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<1>
Accession Number
2013043232
Authors
Alkan-Bozkaya T. Akcevin A. Turkoglu H. Undar A.
Institution
(Alkan-Bozkaya, Akcevin, Turkoglu) Department of Cardiovascular Surgery,
Istanbul Medipol University, Istanbul, Turkey
(Undar) Departments of Pediatrics, Surgery and Bioengineering, Penn State
Hershey College of Medicine, Pediatric Cardiovascular Research Center,
Hershey, PA, United States
Title
Impact of Pulsatile Perfusion on Clinical Outcomes of Neonates and Infants
With Complex Pathologies Undergoing Cardiopulmonary Bypass Procedures.
Source
Artificial Organs. 37 (1) (pp 82-86), 2013. Date of Publication: January
2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
The aim of this clinical trial was to evaluate the pulsatile perfusion
mode in pediatric patients who had complex cardiac pathologies according
to Jenkins stratifications (category 4) undergoing cardiopulmonary bypass
procedures (CPB). Patients with transposition of great arteries (TGA) and
ventricular septal defect (VSD) were included in this clinical study.
Eighty-nine consecutive pediatric patients undergoing open heart surgery
for repair of TGA-VSD were prospectively entered into the study and were
randomly assigned to either the pulsatile perfusion group (Group P, n=58)
or the nonpulsatile perfusion group (Group NP, n=31). There were no
differences between groups in terms of demographical and intraoperative
parameters. The pulsatile group needed significantly less inotropic
support (P<0.05) and had lower lactate levels (P<0.001), higher urine
output (P<0.01), and higher albumin levels (P<0.05). In addition, the
pulsatile group had less ICU (P<0.01) and hospital stays (P<0.001). We
conclude that the use of pulsatile flow is a better option and should be
considered for repair of the complex congenital heart defects. 2013, The
Authors. Artificial Organs 2013, International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<2>
Accession Number
2013037937
Authors
Farooq V. Serruys P.W. Garcia-Garcia H.M. Zhang Y. Bourantas C.V. Holmes
D.R. MacK M. Feldman T. Morice M.-C. Stahle E. James S. Colombo A. Diletti
R. Papafaklis M.I. De Vries T. Morel M.-A. Van Es G.A. Mohr F.W. Dawkins
K.D. Kappetein A.-P. Sianos G. Boersma E.
Institution
(Farooq, Serruys, Garcia-Garcia, Zhang, Bourantas, Diletti, Papafaklis,
Boersma) Department of Interventional Cardiology, Erasmus University
Medical Centre, Thoraxcenter, Rotterdam, Netherlands
(Holmes) Mayo Clinic, Rochester, MN, United States
(MacK) Medical City Dallas Hospital, Dallas, TX, United States
(Feldman) Evanston Hospital, Evanston, IL, United States
(Morice) Institut Jacques Cartier, Massy, France
(Stahle, James, Sianos) University Hospital Uppsala, Uppsala, Sweden
(Colombo) San Raffaele Scientific Institute, Milan, Italy
(De Vries, Morel, Van Es) Cardialysis BV, Rotterdam, Netherlands
(Mohr) Herzzentrum, Leipzig, Germany
(Dawkins) Boston Scientific Corporation, Natick, MA, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Thoraxcenter, Rotterdam, Netherlands
Title
The negative impact of incomplete angiographic revascularization on
clinical outcomes and its association with total occlusions: The SYNTAX
(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac
Surgery) trial.
Source
Journal of the American College of Cardiology. 61 (3) (pp 282-294), 2013.
