells) produced greatest reductions in LV volumes and increased EF.
Allogeneic MSCs did not stimulate significant donor-specific alloimmune
reactions. Conclusions: In this early-stage study of patients with ICM,
transendocardial injection of allogeneic and autologous MSCs without a
placebo control were both associated with low rates of treatment-emergent
SAEs, including immunologic reactions. In aggregate, MSC injection
favorably affected patient functional capacity, quality of life, and
ventricular remodeling. Trial Registration: clinicaltrials.gov Identifier:
NCT01087996. 2012 American Medical Association. All rights reserved.

<5>
Accession Number
2012720947
Authors
Shane E. Cohen A. Stein E.M. McMahon D.J. Zhang C. Young P. Pandit K.
Staron R.B. Verna E.C. Brown R. Restaino S. Mancini D.
Institution
(Shane, Cohen, Stein, McMahon, Zhang, Young, Pandit, Verna, Brown,
Restaino, Mancini) Department of Medicine, Columbia University Medical
Center, Columbia University, New York, NY 10032, United States
(Staron) Department of Radiology, Columbia University Medical Center,
Columbia University, New York, NY 10032, United States
Title
Zoledronic acid versus alendronate for the prevention of bone loss after
heart or liver transplantation.
Source
Journal of Clinical Endocrinology and Metabolism. 97 (12) (pp 4481-4490),
2012. Date of Publication: December 2012.
Publisher
Endocrine Society (8401 Connecticut Ave. Suite 900, Chevy Chase MD 20815,
United States)
Abstract
Context: The first year after transplantation is characterized by rapid
bone loss. Objective: The aim of this study was to compare zoledronic acid
(zoledronate) and alendronate for prevention of transplantation bone loss.
Design and Setting: A randomized clinical trial was conducted at a
transplantation center. Patients: The study included 84 adults undergoing
heart or liver transplantation and a concurrently transplanted,
nonrandomized reference group of 27 adults with T scores greater than
-1.5. Interventions: Alendronate (70 mg weekly for 12 months) or one 5-mg
infusion of zoledronate were both initiated 26 +/- 8 d after
transplantation. Main Outcome Measures: The primary outcome was total hip
bone mineral density (BMD) 1 yr after transplantation. Secondary outcomes
included femoral neck and lumbar spine BMD and serum C-telopeptide, a bone
resorption marker. Results: In the reference group, BMD declined at the
spine and hip (P < 0.001). In the randomized groups, hip BMD remained
stable. Spine BMD increased in the zoledronate group and did not change in
the alendronate group; at 12 months, the 2.2% difference between groups
(95% confidence interval, 0.6 to 3.9%; P = 0.009) favored zoledronate. In
heart transplant patients, spine BMD declined in the alendronate and
increased in the zoledronate group (-3.0 vs. +1.6%, respectively;
between-group difference, 4.2%; 95% confidence interval, 2.1 to 6.3%; P <
0.001). In liver transplant patients, spine BMD increased comparably in
both groups. Twelve-month C-telopeptide was lower in the zoledronate group
than in the alendronate group (79 vs. 49%; P = 0.04). Conclusions: One
5-mg infusion of zoledronate and weekly alendronate prevent bone loss at
the hip and, in liver transplant patients, increase spine BMD. In heart
transplant patients, spine bone BMD remained stable with zoledronate but
decreased with alendronate. Copyright 2012 by The Endocrine Society.

<6>
Accession Number
2012730816
Authors
Busch J.C. Lillou D. Wittig G. Bartsch P. Willemsen D. Oldridge N.
Bjarnason-Wehrens B.
Institution
(Busch) Institute of Cardiology and Sports Medicine, German Sport
University Cologne, Am Sportpark 6, 50933 Cologne, Germany
(Lillou, Wittig, Bartsch, Willemsen) Rehabilitation, Schuechtermann
Clinic, Bad Rothenfelde, Germany
(Oldridge) School of Medicine and Public Health, University of Wisconsin,
Milwaukee, WI, United States
(Oldridge) Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's
Medical Center, Milwaukee, WI, United States
(Busch, Bjarnason-Wehrens) Institute of Cardiology and Sports Medicine,
German Sport University Cologne, Cologne, Germany
Title
Resistance and balance training improves functional capacity in very old
participants attending cardiac rehabilitation after coronary bypass
surgery.
Source
Journal of the American Geriatrics Society. 60 (12) (pp 2270-2276), 2012.
Date of Publication: December 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objectives To compare the efficacy of intensive functional exercise
training with that of usual cardiac rehabilitation (CR) in very old adults
soon after coronary bypass surgery (CABG). Design Randomized controlled
trial. Setting In-hospital CR. Participants Individuals aged 75 and older
(n = 173, mean 78.5 +/- 3.2) participated in inpatient CR, which started
soon after surgery (13.1 +/- 5.3 days) and lasted for a mean of 20.4 +/-
3.2 days. Intervention Participants were randomly assigned to an inpatient
CR intervention group (IG; n = 84) or a control group (CG; n = 89). All
participants participated in the inpatient CR program. In addition, IG
participants participated in resistance training and special balance
training (5 d/wk). Measurements Six-minute walk test, cardiopulmonary
exercise testing, Timed-Up-and-Go Test (TUG), and a maximal isometric
strength test were used to access functional capacity and the MacNew
questionnaire to evaluate health-related quality of life (HRQL). Results
There were significant improvements (P < .001) in all measured variables
over the duration of CR. Improvements in functional capacity were
significantly greater in the IG than the CG for 6-minute walk distance
(6-MWD) (IG 67.3 +/- 49.0 m vs CG 41.9 +/- 51.7 m; P = .003), TUG time
(IG -2.4 +/- 2.2 seconds vs CG -1.2 +/- 3.4 seconds; P = .005), and
relative workload (IG 0.19 +/- 0.21 W/kg vs CG 0.13 +/- 0.11 W/kg; P =
.03). Conclusion There were significant improvements in all measured
variables in very old adults participating in CR soon after CABG. With
additional functional exercise training, participants randomized to IG
improved significantly more than those randomized to CG on 6-MWD, TUG
time, and relative workload. 2012, Copyright the Authors Journal
compilation 2012, The American Geriatrics Society.

<7>
Accession Number
2012727649
Authors
Sanati H.R. Zahedmehr A. Shakerian F. Bakhshandeh H. Firoozi A. Kiani R.
Sadeghpour A. Asgharnedjad E. Mikaelpour A. Nabati M.
Institution
(Sanati, Zahedmehr, Shakerian, Bakhshandeh, Firoozi, Kiani, Asgharnedjad)
Department of Interventional Cardiology, Cardiovascular Intervention
Research Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Sadeghpour, Mikaelpour, Nabati) Rajaei Cardiovascular, Medical and
Research Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Title
Percutaneous mitral valvuloplasty using echocardiographic intercommissural
diameter as reference for balloon sizing: A randomized controlled trial.
Source
Clinical Cardiology. 35 (12) (pp 749-754), 2012. Date of Publication:
2012.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background: Percutaneous balloon mitral valvuloplasty is the preferred
therapeutic strategy in patients with mitral stenosis, but it has
shortcomings in a subset of patients. Hypothesis: A new method of balloon
sizing through echocardiographic measurement of the intercommissural
diameter would be safe and effective and lead to better outcomes. Methods:
Eighty-six mitral-stenosis patients were randomly assigned to undergo
balloon mitral valvuloplasty either with height-based balloon reference
sizing (HBRS group, n = 43) or with balloons sized by the
echocardiographic measurement of intercommissural diameter (EBRS group, n
= 43). Postprocedural mitral valve area (MVA) and severity of mitral
regurgitation (MR) were assessed via echocardiography and
ventriculography. Intention-to-treat approach was applied for the
statistical analysis. Results: Baseline characteristics were not different
between the groups. The mean of the estimated balloon reference sizes was
significantly higher in the HBRS patients than in the EBRS group (26.4 +/-
0.92 mm, 95% confidence interval [CI]: 26.2-26.6 vs 24.5 +/- 1.03 mm, 95%
CI: 24.2-24.7, respectively; P = 0.006). Final MVAs were significantly
larger in the EBRS group (1.5 +/- 0.2 cm², 95% CI: 1.46-1.59 vs
1.4 +/- 0.2 cm², 95% CI: 1.35-1.47, respectively; P = 0.01).
The occurrence of new or aggravated MR was significantly lower in the EBRS
group as assessed both by echocardiography (P = 0.04) and ventriculography
(P = 0.05). Mitral regurgitation was aggravated in 13 (29.3%) patients in
the HBRS group and in 5 (11.5%) patients in the EBRS group. Conclusions:
Percutaneous balloon mitral valvuloplasty via the Inoue technique using
balloons sized by the echocardiographic measurement of the maximal
commissural diameter is an effective and safe method that might lead to an
acceptable increase in the MVA and significant decrease in the rate and
severity of iatrogenic MR. 2012 Wiley Periodicals, Inc.