Date of Publication: 22 Jan 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The study sought to evaluate the clinical impact of
angiographic complete (CR) and incomplete (ICR) revascularization and its
association with the presence of total occlusions (TO), after percutaneous
coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery
in the "all-comers" SYNTAX (Synergy Between Percutaneous Coronary
Intervention with Taxus and Cardiac Surgery) trial. Background: In
patients with complex coronary artery disease undergoing PCI or CABG, the
long-term prognostic implications of CR versus ICR is unsettled. Methods:
In this post hoc study, consisting of randomized (n = 1,800) and nested
PCI (n = 198) and CABG (n = 649) registries, 4-year clinical outcomes were
compared in groups, with and without angiographic CR, in the PCI and CABG
arms. Clinical outcomes were analyzed with Kaplan-Meier estimates,
log-rank comparisons, and Cox regression analyses. Multivariate predictors
of ICR were determined. Similar analyses were undertaken in the TO and
non-TO treated groups of both study arms. Results: Angiographic CR was
achieved in 52.8% of the PCI arm and 66.9% of the CABG arm. Within the PCI
and CABG arms, ICR (compared with CR) seemed to be a surrogate marker of a
greater burden of anatomical coronary complexity and clinical comorbidity
and was associated with significantly higher frequencies of 4-year
mortality, all-cause revascularization, stent thrombosis (PCI arm), and
major adverse cardiac and cerebrovascular events. The presence of a TO was
the strongest independent predictor of ICR after PCI (hazard ratio: 2.70,
95% confidence interval: 1.98 to 3.67, p < 0.001). Eight hundred and forty
patients (PCI: 26.3%, CABG: 36.4%, p < 0.001) were identified to have
1,007 TOs, with 68.1% of TOs located in the proximal-mid coronary
vasculature. The findings associating ICR (compared with CR) with higher
frequencies of 4-year mortality and major adverse cardiac and
cerebrovascular events remained consistent in the TO-treated groups in the
PCI and CABG arms. Conclusions: Within the PCI and CABG arms of the
all-comers SYNTAX trial, angiographically determined ICR has a detrimental
impact on long-term clinical outcomes, including mortality. This effect
remained consistent in patients with and without TOs. 2013 American
College of Cardiology Foundation.

<3>
Accession Number
2013049771
Authors
Vasques F. Rainio A. Heikkinen J. Mikkola R. Lahtinen J. Kettunen U.
Juvonen T. Biancari F.
Institution
(Vasques, Rainio, Heikkinen, Mikkola, Lahtinen, Kettunen, Juvonen,
Biancari) Division of Cardio-thoracic and Vascular Surgery, Department of
Surgery, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland
Title
Off-pump versus on-pump coronary artery bypass surgery in patients aged 80
years and older: Institutional results and meta-analysis.
Source
Heart and Vessels. 28 (1) (pp 46-56), 2013. Date of Publication: January
2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Patients aged >=80 years are at high risk of adverse events after coronary
artery bypass grafting. This study was performed to evaluate whether
off-pump coronary artery bypass surgery (OPCAB) is superior to
conventional surgery (CCAB) in these high-risk patients. The outcome of
185 patients aged >=80 years who underwent OPCAB or CCAB at our
institution was reviewed and a meta-analysis on this issue was performed.
Similar immediate postoperative results were observed after OPCAB and CCAB
at our institution, despite significantly different operative risk (mean
logistic EuroSCORE, OPCAB 20.3% vs CCAB 13.4%, P = 0.003). Among 56
propensity score matched pairs a trend toward lower postoperative stroke
(0%, 95% CI 0-0 vs 3.6%, 95% CI 0-10.0, P = 0.50) was observed after
OPCAB. No significant differences were observed in the other outcome end
points. Five-year survival was 81.0% after OPCAB and 78.1% after CCAB (P =
0.239). Pooled analysis of eight studies including 3416 patients showed a
significantly higher risk of postoperative stroke after CCAB (pooled
rates: 4.2%, 95% confidence interval (95% CI) 2.4-7.1 vs 1.5%, 95% CI
0.9-2.5, risk ratio (RR) 2.15, 95% CI 1.17-3.96, P = 0.01). A trend toward
higher immediate postoperative mortality was observed after CCAB (15
studies including 4409 patients, pooled rates: 6.5%, 95% CI 5.2-8.0 vs
5.6%, 95% CI 4.2-7.4, RR 1.29, 95% CI 0.86-1.93, P = 0.21). Generic
inverse variance analysis showed similar intermediate survival after CCAB
and OPCAB (RR 1.31, 95% CI 0.85-2.01, P = 0.22). At 2 years, survival was
82.8% (95% CI 76.4-89.2) after CCAB and 88.3% (95% CI 82.9-93.7) after
OPCAB. Current results indicate that OPCAB compared with CCAB in patients
aged >=80 years is associated with significantly lower postoperative
stroke and with a trend toward better early survival. However, suboptimal
quality of the available studies, particularly the lack of comparability
of the study groups, prevents conclusive results on this controversial
issue. 2011 Springer.

<4>
Accession Number
2013043798
Authors
Lomivorotov V.V. Efremov S.M. Kalinichenko A.P. Kornilov I.A. Knazkova
L.G. Chernyavskiy A.M. Lomivorotov V.N. Karaskov A.M.
Institution
(Lomivorotov, Efremov, Kalinichenko, Kornilov, Knazkova, Chernyavskiy,
Lomivorotov, Karaskov) Research Institute of Circulation Pathology,
Rechkunovskaya Street 15, Novosibirsk 630055, Russian Federation
Title
Methylprednisolone Use is Associated with Endothelial Cell Activation
Following Cardiac Surgery.
Source
Heart Lung and Circulation. 22 (1) (pp 25-30), 2013. Date of Publication:
January 2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: The objective of this study was to investigate the effect of
the perioperative use of methylprednisolone in medium doses on markers of
endothelial cell activation in patients with coronary artery disease
undergoing cardiopulmonary bypass. Methods: In this prospective,
double-blinded, placebo-controlled, randomised study, 44 patients,
undergoing a coronary artery bypass graft surgery received either
methylprednisolone 20mg/kg or a placebo intraoperatively after anaesthesia
induction. The primary endpoint was endothelin-1, and secondary endpoints
were E-selectin, interleukin (IL)-6 and IL-10,
PaO₂/FiO₂ coefficient, and microalbuminuria.
Results: Endothelin-1 was higher in the study group postoperatively at
10min (p=0.0008), 2h (p=0.02), 4h (p=0.005), and 24h (p=0.004). IL-6 was
lower in the study group postoperatively at 2h (p=0.03), 4h (p=0.04), and
24h (p<0.0001). IL-10 was higher in the study group postoperatively at
10min (p<0.0001), 2h (p=0.009), and 4h (p=0.001).
PaO₂/FiO₂ was lower in the study group at 24h after
surgery (p=0.03). Microalbuminuria was similar in both groups. Conclusion:
Despite an obvious anti-inflammatory effect, methylprednisolone causes
endothelial cell activation in patients undergoing cardiopulmonary bypass.
2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

<5>
Accession Number
2013044601
Authors
Park J.-B. Koo B.-K. Choi W.-G. Kim S.-Y. Park J. Kwan J. Park C.G. Kim
H.-S.
Institution
(Park, Koo, Kim) Division of Cardiology, Department of Internal
Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul,
South Korea
(Choi) Division of Cardiology, Department of Internal Medicine, Konkuk
University Chungju Hospital, Chungju, South Korea
(Kim) Department of Cardiology, Seoul Medical Center, Seoul, South Korea
(Park) Division of Cardiology, Department of Internal Medicine, Sejong
General Hospital, Bucheon, South Korea
(Kwan) Division of Cardiology, Department of Internal Medicine, Inha
University Hospital, Incheon, South Korea
(Park) Division of Cardiology, Cardiovascular Center, Korea University
Guro Hospital, Seoul, South Korea
Title
Comparison of Antiplatelet Efficacy and Tolerability of Clopidogrel
Napadisilate With Clopidogrel Bisulfate in Coronary Artery Disease
Patients After Percutaneous Coronary Intervention: A Prospective,
Multicenter, Randomized, Open-Label, Phase IV, Noninferiority Trial.
Source
Clinical Therapeutics. 35 (1) (pp 28-37.e4), 2013. Date of Publication:
January 2013.
Publisher
Excerpta Medica Inc. (105 Raider Blvd, Suite 101, Hillsborough NJ 08844,
United States)
Abstract
Background: Clopidogrel bisulfate, a potent antiplatelet agent, has a
pivotal role in the prevention and treatment of atherothrombotic disease.