<8>
Accession Number
2012731605
Authors
Vidal E. Torre-Cisneros J. Blanes M. Montejo M. Cervera C. Aguado J.M. Len
O. Carratala J. Cordero E. Bou G. Munoz P. Ramos A. Gurgui M. Borrell N.
Fortun J.
Institution
(Vidal, Torre-Cisneros) Unit of Infectious Diseases, Reina Sofia
University Hospital, IMIBIC, Cordoba, Spain
(Blanes) Department of Infectious Diseases, University Hospital La Fe,
Valencia, Spain
(Montejo) Unit of Infectious Diseases, University Hospital de Cruces,
Bilbao, Spain
(Cervera) Department of Infectious Diseases, Hospital Clinic-Institut
d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of
Barcelona, Barcelona, Spain
(Aguado) Unit of Infectious Diseases, University Hospital 12 de Octubre,
Madrid, Spain
(Len) Department of Infectious Diseases, University Hospital Vall
d'Hebron, Barcelona, Spain
(Carratala) Department of Infectious Diseases, IDIBELL-University Hospital
Bellvitge, Barcelona, Spain
(Cordero) Department of Infectious Diseases, University Hospital Virgen
del Rocio, Sevilla, Spain
(Bou) Department of Microbiology, University Hospital Juan Canalejo,
Coruna, Spain
(Munoz) Department of Clinical Microbiology and Infectious Diseases,
University Hospital Gregorio Maranon, Madrid, Spain
(Ramos) Department of Infectious Diseases, University Hospital Puerta de
Hierro, Madrid, Spain
(Gurgui) Unit of Infectious Diseases, University Hospital de la Santa Creu
i Sant Pau, Barcelona, Spain
(Borrell) Department of Microbiology, University Hospital Son Dureta,
Mallorca, Spain
(Fortun) Unit of Infectious Diseases, University Hospital Ramon y Cajal,
Madrid, Spain
Title
Bacterial urinary tract infection after solid organ transplantation in the
RESITRA cohort.
Source
Transplant Infectious Disease. 14 (6) (pp 595-603), 2012. Date of
Publication: December 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background: Urinary tract infection (UTI) is the most common infection in
renal transplant patients, but it is necessary to determine the risk
factors for bacterial UTI in recipients of other solid organ transplants
(SOTs), as well as changes in etiology, clinical presentation, and
prognosis. Methods: In total, 4388 SOT recipients were monitored in 16
transplant centers belonging to the Spanish Network for Research on
Infection in Transplantation (RESITRA). The frequency and characteristics
of bacterial UTI in transplant patients were obtained prospectively from
the cohort (September 2003 to February 2005). Results: A total of 192
patients (4.4%) presented 249 episodes of bacterial UTI (0.23 episodes per
1000 transplantation days); 156 patients were kidney or kidney-pancreas
transplant recipients, and 36 patients were liver, heart, and lung
transplant recipients. The highest frequency was observed in renal
transplants (7.3%). High frequency of cystitis versus pyelonephritis
without related mortality was observed in both groups. The most frequent
etiology was Escherichia coli (57.8%), with 25.7% producing
extended-spectrum beta-lactamase (ESBL). In all transplants but renal,
most cases occurred in the first month after transplantation. Cases were
uniformly distributed during the first 6 months after transplantation in
renal recipients. Age (odds ratio [OR] per decade 1.1, 95% confidence
interval [CI] 1.02-1.17), female gender (OR 1.74, 95% CI 1.42-2.13), and
the need for immediate post-transplant dialysis (OR 1.63, 95% CI
1.29-2.05) were independent variables associated with bacterial UTI in
renal and kidney-pancreas recipients. The independent risk factors
identified in non-renal transplants were age (OR per decade 1.79, 95% CI
1.09-3.48), female gender (OR 1.7, 95% CI 1.43-2.49), and diabetes (OR
1.02, 95% CI 1.001-1.040). Conclusions: UTI was frequent in renal
transplants, but also not unusual in non-renal transplants. Because E.
coli continues to be the most frequent etiology, the emergence of
ESBL-producing strains has been identified as a new problem. In both
populations, most cases were cystitis without related mortality. Although
the first month after transplantation was a risk period in all
transplants, cases were uniformly distributed during the first 6 months in
renal transplants. Age and female gender were identified as risk factors
for UTI in both populations. Other particular risk factors were the need
for immediate post-transplant dialysis in renal transplants and diabetes
in non-renal transplants. 2012 John Wiley & Sons A/S.

<9>
Accession Number
2012724805
Authors
Bloomfield H.
Institution
(Bloomfield) Center for Chronic Disease Outcomes Research, VA Medical
Center, Minneapolis, MN, United States
Title
Self-monitoring of oral anticoagulation reduces thromboembolic events and
does not increase risk of bleeding in selected patients and settings.
Source
Evidence-Based Medicine. 17 (6) (pp e14), 2012. Date of Publication:
December 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)