Clopidogrel napadisilate, a different salt preparation of clopidogrel, has
been developed and approved in Korea and several European countries.
Recent studies have suggested that clopidogrel napadisilate might have
improved stability and comparable bioequivalence to clopidogrel bisulfate.
However, these 2 clopidogrel preparations have not been compared in terms
of efficacy and tolerability in patients with coronary artery disease
(CAD) who underwent percutaneous coronary intervention (PCI). Objective:
We sought to investigate the antiplatelet efficacy and safety profile of
clopidogrel napadisilate compared with clopidogrel bisulfate in CAD
patients. Methods:This was a randomized, multicenter, open-label, Phase
IV, noninferiority clinical trial. We prospectively recruited CAD patient
in 6 institutions in Korea between October 2010 and November 2011.
Patients who underwent PCI were randomly assigned to the test group
(clopidogrel napadisilate plus aspirin) or control group (clopidogrel
bisulfate plus aspirin). Antiplatelet efficacy and safety profile were
assessed after 4 weeks of maintenance treatment. The primary end point was
noninferiority of the percentage of P2Y₁₂ inhibition, measured
by point-of-care assay. The rate of major adverse cardiovascular events
(MACE), as a secondary end point, was compared between the 2 clopidogrel
preparations. To assess tolerability, we evaluated the incidence,
severity, and causal relation of adverse events (AEs) of 2 groups. Results
A total of 169 patients were screened, and 127 patients completed the
study (64 in the test group and 63 in the control group; P = 0.296). The
baseline characteristics of patients did not differ significantly between
the treatment groups. The between-group difference in percentage of
P2Y₁₂ inhibition did not exceed the prespecified limit for
noninferiority P for noninferiority = 0.032; 95% CI, -8.33 to 5.53). With
respect to the risk of MACE, no significant difference was found in the
incidence of myocardial infarction or stroke between the groups (1 in the
test group and 2 in the control group; P > 0.99); no mortality was
reported in either group. The tolerability of clopidogrel napadisilate was
comparable with that of clopidogrel bisulfate in terms of all AEs,
drug-related AEs, and serious AEs (all AEs: test group, 33.3%; control
group, 32.9% [P > 0.99]; drug-related AEs: test group, 4.17%; control
group, 0% [P = 0.113]; serious AEs: test group, 1.39%; control group,
5.26% [P=0.367]). Conclusions: In this study of CAD Korean patients who
have undergone PCI, the antiplatelet efficacy of clopidogrel napadisilate
was noninferior to that of clopidogrel bisulfate after 4 weeks of
maintenance treatment. No statistically significant difference was found
in tolerability between the 2 treatment groups. ClinicalTrials.gov
identifier: NCT01584791. 2013 Elsevier HS Journals, Inc.

<6>
Accession Number
2013038487
Authors
Alvarez V. Rossetti A.O. Papavasileiou V. Michel P.
Institution
(Alvarez, Rossetti, Papavasileiou, Michel) Department of Clinical
Neurosciences, Centre Hospitalier Universitaire Vaudois, University of
Lausanne, 1011 Lausanne, Switzerland
Title
Acute seizures in acute ischemic stroke: Does thrombolysis have a role to
play?.
Source
Journal of Neurology. 260 (1) (pp 55-61), 2013. Date of Publication:
January 2013.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Seizures appear at stroke presentation, during the acute phase or as a
late complication of stroke. Thrombolysis has not been investigated as a
risk factor despite its potential neurotoxic effect. We try to identify
risk factors for seizures during the acute phase of ischemic stroke in a
cohort including thrombolysed patients. We undertook a case-control study
at a single stroke center using data from Acute Stroke Registry and
Analyse of Lausanne (ASTRAL). Patients with seizure occurring during the
first 7 days following stroke were retrospectively identified. Bi-variable
and multivariable statistical analyses were applied to compare cases and
randomly selected controls. We identified 28 patients experiencing from
seizures in 2,327 acute ischemic strokes (1.2 %). All seizures occurred
during the first 72 h. Cortical involvement, thrombolysis with rt-PA,
arterial recanalization, and higher initial NIHSS were statistically
associated with seizures in univariated analysis. Backward linear
regression identified cortical involvement (OR 7.53, 95 % CI 1.6-35.2, p <
0.01) and thrombolysis (OR 4.6, 95 % CI 1.6-13.4, p = 0.01) as being
independently associated with seizure occurrence. Overall, 3-month outcome
measured by the modified Rankin scale (mRS) was comparable in both groups.
In the subgroup of thrombolysed patients, outcome was significantly worse
at 3 months in the seizure group with 9/12 (75 %) patients with mRS >=3,
compared to 6/18 (33.3 %) in the seizure-free group (p = 0.03). Acute
seizures in acute ischemic stroke were relatively infrequent. Cortical
involvement and thrombolysis with rt-PA are the principal risk factors.
Seizures have a potential negative influence on clinical outcome in
thrombolysed patients. 2012 Springer-Verlag.

<7>
Accession Number
2013034057
Authors
Lomivorotov V.V. Efremov S.M. Boboshko V.A. Nikolaev D.A. Vedernikov P.E.
Lomivorotov V.N. Karaskov A.M.
Institution
(Lomivorotov, Efremov, Boboshko, Nikolaev, Vedernikov, Lomivorotov,
Karaskov) Department of Anesthesiology and Intensive Care, Research
Institute of Circulation Pathology, Novosibirsk, Russian Federation
Title
Evaluation of nutritional screening tools for patients scheduled for
cardiac surgery.
Source
Nutrition. 29 (2) (pp 436-442), 2013. Date of Publication: February 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objective: The aim of this study was to assess the prognostic value of
different nutritional screening tools in patients undergoing
cardiopulmonary bypass with regard to an adverse clinical course. Methods:
This prospective cohort study analyzed 894 adult patients who underwent
cardiopulmonary bypass. Patients were screened using four nutritional
screening tools: Nutritional Risk Screening 2002 (NRS-2002), the
Malnutrition Universal Screening Tool (MUST), the Mini-Nutritional
Assessment (MNA), and the Short Nutritional Assessment Questionnaire
(SNAQ). Nutritional status was assessed using the Subjective Global
Assessment. In-hospital mortality, postoperative complications, length of
stay in the intensive care unit, and length of hospitalization were
analyzed. Results: The sensitivities of the SNAQ, MUST, and NRS-2002 to
detect the malnutrition confirmed by the Subjective Global Assessment were
91.5%, 97.9%, and 38.3%, respectively, and the MNA showed a sensitivity of
81.8% for the elderly. Malnutrition detected by the SNAQ, MUST, and
NRS-2002 was associated with postoperative complications (odds ratios
[ORs] 1.75, 1.98, and 1.82, respectively) and a stay in the intensive care
unit longer than 2 d (ORs 1.46, 1.56, and 2.8). Malnutrition as detected
by the SNAQ and MUST was also associated with prolonged hospitalization
(ORs 1.49 and 1.59). According to multivariate logistic regression
analysis, postoperative complications were independently predicted by the
European System for Cardiac Operative Risk Evaluation (OR 1.1, P <
0.0001), cardiopulmonary bypass time (OR 1.01, P < 0.0001), and
malnutrition identified by the MUST (OR 1.2, P = 0.01). Conclusion: The
MUST independently predicts postoperative complications. The SNAQ and MUST
have comparable accuracy in detecting malnutrition. Whether preoperative
nutritional therapy would improve the outcome in malnourished patients
needs to be studied. 2013 Elsevier Inc.

<8>
Accession Number
2013035819
Authors
Kassaian S.E. Abbasi K. Hakki Kazazi E. Soltanzadeh A. Alidoosti M. Karimi
A. Shirani S. Salarifar M. Ahmadi S.H. Hajizeinali A.M. Razmjoo K.
Institution
(Kassaian, Alidoosti, Salarifar, Hajizeinali) Department of Interventional
Cardiology, Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Abbasi, Karimi, Ahmadi) Department of Cardiothoracic Surgery, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Hakki Kazazi) Department of Research, Tehran Heart Center, Tehran
University of Medical Sciences, North Kargar Street, 1411713138 Tehran,
Iran, Islamic Republic of
(Soltanzadeh, Razmjoo) Department of Neurology, Shariati Hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Shirani) Department of Radiology, Tehran Heart Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Staged carotid artery stenting and coronary artery bypass surgery versus
isolated coronary artery bypass surgery in concomitant coronary and
carotid disease.