<10>
Accession Number
2012727707
Authors
Chieffo A. Latib A. Caussin C. Presbitero P. Galli S. Menozzi A. Varbella
F. Mauri F. Valgimigli M. Arampatzis C. Sabate M. Erglis A. Reimers B.
Airoldi F. Laine M. Palop R.L. Mikhail G. MacCarthy P. Romeo F. Colombo A.
Institution
(Chieffo, Latib, Colombo) Interventional Cardiology Unit, San Raffaele
Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
(Caussin) Hopital Marie Lannelongue, Le Plessis-Robinson, France
(Presbitero) Istituto Clinico Humanitas, Milan, Italy
(Galli) Centro Cardiologico Monzino, Milan, Italy
(Menozzi) Azienda Ospedaliera Universitaria, Parma, Italy
(Varbella) Ospedaledegli Infermi, Rivoli, Italy
(Mauri) Hospital Germans Triasi Pujol, Badalona, Spain
(Valgimigli) Azienda Ospedaliera Universitaria S.Anna, Ferrara, Italy
(Arampatzis) Interbalkan Medical Center, Thessaloniki, Greece
(Sabate) Hospital Santa Creui Sant Pau, Barcelona, Spain
(Erglis) P. Stradins Clinical University Hospital, Riga, Latvia
(Reimers) Ospedale Civile, Mirano, Italy
(Airoldi) Multimedica Hospital, Milan, Italy
(Laine) Helsinki University Central Hospital, Helsinki, Finland
(Palop) Hospital Universitario San Juan, Alicante, Spain
(Mikhail) St Mary's Hospital, London, United Kingdom
(MacCarthy) King's College Hospital, London, United Kingdom
(Romeo) Tor Vergata University, Rome, Italy
Title
A prospective, randomized trial of intravascular-ultrasound guided
compared to angiography guided stent implantation in complex coronary
lesions: The AVIO trial.
Source
American Heart Journal. 165 (1) (pp 65-72), 2013. Date of Publication:
January 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: No randomized studies have thus far evaluated intravascular
ultrasound (IVUS) guidance in the drug-eluting stent (DES) era. The aim
was to evaluate if IVUS optimized DES implantation was superior to
angiographic guidance alone in complex lesions. Methods: Randomized,
multicentre, international, open label, investigator-driven study
evaluating IVUS vs angiographically guided DES implantation in patients
with complex lesions (defined as bifurcations, long lesions, chronic total
occlusions or small vessels). Primary study endpoint was post-procedure in
lesion minimal lumen diameter. Secondary end points were combined major
adverse cardiac events (MACE), target lesion revascularization, target
vessel revascularization, myocardial infarction (MI), and stent thrombosis
at 1, 6, 9, 12, and 24 months. Results: The study included 284 patients.
No significant differences were observed in baseline characteristics. The
primary study end point showed a statistically significant difference in
favor of the IVUS group (2.70 mm +/- 0.46 mm vs. 2.51 +/- 0.46 mm; P
=.0002). During hospitalization, no patient died, had repeated
revascularization, or a Q-wave MI. No difference was observed in the
occurrence of non-Q wave MI (6.3% in IVUS vs. 7.0% in angio-guided group).
At 24-months clinical follow-up, no differences were still observed in
cumulative MACE (16.9%vs. 23.2 %), cardiac death (0%vs. 1.4%), MI (7.0%vs.
8.5%), target lesion revascularization (9.2% vs. 11.9%) or target vessel
revascularization (9.8% vs. 15.5%), respectively in the IVUS vs.
angio-guided groups. In total, only one definite subacute stent thrombosis
occurred in the IVUS group. Conclusions: A benefit of IVUS optimized DES
implantation was observed in complex lesions in the post-procedure minimal
lumen diameter. No statistically significant difference was found in MACE
up to 24 months. 2013 Mosby, Inc.

<11>
Accession Number
2012727710
Authors
Laferton J.A.C. Shedden Mora M. Auer C.J. Moosdorf R. Rief W.
Institution
(Laferton, Shedden Mora, Auer, Rief) Department of Clinical Psychology and
Psychotherapy, Philipps University of Marburg, Gutenbergstrae 18, 35032
Marburg, Germany
(Moosdorf) Department of Cardiac and Thoracic Vessel Surgery, Heart
Center, Philipps University of Marburg, Marburg, Germany
Title
Enhancing the efficacy of heart surgery by optimizing patients'
preoperative expectations: Study protocol of a randomized controlled
trial.
Source
American Heart Journal. 165 (1) (pp 1-7), 2013. Date of Publication:
January 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
In coronary heart disease (CHD) and heart surgery, there is sound evidence
for the relationship between patients' expectations and treatment outcome,
especially for outcome variables such as disability and quality of life.
In addition, patients' expectations have been shown to be modifiable
through psychological interventions. Therefore, targeting patients'
expectations might offer a promising opportunity to enhance heart surgery
outcome. However, few studies have tried to actively change patients'
expectations before surgery. The purpose of this clinical trial is to
optimize patients' outcome expectations before undergoing coronary artery
bypass graft surgery (CABG) through a brief psychoeducational program. The
present article describes the study protocol and reports preliminary data
on feasibility. Using a randomized controlled design, 180 patients who are
scheduled to undergo elective CABG are randomly assigned to either (1)
standard medical care (SMC) alone, (2) to an additional expectation
manipulation intervention during the 2 weeks before surgery, and (3) to an
additional attention-control group ("supportive therapy"). The main goal
is to test (a) whether expectation manipulation intervention can optimize
patients' expectations and (b) whether optimized expectations lead to
enhanced surgery efficacy. The primary outcome variable is illness-related
disability 6 months after surgery, whereas secondary outcome variables
will be quality of life, return to work, physical activity, and medical
outcome variables. First, feasibility data of 36 patients show that the
patients appreciated the additional psychological intervention before
CABG. Satisfaction of those who received psychological interventions was
very high. 2013 Mosby, Inc.

<12>
Accession Number
70947082
Authors
Patel N.N. Rogers C.A. Angelini G.D. Murphy G.J.
Institution
(Patel, Rogers, Angelini, Murphy) Bristol Royal Infirmary, Bristol, United
Kingdom
Title
Pharmacological therapies for the prevention of acute kidney injury
following cardiac surgery: A systematic review.
Source
Journal of the Intensive Care Society. Conference: State of the Art 2010
Meeting of the Intensive Care Society London United Kingdom. Conference
Start: 20101213 Conference End: 20101214. Conference Publication:
(var.pagings). 12 (1) (pp 74), 2011. Date of Publication: January 2011.
Publisher
Stansted News Ltd
Abstract
Post cardiac surgery acute kidney injury (AKI) is common, is associated
with a significant increase in morbidity and mortality. We aimed to
systematically review randomised trials that assessed the renoprotective
utility of pharmacological agents in patients undergoing cardiac surgery.
A systematic review of all randomised trials comparing renoprotective
pharmacological interventions with control in patients undergoing cardiac
surgery with cardiopulmonary bypass was undertaken. 47 randomised
controlled trials involving 3942 patients were included. Pharmacological
interventions included dopamine, fenoldopam, calcium channel antagonists,
natriuretic peptides, diuretics, and N-acetylcysteine. Most trials were of
poor quality, with small sample sizes, under reporting of randomisation
procedure, allocation concealment and method of blinding. There was marked
variation in interventions being compared, populations receiving the
intervention and outcomes being measured. No pharmacological intervention
was associated with a significant reduction in mortality or incidence of
AKI. Fenoldopam and Atrial Natriuretic Peptide (ANP) were associated with
a 70% (NNT 21, 95% CI 11.3, 83.0) and 73% (NNT 14, 95% CI 8.6, 81.0)
reduction, respectively, in the need for RRT. Fenoldopam and sodium
nitroprusside (SNP) were associated with a significant increase of 26.04
mL/min (95% CI 18.94, 33.15) and 6.60 mL/min (95% CI 2.41, 10.79),
respectively in creatinine clearance at 24-48 hr, whereas dopamine was
associated with a significant reduction (-4.26 mL/min, 95% CI-7.14,-1.39).
Vasodilatory agents, such as fenoldopam and ANP show evidence of
renoprotection in patients undergoing cardiac surgery. Evidence does not
support the use of dopamine, diuretics or N-acetylcysteine. Further
studies evaluating the effect of novel renoprotective strategies on
clinical outcomes in adequately powered randomised controlled trials are
required.