Source
Journal of Invasive Cardiology. 25 (1) (pp 8-12), 2013. Date of
Publication: January 2013.
Publisher
HMP Communications (83 General Warren Blvd. Suite 100, Malven PA 19355,
United States)
Abstract
BACKGROUND: We aimed to compare the outcomes of patients who underwent
carotid artery stenting (CAS) followed by coronary artery bypass grafting
(CABG) with the outcomes of those who underwent isolated CABG without
carotid intervention. METHODS: In this prospective cohort study, conducted
between March 2007 and February 2010, all patients who had significant
carotid artery stenosis (>70%) and were candidates for CABG were included.
The outcome measures, including 30-day post-stenting complications,
cardiac surgery neurological complications, myocardial infarction (MI),
and mortality rates, were assessed. RESULTS: A total of 112 patients
underwent CABG without carotid artery intervention and 62 patients were
scheduled for CAS + CABG. The death and MI or stroke rates in the CAS +
CABG patients and isolated CABG group were 9.7% and 6.3%, respectively
(P=.18). In the CAS + CABG group, 4 patients (6.4%) were complicated by
ipsilateral stroke, 2 (3.2%) by MI, and 3 (4.8%) by death; 2 deaths had
neurological causes and 1 death had a cardiac cause. In the isolated CABG
group, 4 stroke cases (3.6%) were diagnosed in the postoperative period, 2
of them (1.8%) being ipsilateral. Also, 1 MI case (0.9%) and 4 deaths
(3.6%) occurred after cardiac surgery; 2 deaths had neurological causes
and the remaining 2 deaths resulted from other postoperative complications
(mediastinitis and arrhythmia). CONCLUSION: The risk of ipsilateral stroke
in the isolated CABG approach in patients with concomitant coronary and
carotid stenosis is small, and there is no evidence that this risk is
lessened by prophylactic CAS. Staged CAS + CABG may become the preferred
option in patients with symptomatic bilateral carotid stenosis with stable
cardiac status if it is conducted in a high-volume center by experienced
operators.

<9>
Accession Number
2013035396
Authors
Straka Z. Budera P. Osmancik P. Vanek T. Hulman M. Smid M. Maly M.
Widimsky P.
Institution
(Straka, Budera, Osmancik, Vanek, Widimsky) Cardiocenter, Third Faculty of
Medicine, Charles University Prague, Czech Republic
(Hulman) National Institute of Cardiovascular Diseases, Bratislava,
Slovakia
(Smid) Cardiocenter, Faculty of Medicine, Charles University Prague,
Pilsen, Czech Republic
(Maly) National Institute of Public Health, Prague, Czech Republic
Title
Design and rationale of the PRAGUE-12 trial: A large, prospective,
randomized, multicenter trial that compares cardiac surgery with left
atrial surgical ablation with cardiac surgery without ablation in patients
with coronary and/or valvular heart disease plus atrial fibrillation.
Source
Clinical Cardiology. 36 (1) (pp 1-5), 2013. Date of Publication: January
2013.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Surgical ablation procedure can restore sinus rhythm (SR) in patients with
atrial fibrillation (AF) undergoing cardiac surgery. However, it is not
known whether it has any impact on clinical outcomes. There is a need for
a randomized trial with long-term follow-up to study the outcome of
surgical ablation in patients with coronary and/or valve disease and AF.
Patients are prospectively enrolled and randomized either to group A
(cardiac surgery with left atrial ablation) or group B (cardiac surgery
alone). The primary efficacy outcome is the SR presence (without any AF
episode) during a 24-hour electrocardiogram after 1 year. The primary
safety outcome is the combined end point of death, myocardial infarction,
stroke, and renal failure at 30 days. Long-term outcomes are a composite
of total mortality, stroke, bleeding, and heart failure at 1 and 5 years.