<13>
Accession Number
70947081
Authors
Patel N.N. Toth T. Jones C. Lin H. Ray P. George S.J. Welsh G. Satchell
S.C. Angelini G.D. Murphy G.J.
Institution
(Patel, Jones, Lin, George, Angelini, Murphy) Bristol Royal Infirmary,
Bristol, United Kingdom
(Toth, Welsh, Satchell) Southmead Hospital, Bristol, United Kingdom
(Ray) Weston General Hospital, Weston-Super-Mare, United Kingdom
Title
Prevention of post-cardiopulmonary bypass acute kidney injury and
endothelial dysfunction using sitaxsentan sodium, an endothelin-a receptor
antagonist.
Source
Journal of the Intensive Care Society. Conference: State of the Art 2010
Meeting of the Intensive Care Society London United Kingdom. Conference
Start: 20101213 Conference End: 20101214. Conference Publication:
(var.pagings). 12 (1) (pp 73), 2011. Date of Publication: January 2011.
Publisher
Stansted News Ltd
Abstract
Acute kidney injury (AKI) post cardiac surgery is associated with
mortality rates approaching 20%. Our objective was to characterise post
cardio-pulmonary bypass (CPB) AKI in an animal model with significant
homology to cardiac surgery patients and to assess the effect of
Sitaxsentan Sodium, an endothelin-A receptor antagonist on these changes.
Adult White-Landrace pigs (50-70 kg, n=21) were randomised to undergo
either: a) sham procedure, b) 2.5 hours of CPB, or c) 2.5 hours of CPB +
sitaxsentan sodium (0.7 mg/kg). Perfusion pressure and hydration were
standardised. Endpoints included serial functional and biochemical
measures of AKI. All pigs were recovered for 24 hours prior to in-vivo
measurement of renal endothelial function, nephrectomy and histological
assessment. (Table Presented) CPB caused significant renal dysfunction and
an increase in urinary IL-18 excretion when compared to sham controls at
24 hours (Table 1), similar to cardiac surgical patients. CPB resulted in
significant changes in renal tubular morphology with marked tubular
dilatation, medullary hypoxia and a reduction in intra-renal high energy
phosphates(ATP/ADP ratio). This was associated with endothelial injury
characterised by a reduction in nitric oxide bioavailability, and eNOS and
dBA lectin staining (disruption of the endothelial glycocalyx),
endothelial dysfunction characterised by renal vasoconstriction in
response to acetylcholine, and endothelial activation characterised by
upregulation of endothelin-1, iNOS and the vasoconstrictor adenosine. When
compared to CPB, Sitaxsentan prevented AKI by preserving creatinine
clearance, reducing proteinuria and IL-18 excretion, and preserving
intra-renal high energy phosphates. It achieved this by preserving
endothelial function, nitric oxide bioavailability, and preventing
endothelial injury and activation. Sitaxsentan sodium represents a novel
renoprotective intervention and warrants evaluation in a randomised
controlled trial.

<14>
Accession Number
70947070
Authors
Patel N.N. Toth T. Jones C. Lin H. Ray P. George S.J. Welsh G. Satchell
S.C. Angelini G.D. Murphy G.J.
Institution
(Patel, Jones, Lin, George, Angelini, Murphy) University of Bristol,
Bristol Royal Infirmary, Bristol, United Kingdom
(Toth, Welsh, Satchell) North Bristol NHS Trust, Southmead Hospital,
Bristol, United Kingdom
(Ray) Weston General Hospital, Weston-Super-Mare, United Kingdom
Title
Sildenafil citrate, a phosphodiesterase-5 inhibitor, prevents post
cardiopulmonary bypass acute kidney injury.
Source
Journal of the Intensive Care Society. Conference: State of the Art 2010
Meeting of the Intensive Care Society London United Kingdom. Conference
Start: 20101213 Conference End: 20101214. Conference Publication:
(var.pagings). 12 (1) (pp 67-68), 2011. Date of Publication: January 2011.
Publisher
Stansted News Ltd
Abstract
Acute kidney injury (AKI) post cardiac surgery is associated with
mortality rates approaching 20%. Our objective was to characterise post
cardiopulmonary bypass (CPB) AKI in an animal model with significant
homology to cardiac surgery patients and to assess the effect of
Sildenafil, a phosphodiesterase-5 antagonist on these changes. (Table
Presented) Adult White-Landrace pigs (50-70 kg, n=21) were randomised to
undergo either: sham procedure 2.5 hours of CPB 2.5 hours of CPB +
sildenafil (10 mg) Perfusion pressure and hydration were standardised.
Endpoints included serial functional and biochemical measures of AKI. All
pigs were recovered for 24 hours prior to in-vivo measurement of renal
endothelial function, nephrectomy and histological assessment. Data were
analysed using ANOVA with post-hoc bonferroni tests. CPB caused
significant renal dysfunction and an increase in urinary IL-18 excretion
when compared to sham controls at 24 hours, similar to cardiac surgical
patients. CPB resulted in significant changes in renal tubular morphology
with marked tubular dilatation, medullary hypoxia and a reduction in
intra-renal high energy phosphates(ATP/ADP ratio). This was associated
with endothelial injury characterised by a reduction in (Table Presented)
nitric oxide bioavailability, and eNOS and dBA lectin staining(disruption
of the endothelial glycocalyx), endothelial dysfunction characterised by
renal vasoconstriction in response to acetylcholine, and endothelial
activation characterised by upregulation of endothelin-1, iNOS and the
vasoconstrictor adenosine. When compared to CPB, sildenafil prevented AKI
by preserving creatinine clearance, reducing IL-18 excretion, and
preserving intra-renal high energy phosphates. It achieved this by
preserving endothelial function, nitric oxide bioavailability, and
preventing endothelial injury and activation. Absolute mean differences
are presented in the Table. Sildenafil represents a novel renoprotective
intervention and warrants evaluation in a randomised controlled trial.

<15>
Accession Number
70947064
Authors
Patel N.N. Toth T. Jones C. Lin H. Ray P. George S.J. Welsh G. Satchell
S.C. Angelini G.D. Murphy G.J.
Institution
(Patel, Jones, Lin, George, Angelini, Murphy) Bristol Royal Infirmary,
Bristol, United Kingdom
(Toth, Welsh, Satchell) Southmead Hospital, Bristol, United Kingdom
(Ray) Weston General Hospital, Weston-Super-Mare, United Kingdom
Title
Developing novel renoprotective agents for the prevention of post cardiac
surgery acute kidney injury.
Source
Journal of the Intensive Care Society. Conference: State of the Art 2010
Meeting of the Intensive Care Society London United Kingdom. Conference
Start: 20101213 Conference End: 20101214. Conference Publication:
(var.pagings). 12 (1) (pp 62-63), 2011. Date of Publication: January 2011.
Publisher
Stansted News Ltd
Abstract
Background Acute kidney injury (AKI) following cardiac surgery, defined as
a >25% reduction in glomerular filtration rate, is associated with a
four-fold increase in postoperative mortality. Despite the importance of
this clinical problem, our understanding of the underlying processes is
poor and there is no effective treatment. This is a reflection of the poor
homology between rodent models, the mainstay of research into kidney
injury, and that which occurs in humans, and it has been suggested that
large animal models of AKI with closer homology to humans are required if
clinical progress is to be achieved. The aim of this programme of research
was: To undertake a systematic review of the evidence from randomised
controlled clinical trials that have evaluated pharmacological agents for
the prevention of AKI post cardiac surgery. To characterise
post-cardiopulmonary bypass (CPB) AKI in a novel porcine recovery model
with potentially greater homology to cardiac surgery patients. To
determine the effect of endothelin-A (ET-A) receptor blockade on post CPB
AKI in swine. To determine the effect of phosphodiesterase-5 (PDE-5)
inhibition on post CPB AKI in swine. Methods Systematic review We searched
PubMed, Embase and the Cochrane Central Register of Controlled Trials for
randomised controlled trials comparing renoprotective pharmacological
interventions with control in adult patients undergoing cardiac surgery
with cardiopulmonary bypass. We extracted data for mortality, need for
renal replacement therapy (RRT), incidence of AKI, and creatinine
clearance at 24-48 hours. The meta-analysis was performed in line with
recommendations from the Cochrane Collaboration and the Quality of
Reporting of Meta-analyses guidelines with standard software. Porcine
recovery model of post-CPB AKI Plan of investigation Pigs (n=8 per group)
were randomised to the following groups: Group 1. Sham operation. Pigs
underwent a neck dissection under general anaesthesia. Group 2. CPB only.
Pigs underwent 2.5 hours of CPB. Group 3. CPB plus sitaxsentan sodium
(ET-A antagonist). Pigs underwent 2.5 hours of CPB. Each pig received an
infusion of sitaxsentan sodium 0.7 mg/kg over 30 minutes, at commencement
of CPB. Group 4. CPB plus sildenafil citrate (PDE-5 inhibitor). Pigs
underwent 2.5 hours of CPB. Each pig received an infusion of sildenafil 10
mg over 30 minutes, at commencement of CPB. Experimental methods
Thirty-two adult female Large White Landrace crossbred pigs weighing 50-70
kg were used. Minimally invasive CPB was achieved via Smart
Cannulae (Smartcanula LLC, Lausanne, Switzerland) placed in the
aorta and right atrium via the right internal carotid artery and external
jugular vein respectively. Heparinisation, priming, temperature, perfusion
pressure, pump flows and acid base balance were managed according to
standard protocols. Total CPB time was 2.5 hours. Sham procedure animals
underwent similar general anaesthesia, surgical dissection and
heparinisation as CPB operated animals. Urine output was measured via a
urethral catheter. Animals were recovered, re-anaesthetised and
re-evaluated at 24 hours. Collection of serum and urine samples and
measurement of renal and endothelial function, oxygenation, and perfusion
occured at four time points: Baseline, the end of CPB, 1.5 hours post CPB
and 24 hours post CPB. Organ harvest was performed prior to euthanasia.
Outcomes Renal function: Creatinine clearance (primary outcome), free
water clearance and fractional sodium excretion were calculated from urine
volumes and serum samples taken at the four specified time points using
standard formulae. Renal injury: H&E stained 5 mum formalin fixed,
paraffin embedded sections were scored for tubular injury by a renal
histopathologist blinded to treatment allocation. Urinary IL-18, albumin
and protein were measured in the urine. Renal endothelial function: Renal
blood flow was recorded using a Transonic flow probe placed on the renal
artery via a mini-laparotomy. Endothelial dysfunction was determined by
the change in renal blood flow in response to a supra-renal aortic
infusion of acetylcholine (0.1-10 mug/kg/min). Cortical perfusion and
medullary oxygenation was measured by cortical surface probes and
O₂ sensors connected to a dual channel tissue monitoring system
(Oxylite, Oxford Optronix, Oxford UK). Mechanisms: Endothelial
injury-immunocytochemistry (ICC) for lectin Dolichos biflorus agglutinin,
Pecam-1 and ve-Cadherin. Nitric oxide (NO) bioavailability was assessed by
measuring urinary nitrate/nitrite concentration using the Greiss reaction.
Endothelial activation-ICC for endothelin-1, eNOS and iNOS, Inflammatory
cell infiltrate-ICC for MAC-387. High energy phosphates-will be measured
using HPLC of snap frozen tissue, Apoptosis-assessed using In-Situ End
Labelling (ISEL). Results Systematic review Forty-nine randomised
controlled trials involving 4,605 patients were included. Pharmacological
interventions included dopamine, fenoldopam, (Table Presented) calcium
channel antagonists, natriuretic peptides, diuretics, and
N-acetylcysteine. Most trials were of poor quality, with small sample
sizes, under reporting of randomisation procedure, allocation concealment
and method of blinding. No pharmacological intervention significantly
reduced mortality or the reported incidence of AKI. Fenoldopam and atrial
natriuretic peptide reduced the need for renal replacement therapy by 70%
(NNT 21, 95% CI 113, 830) and 76% (NNT 29, 95% CI 171, 844) respectively.
Dopamine caused a significant reduction in creatinine clearance (-426
mL/min, 95% CI-714,-139). Post-cardiopulmonary bypass acute kidney injury
in swine CPB caused AKI characterised by a mean reduction in creatinine
clearance of 50 mL/min (95% confidence interval (CI) 6.1 to 94.0) and a
mean rise in IL-18 of 211.5 pg/ml (95% CI 107.4 to 315.6) compared to sham
procedures (Table 1). This was associated with vascular endothelial
injury, activation and dysfunction, reduced NO bioavailability and a
significant increase in the expression of the paracrine vasoconstrictors
adenosine and endothelin-1 (Figure 1). In post CPB kidneys at 24 hours
there was persistent hypoxia at the level of the outer medulla, cortical
ATP depletion and evidence of proximal tubule epithelial cell stress and
apoptosis. There was no evidence of acute tubular necrosis (ATN). CPB
caused changes in the podocyte slit diaphragm and marked proteinuria.
Effect of ET-A receptor antagonism using sitaxsentan sodium When compared
to CPB, sitaxsentan prevented AKI by preserving creatinine clearance,
reducing proteinuria and IL-18 excretion, and preserving intra-renal high
energy phosphates (Table 1). It achieved this by preserving endothelial
function, nitric oxide bioavailability, and preventing endothelial injury
and activation (Figure 1). Effect of PDE-5 antagonism using sildenafil
citrate Like sitaxsentan, sildenafil prevented AKI by preserving
creatinine clearance, reducing IL-18 excretion, preserving intra-renal
high energy phosphates, renal blood flow and medullary oxygen tension
(Table 1). It achieved this by preserving endothelial function, nitric
oxide bioavailability, and preventing endothelial injury and activation
(Figure 1). Conclusions Currently, there are no effective renoprotective
agents for the prevention of post-CPB AKI. We have characterised post CPB
AKI in a novel swine (Graph Presented) recovery model. We have identified
injury to the vascular endothelium, loss of NO bioavailability,
endothelial dysfunction, vasoconstriction and medullary hypoxia as central
to this process. In contrast ATN was not evident. Administration of an
ET-A receptor antagonist or a PDE-5 inhibitor reversed these changes. The
endogenous endothelin system and NO pathways represent therapeutic targets
for the prevention of post cardiac surgery AKI.

<16>
Accession Number
2012719908
Authors
Gerber D.R.
Institution
(Gerber) Edward D. Viner Intensive Care Unit, Cooper University Hospital,
Camden, NJ 08103, United States
(Gerber) Cooper Medical School of Rowan University, Camden, NJ 08103,
United States
(Gerber) Univ. of Medicine and Dentistry of New Jersey-Robert Wood Johnson
Medical School, Camden NJ 08103, United States
(Gerber) Division of Critical Care Medicine, Cooper University Hospital,
Camden 08103, NJ, United States
Title
Risks of packed red blood cell transfusion in patients undergoing cardiac
surgery.
Source
Journal of Critical Care. 27 (6) (pp 737.e1-737.e9), 2012. Date of
Publication: December 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Packed red blood cell (PRBC) transfusion is common in patients undergoing
cardiac surgery. Evidence has accumulated demonstrating that such patients
can tolerate relatively low hemoglobins, and an extensive body of
literature has developed demonstrating that patients undergoing such
surgery who receive PRBC are at risk for several adverse outcomes
including increased mortality, atrial fibrillation, and more postoperative
infections, as well as numerous other complications. The PubMed database
was searched for the English language literature on the topic of PRBC
transfusion and outcomes in patients undergoing cardiac surgery, as well
as alternatives to this intervention. Data were reviewed to assess the
impact of transfusion in patients undergoing cardiac surgery on mortality,
cardiac, infectious, and pulmonary, as well as a variety of miscellaneous
complications. Patients receiving PRBC were consistently identified as
being at higher risk for complications in all categories. The limited
prospective data were consistent with the retrospective data, which
comprised most of the literature. The preponderance of the literature
suggests that patients undergoing cardiac surgery can tolerate lower
hemoglobin/hematocrit values than traditionally appreciated. Most
published data also indicate that PRBC transfusion should be reserved for
patients with an identifiable clinical/physiologic indication fir this
intervention, consistent with recent specialty society guidelines. 2012
Elsevier Inc.