We finished the enrollment with a total of 224 patients from 3 centers in
2 countries in December 2011. Currently, the incomplete 1-year data are
available, and the patients who enrolled first will have their 5-year
visits shortly. PRAGUE-12 is the largest study to be conducted so far
comparing cardiac surgery with surgical ablation of AF to cardiac surgery
without ablation in an unselected population of patients who are operated
on for coronary and/or valve disease. Its long-term results will lead to a
better recognition of ablation's potential clinical benefits. The
PRAGUE-12 trial is partially funded by the Charles University Research
Projects MSM0021620817 and UNCE 204010/2012. The authors have no other
funding, financial relationships, or conflicts of interest to disclose.
2012 Wiley Periodicals, Inc.

<10>
Accession Number
2013033062
Authors
Farah P. Ahmad-Ali A. Hanane G. Abbas E.
Institution
(Farah, Hanane) Department of Pediatrics, Islamic Azad University, Kazerun
Branch, Kazerun, Iran, Islamic Republic of
(Ahmad-Ali) Department of Surgery, Division of Cardiovascular Surgery,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Abbas) Department of Medicine, New York Medical College, Valhalla, NY,
United States
Title
Additive effect of phosphodiesterase inhibitors in control of pulmonary
hypertension after congenital cardiac surgery in children.
Source
Iranian Journal of Pediatrics. 23 (1) (pp 19-26), 2013. Date of
Publication: February 2013.
Publisher
Tehran University of Medical Sciences (TUMS) (No. 31, Poursina St. Ghods
Ave, Tehran, Iran, Islamic Republic of)
Abstract
Objective: Control of residual pulmonary arterial hypertension (PAH) after
closure of left to right shunts in children is still a challenging issue.
The purpose of this study was to compare the effect of two
phosphodiesterase inhibitors in pediatric cardiac surgical patients.
Methods: A total of 48 postoperative children were enrolled in the study
between 2008 and 2010. Patients were stratified based upon choice of
pulmonary vasodilator into three equal groups (n=16); Milrinone group
received intravenous milrinone (0.75 mu/kg/min), Sildenafil group received
oral sildenafil (0.3 mg/kg every 3 hours) and the Combination group
received both medications. Findings: Demographic variables and types of
congenital anomalies were not different among the 3 groups. Patients in
the Combination group had higher preoperative pulmonary artery to aortic
(PA/AO) pressure ratios compared to other two groups (P=0.001).
Postoperatively, patients in Milrinone group incurred lower systolic PA
and PA/AO pressures compared to Sildenafil group (P=0.014, 0.003), but it
was the same in Sildenafil and Combination group (P=0.2; 0.330
respectively). Pulmonary hypertensive crisis was noted in 6 patients in
Sildenafil group, and 3 patients in Combination group (P=0.02).
Significant rise in PA pressure was noticed after discontinuation of drug
in Milrinone group (P=0.001), which was not observed in the Combination
group (P= 0.6). No mortality was noticed in any of the groups. Conclusion:
Intravenous milrinone is more effective than oral sildenafil in control of
postoperative PAH and elimination of pulmonary hypertensive crisis.
Combination of two drugs reduces the risk of rebound pulmonary arterial
hypertension after discontinuation of milrinone. 2013 by Pediatrics
Center of Excellence, Children's Medical Center, Tehran University of
Medical Sciences, All rights reserved.

<11>
Accession Number
2013025672
Authors
Poon K.K. Crowhurst J. James C. Campbell D. Roper D. Chan J. Incani A.
Clarke A. Tesar P. Aroney C. Raffel O.C. Walters D.L.
Institution
(Poon, James, Roper, Chan, Incani, Clarke, Tesar, Aroney, Raffel, Walters)
Cardiology Program, Prince Charles Hospital, Rode Road, Brisbane, QLD
4032, Australia
(Crowhurst, Campbell) Department of Radiology, Prince Charles Hospital,
Brisbane, QLD, Australia
(Clarke, Tesar) Department of Cardiothoracic Surgery, Prince Charles
Hospital, Brisbane, QLD, Australia
Title
Impact of optimising fluoroscopic implant angles on paravalvular
regurgitation in transcatheter aortic valve replacements - Utility of
three-dimensional rotational angiography.