<17>
Accession Number
2012719918
Authors
Corley A. Spooner A.J. Barnett A.G. Caruana L.R. Hammond N.E. Fraser J.F.
Institution
(Corley, Spooner, Caruana, Hammond, Fraser) Critical Care Research Group,
The Prince Charles Hospital and University of Queensland, Brisbane,
Australia
(Barnett) Institute of Health and Biomedical Innovation, School of Public
Health, Queensland University of Technology, Brisbane, Australia
Title
End-expiratory lung volume recovers more slowly after closed endotracheal
suctioning than after open suctioning: A randomized crossover study.
Source
Journal of Critical Care. 27 (6) (pp 742.e1-742.e7), 2012. Date of
Publication: December 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Purpose: Endotracheal suctioning causes significant lung derecruitment.
Closed suction (CS) minimizes lung volume loss during suction, and
therefore, volumes are presumed to recover more quickly postsuctioning.
Conflicting evidence exists regarding this. We examined the effects of
open suction (OS) and CS on lung volume loss during suctioning, and
recovery of end-expiratory lung volume (EELV) up to 30 minutes
postsuction. Material and Methods: Randomized crossover study examining 20
patients postcardiac surgery. CS and OS were performed in random order, 30
minutes apart. Lung impedance was measured during suction, and
end-expiratory lung impedance was measured at baseline and postsuctioning
using electrical impedance tomography. Oximetry, partial pressure of
oxygen in the alveoli/fraction of inspired oxygen ratio and compliance
were collected. Results: Reductions in lung impedance during suctioning
were less for CS than for OS (mean difference, - 905 impedance units; 95%
confidence interval [CI], - 1234 to -587; P < .001). However, at all
points postsuctioning, EELV recovered more slowly after CS than after OS.
There were no statistically significant differences in the other
respiratory parameters. Conclusions: Closed suctioning minimized lung
volume loss during suctioning but, counterintuitively, resulted in slower
recovery of EELV postsuction compared with OS. Therefore, the use of CS
cannot be assumed to be protective of lung volumes postsuctioning.
Consideration should be given to restoring EELV after either suction
method via a recruitment maneuver. 2012 Elsevier Inc.

<18>
Accession Number
70944563
Authors
Lamy A. Devereaux P. Prabhakaran D. Taggart D. Hu S. Paolasso E. Straka Z.
Piegas L. Akar R. Ou N. Chrolavicius S. Yusuf S.
Institution
(Lamy, Devereaux, Prabhakaran, Taggart, Hu, Paolasso, Straka, Piegas,
Akar, Ou, Chrolavicius, Yusuf) HamiltonONCanada
Title
Importance of risk stratification to explain international variations in
results of the coronary trial (off-pump vs. on-pump CABG surgery)-the
Canadian results.
Source
Canadian Journal of Cardiology. Conference: 65th Annual Meeting of the
Canadian Cardiovascular Society Toronto, ON Canada. Conference Start:
20121027 Conference End: 20121031. Conference Publication: (var.pagings).
28 (5 SUPPL. 1) (pp S416-S417), 2012. Date of Publication:
September-October 2012.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: We reported the results of a large randomized controlled trial
evaluating off-pump coronary artery bypass grafting (CABG) versus on-pump
CABG and found that the results (first co-primary outcome at 30 days)
between the two techniques appeared to vary across regions of the world.
We assessed whether this apparent variability in results was related to
the risk of patients as assessed by the EuroSCORE. METHODS: The study has
enrolled 4,752 patients from 79 centers in 19 countries, with coronary
artery disease who were scheduled to undergo CABG surgery. We examined
whether the variation by region in the co-primary composite outcome of
mortality, myocardial infarction (MI), stroke, and new renal failure at 30
days could be explained by the risk of patients. RESULTS: There was no
overall difference in the rate of the primary composite outcome between
off-pump and on-pump CABG (9.8% vs.10.3%; hazard ratio [HR] for the
off-pump group, 0.95; 95% confidence interval [CI], 0.79 to 1.14; P =
0.59). However, the HRfor the primary outcome appeared to vary in the 4
regions of our trial: 0.68 in South America, 0.89 in North
America+Europe+Australia, 1.12 in China and 1.41 in India, (test for
interaction p=0.058). Surgical risk factors, such as the number of
diseased vessels, and surgeon expertise did not explain this variation.
However, the EuroSCORE (additive model) also influenced the apparent
differences in results. In post hoc analyses, low-risk patients (score 0
to 2) had a trend to more events with off-pump compared to on-pump CABG
(HR=1.35), while moderate and high risk patients (score of 3 and more)
tended to have better results with off-pump CABG (HR=0.87); p=0.047 for
interaction. A lower EuroSCORE was more prevalent in India (511/1256,
40.7%) and China (283/781, 36.2%), than in South America (177/776, 22.8%)
or in North America+Europe+Australia (368/1819, 20.2%). Adjustment for
these differences in the EuroSCORE eliminated the variations in results by
region (p = 0.524 for heterogeneity). Results from Canadian centers (830
patients) will be presented at the meeting. CONCLUSIONS: Although CORONARY
demonstrated no overall differences in results between off-pump vs.
on-pump surgery, higher risk patients tended to benefit more from off-pump
compared to on-pump surgery to a greater extent with the reverse in lower
risk patients.

<19>
Accession Number
70944496
Authors
Sarrazin J. Nair G. Nanthakumar K. Leong-Sit P. Sapp J. Kuriachan Singh S.
Nery P. Gula L.J. Downar E. Chauhan Skanes A.C. Nault I.
Institution
(Sarrazin, Nair, Nanthakumar, Leong-Sit, Sapp, Kuriachan, Singh, Nery,
Gula, Downar, Chauhan, Skanes, Nault) QuebecQCCanada
Title
Safety and efficacy of epicardial access for catheter ablation: A canadian
multicenter experience.
Source
Canadian Journal of Cardiology. Conference: 65th Annual Meeting of the
Canadian Cardiovascular Society Toronto, ON Canada. Conference Start:
20121027 Conference End: 20121031. Conference Publication: (var.pagings).
28 (5 SUPPL. 1) (pp S380-S381), 2012. Date of Publication:
September-October 2012.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Access to the pericardial space is often required to ablate
epicardial substrates for cardiac arrhythmias. Percutaneous approach is
being increasingly used as part of ablation procedures. A systematic
review of the safety and feasibility of epicardial access for arrhythmia
ablation in Canadian centers has not been performed. METHODS: In 8
Canadian centers, 63 patients (54 men, age 52+/- 16 years, LVEF 34+/- 16%,
42 patients with prior failed endocardial ablation) underwent 67
epicardial mapping and/or ablation procedures. Fifty-four patients (86%)
had an underlying cardiomyopathy (CM). The diagnosis was non-ischemic
dilated CM in 26 patients, ischemic CM in 12, arrhythmogenic right
ventricular CM in 5, myocarditis in 5, cardiac sarcoidosis in 3, valvular
heart disease in 1, Chagas disease in 1, and left ventricular
non-compaction in 1. Indications for the procedure were ventricular
tachycardia (VT) in 62 patients (93%), Wolff-Parkinson-White in 2
patients, atrial tachycardia in 2 patients, and highly symptomatic
premature ventricular complexes in 1 patient. RESULTS: Percutaneous
epicardial access was attempted in 62 patients and an open surgical
approach was used in 1 patient. Successful percutaneous access was
obtained in 65/66 procedures (98%). An increase in the number of
epicardial procedures was observed over time (7 in 2006-2007, 19 in
2008-2009, 31 in 2010-2011, 10 in 2012). The procedure was performed under
general anesthesia in 36 patients (57%). Procedure duration was 315 +/- 82
minutes with a mean of 21 +/- 16 minutes of RF. Acute complete success (no
inducible arrhythmias) was achieved in 43 procedures (64%) and partial
success (elimination of clinical arrhythmia but other arrhythmias still
inducible) was achieved in an additional 14 procedures giving an overall
success rate of 85%. Major complications occurred with 3 procedures (4%):
RV laceration requiring surgical repair, retroperitoneal bleed, and
constrictive pericarditis at 10 months. Minor complications occurred with
12 procedures (18%), including pericardial effusion treated conservatively
in 3 patients, pericarditis in 3, pulmonary edema in 2, pleural effusion
in 1, pneumoperitoneum in 1, transient complete heart block in 1, and
thermal injury from ground patch in 1. Only 2 patients died within the
first month post-procedure because of persistent VT. CONCLUSIONS: Many
centers in Canada are now adopting percutaneous epicardial access for
ablation of epicardial ventricular and occasionally supraventricular
arrhythmias. Percutaneous epicardial access can be obtained safely in the
majority of patients, offering an effective and minimally invasive
approach to ablation of epicardial arrhythmia substrates.

<20>
Accession Number
70944413
Authors
Sas G. Lambert L.J. Boothroyd L.J. Ducharme A. Charbonneau E. Carrier M.
Cecere R. Guertin J.R. Morin J.E. Bogaty P.
Institution
(Sas, Lambert, Boothroyd, Ducharme, Charbonneau, Carrier, Cecere, Guertin,
Morin, Bogaty) MontrealQCCanada
Title
What can the patient with chronic end-stage heart failure expect from a
long-term left ventricular assist device? A systematic review of current
evidence.
Source
Canadian Journal of Cardiology. Conference: 65th Annual Meeting of the
Canadian Cardiovascular Society Toronto, ON Canada. Conference Start:
20121027 Conference End: 20121031. Conference Publication: (var.pagings).
28 (5 SUPPL. 1) (pp S337-S338), 2012. Date of Publication:
September-October 2012.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Cardiac transplantation is the treatment of choice for
patients who have end-stage heart failure (HF) but wait times for a
suitable donor heart are often long and many patients are ineligible. The
continuous-flow left ventricular assist device (LVAD) HeartMate II (HM II)
is recognized as an alternative therapeutic option in suitable patients.
Patients require clear, evidence-based information on HM II use in order
to make an informed decision about this treatment option. OBJECTIVES: To
assess the benefits and risks of HM II in patients with chronic end-stage
HF (New York Heart Association class IV refractory to optimal medical
therapy). METHODS: A systematic search of scientific literature
(2008-2012) identified 6 studies of patients implanted with HM II as
>>bridge to transplant<< (BTT; transplant-eligible patients) and 4 studies
of patients implanted with HM II as >>destination therapy<< (DT;
transplant-ineligible patients). Study selection, data extraction and
quality assessment were done by two independent reviewers. A synthesis of
the data was discussed with clinicians specialized in the LVAD domain.
RESULTS: BTT patients have a >75% chance of 1-year survival; DT patients
have a >70% chance of 1-year survival. Six months after LVAD implantation,
>80% of both groups of patients are able to perform activities of daily
living with no or only mild HF symptoms, and patients can walk an average
of 325 metres in 6 minutes. Both groups of patients can expect no
deterioration of neurocognitive function while on support; for BTT
patients, renal/liver function may improve. Patients should expect to
spend 3 weeks in hospital for the LVAD implantation. While on support,
there is a significant risk of various serious complications, as
summarized in the Table. Most complications occur in the first 30 days
(particularly bleeding requiring surgery); afterwards, the most likely
complication is infection. Patients must accept long-term lifestyle
adaptation and meticulous device care, and will require the continuous
support of family/friends and formal caregivers. CONCLUSION: A systematic
literature review that examines all aspects of LVAD use and is interpreted
from the patient's perspective can be used to support decision-making that
is both patient-centred and evidence-based. Because current data is
relatively limited (especially with respect to perceived quality of life)
and level of evidence is generally weak, this approach promises to become
increasingly informative as more experience becomes available. (Table
Presented).

<21>
Accession Number
70944361
Authors
Khatri P.J. Webb J.G. Rodes-Cabau J. Fremes S.E. Ruel M. Lau K. Guo H.
Wijeysundera H. Ko D.T.
Institution
(Khatri, Webb, Rodes-Cabau, Fremes, Ruel, Lau, Guo, Wijeysundera, Ko)
TorontoONCanada
Title
Adverse effects associated with transcatheter aortic valve implantation: A
meta-analysis of contemporary studies.
Source
Canadian Journal of Cardiology. Conference: 65th Annual Meeting of the
Canadian Cardiovascular Society Toronto, ON Canada. Conference Start:
20121027 Conference End: 20121031. Conference Publication: (var.pagings).
28 (5 SUPPL. 1) (pp S310-S311), 2012. Date of Publication:
September-October 2012.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has emerged as
an important treatment in patients with severe symptomatic aortic stenosis
at high operative risk, but accurate estimates of serious adverse effects
in contemporary practice are not available. We sought to quantify the
adverse effects associated with TAVI, and to evaluate whether the type of
transcatheter valve and the route of valve implantation are associated
with differences in adverse outcomes. METHODS: We searched the PubMed
electronic database up to August 31, 2011 to identify all studies that
included at least 100 TAVI patients and reported at least one outcome of
interest. Two reviewers abstracted the data independently. A random
effects model was used to combine data on adverse outcomes and conduct
stratified analyses. RESULTS: A total of 37 studies enrolling 9,795
patients met the inclusion criteria. Overall 30-day and 1-year survival
after TAVI were 91.4% (95% CI, 90.5% to 92.3%) and 79.2% (95% CI, 76.7% to
81.5%), respectively. Heart block requiring permanent pacemaker
implantation was the most common adverse outcome (13.7%), and almost five
times more common with the CoreValve (26.5%) than with the Sapien valve
(5.7%). The overall rate of vascular complications was 10.0% and highest
with transarterial implantation of the Sapien valve (17.0%). Acute renal
failure requiring renal replacement therapy was the third most common
complication, occurring in 4.6% of cases. CONCLUSION: The most common
adverse effects associated with TAVI are heart block, vascular
complications, and renal failure. The type of transcatheter valve and the
route of implantation are associated with observed variations in the risks
of some adverse effects.

<22>
Accession Number
70944314
Authors
Arsenault K.A. Paikin J.S. Hirsh J. Dale B. Whitlock R.P. Teoh K. Young E.
Ginsberg J.S. Weitz J.I. Eikelboom J.W.
Institution
(Arsenault, Paikin, Hirsh, Dale, Whitlock, Teoh, Young, Ginsberg, Weitz,
Eikelboom) HamiltonONCanada
Title
Subtle differences in commercial heparins can have serious consequences
for cardiopulmonary bypass patients: A randomized controlled trial.
Source
Canadian Journal of Cardiology. Conference: 65th Annual Meeting of the
Canadian Cardiovascular Society Toronto, ON Canada. Conference Start:
20121027 Conference End: 20121031. Conference Publication: (var.pagings).
28 (5 SUPPL. 1) (pp S285), 2012. Date of Publication: September-October
2012.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Heparin is widely used during cardiopulmonary bypass (CPB).
Prompted by anecdotal reports from our institution and a subsequent chart
review describing increased heparin and protamine dosing requirements
after switching from Hepalean to Pharmaceutical Partners of Canada (PPC)
heparin, we compared the potency, reversibility and perioperative bleeding
risk of these two heparins. METHODS: Because in-vitro testing failed to
detect differences in the potency or protamine reversibility of the two
heparin preparations, we conducted a parallel group, single-centre,
double-blind, randomized controlled trial to compare PPC heparin with
Hepalean in patients undergoing coronary artery bypass graft surgery on
CPB. The primary outcomes were activated clotting times (ACT) measured
immediately after the first weight-adjusted heparin dose and the total
heparin requirement to maintain a target ACT of 480 seconds or higher
during CPB. This trial is registered with ClinicalTrials.gov
(NCT01343381). RESULTS: Between June 1, 2011, and June 30, 2011, we
randomly assigned 11 patients to receive PPC heparin and 10 to receive
Hepalean. Despite similar initial doses of heparin, the median initial ACT
was numerically lower in the PPC group than in the Hepalean group (516.0
[inter-quartile range: 481.0-633.0] vs. 584.0 [520.0-629.0] sec; p = 0.418
) and those given PPC required a higher total heparin dose (46000
[39500-60000] vs. 34500.0 [3225-37000] U; p=0.011) and dose of heparin per
kg than those given Hepalean (572.9 [443.0-659.7] vs. 401.1 [400.0-419.4]
U/kg; p = 0.003). Key secondary results included an increased median total
protamine dose (600.0 [550.0-700.0] vs. 500.0 [425.0-542.5] mg; p = 0.026)
and a non-significant increase in chest-tube output over 24h (830.0
[425.0-1135.0] vs. 702.5 [550.0-742.5] mL; p=0.324). CONCLUSION: PPC
heparin use was associated with higher heparin and protamine dose
requirements than Hepalean and a trend toward increased bleeding. These
findings indicate that heparin preparations are not interchangeable and
suggest that a direct comparison of potency with the brand in use is
needed if a change is made to ensure that the agents exert similar
anticoagulant effects in-vivo.

<23>
Accession Number
70944160
Authors
Ibrahim R. Avram R. Stevens L.M. Noiseux N. Gobeil F. Mansour S.
Institution
(Ibrahim, Avram, Stevens, Noiseux, Gobeil, Mansour) MontrealQCCanada
Title
Prevalence, clinical characteristics and management of coronary chronic
total occlusions in current practice: A canadian single center experience.
Source
Canadian Journal of Cardiology. Conference: 65th Annual Meeting of the
Canadian Cardiovascular Society Toronto, ON Canada. Conference Start:
20121027 Conference End: 20121031. Conference Publication: (var.pagings).
28 (5 SUPPL. 1) (pp S209), 2012. Date of Publication: September-October
2012.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Coronary chronic total occlusions (CTOs) are commonly
encountered complex lesions. However, the true prevalence of CTOs in the
current Canadian practice with the modern medical therapy remains unknown.
In addition, CTOs remain the most powerful predictor of referral for
coronary bypass surgery or medical therapy with an unchanged low
CTO-percutaneous coronary intervention (PCI) attempt rate in the last
years. METHODS: We aim to determine the prevalence, clinical
characteristics and management of CTOs among all comers population
referred for diagnostic coronary angiography. The rate of CTO attempt
recanalization and procedure success were recorded. Therefore, we
performed a systematic review of all coronary angiographies performed in a
high volume Canadian university center between January and July 2010.
Patients with at least one CTO (coronary obstruction with TIMI flow grade
0-in the absence of a patent graft-with an estimated duration of >3
months) were included in our study. Patients with acute coronary syndrome
or new onset angina involving the occluded artery territory were excluded.
Detailed baseline clinical, angiographic, electrocardiographic, and
revascularization data were collected. RESULTS: In the study period, a
total of 2087 coronary angiogram was performed with 371 patients (18%) met
the selection criteria. The mean age was 67+/- 11 years with 75% males,
the mean left ventricular ejection fraction (LVEF) was 46 +/- 16% (with
47% of patients with a LVEF< 50%). Previous history of myocardial
infarction was documented in 36% of CTOs patients with only one third of
them having ECG evidence of a Q wave in the CTO territory. Ischemia in the
CTO territory was documented prior to the coronary angiogram in 53% of
cases. Almost half of CTOs were located in the right coronary artery, 24%
in the circumflex and and 29% in the left anterior descending artery
distribution. Only 10% of patients had aCTO-PCI attempt with a success
rate of 78%. The majority of patients (79%) were treated medically and 11%
were referred for coronary artery bypass graft (CABG) surgery. CONCLUSION:
Chronic total occlusions remain common findings in the current practice
with low rate of revascularization. New CTO-PCI techniques and dedicated
operators could increase the rate of PCI success with potential long term
clinical benefit.

<24>
Accession Number
70943926
Authors
Ramirez F.D. Hibbert B. Simard T. Pourdjabbar A. Wilson K.R. Hibbert R.
Kazmi M. Hawken S. Ruel M. Labinaz M. O'Brien E.R.
Institution
(Ramirez, Hibbert, Simard, Pourdjabbar, Wilson, Hibbert, Kazmi, Hawken,
Ruel, Labinaz, O'Brien) OttawaONCanada
Title
Natural history and management of aortocoronary saphenous vein graft
aneurysms: A systematic review of published cases.
Source
Canadian Journal of Cardiology. Conference: 65th Annual Meeting of the
Canadian Cardiovascular Society Toronto, ON Canada. Conference Start:
20121027 Conference End: 20121031. Conference Publication: (var.pagings).
28 (5 SUPPL. 1) (pp S87-S88), 2012. Date of Publication: September-October
2012.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Saphenous vein graft aneurysms (SVGAs) are a very rare
complication of coronary artery bypass grafting (CABG). Our objective was
to determine the clinical features and management options for
aortocoronary SVGAs in an effort to develop an approach to identifying and
managing patients with this complication. METHODS/RESULTS: We performed a
systematic review of published cases in MEDLINE and SCOPUS between 1966
and December 2010. Standardized data were extracted by two independent
reviewers. We identified 209 reported cases of aortocoronary SVGAs in 168
articles. Patients were predominantly male (86.6%) and had a mean age of
65.3 +/- 10.6 years. SVGAs were identified on average 13.1 +/- 6.0 years
after CABG with a mean diameter of 60.7 +/- 31.8 mm. Mechanical
complications were reported in 34.0% of cases at presentation. Though most
patients presented with chest pain (43.5%), SVGAs were commonly identified
incidentally on imaging (35.4%). The most commonly employed investigations
were cardiac catheterization (66.5%) and computed tomography (60.3%). In
cases in which serial follow-up were described, nearly all aneurysms
continued to increase in size. Surgical management was reported in 58.4%
of cases, percutaneous intervention in 15.8%, and conservative therapy in
20.1% with short-term mortality rates of 13.9%, 6.1%, and 23.8%,
respectively. CONCLUSIONS: SVGAs represent a rare but increasingly
recognized complication of CABG most often seen remotely from the surgery.
A large subset of patients with SVGAs are asymptomatic. It is hypothesized
that the aneurysms continue to grow over time albeit at variable rates.
Though further study is required, both surgical and percutaneous
interventions appear to have favourable outcomes. In select patients,
percutaneous management offers an alternative to repeat sternotomy.