Source
EuroIntervention. 8 (5) (pp 538-545), 2012. Date of Publication: September
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The clinical value of optimising implant angles during transcatheter
aortic valve replacements (TAVR) remains undefined. The Aortic Valve Guide
(AVG) is a proprietary software that provides structured analysis of
three-dimensional images from rotational angiography (DynaCT). This study
compares AVG with preprocedural multislice computed tomography (MSCT) and
DynaCT in optimal implant angle prediction for TAVR, and evaluates if an
optimised implant angle is associated with reduced paravalvular
regurgitation (PVR). Methods and results: One hundred and six consecutive
patients were included, comprising three groups. Group 1 (n=19) underwent
no preprocedural MSCT or DynaCT (or AVG); Group 2 (n=44) underwent
periprocedural DynaCT, without AVG; Group 3 (n=43) had DynaCT with AVG.
Implant angles yielded were graded as excellent, satisfactory or poor.
Group 3 were more likely than Groups 2 and 1 to have excellent implant
angles (83.7% vs. 52.3% vs. 42.1%, respectively, p=0.001). In 100 patients
who had 30-day transthoracic echocardiogram follow-up, an excellent
implant angle was significantly more likely to be associated with no PVR
than a non-excellent angle (41.3% vs. 21.6%, respectively, p=0.045),
independent of operator experience and THV used. Conclusions: Optimising
implant angles may be important in reducing PVR. This is significantly
more likely to be achieved with AVG rotational angiography. Europa
Digital & Publishing 2012. All rights reserved.

<12>
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Accession Number
2013032256
Authors
Soro M. Gallego L. Silva V. Ballester M.T. Llorens J. Alvarino A.
Garcia-Perez M.L. Pastor E. Aguilar G. Marti F.J. Carratala A. Belda F.J.
Institution
(Soro, Gallego, Silva, Ballester, Llorens, Garcia-Perez, Pastor, Aguilar,
Marti, Belda) Department of Anaesthesia and Critical Care, Central
Laboratory, Hospital Clinico Universitario de Valencia, Avenida Blasco
Ibanez 17, 46010 Valencia, Spain
(Alvarino, Carratala) Department of Clinical Chemistry, Central
Laboratory, Hospital Clinico Universitario de Valencia, Valencia, Spain
(Marti) Department of Surgery, University of Valencia, Valencia, Spain
Title
Cardioprotective effect of sevoflurane and propofol during anaesthesia and
the postoperative period in coronary bypass graft surgery: A double-blind
randomised study.
Source
European Journal of Anaesthesiology. 29 (12) (pp 561-569), 2012. Date of
Publication: December 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Context: Volatile anaesthetics may have direct cardioprotective properties
due to effects similar to ischaemic preconditioning and postconditioning.
Clinical results in cardiac surgery patients are controversial and may be
related to the timing of administration of anaesthetics intraoperatively.
Objective: We hypothesised that the cardioprotective effect of sevoflurane
in coronary bypass graft surgical patients would be greater if
administration during anaesthesia continued in the ICU for at least 4 h
postoperatively until weaning from mechanical ventilation. Design:
Double-blind, double-dummy, prospective, randomised and controlled
clinical trial. Setting: In a single centre between June 2006 and June
2007. Patients Seventy-five adult patients were assigned randomly to
receive anaesthesia and postoperative sedation either with propofol
(control, n=37) or sevoflurane (n=36). Intervention:s Myocardial
biomarkers were measured before surgery, at the time of admission to the
intensive care unit and at 6, 24, 48 and 72 h. The need for inotropic
support, and lengths of stay in the intensive care unit and hospital were
also recorded. Main outcome measures: Elevation of myocardial biomarkers
was the primary endpoint. The secondary endpoints were haemodynamic events
and lengths of stay in the intensive care unit and hospital. Results:
Necrosis biomarkers increased significantly in the postoperative period in
both groups with no significant differences at any time. Inotropic support
was needed in 72.7 and 54.3% of patients in the propofol and sevoflurane
groups, respectively (P=0.086). There were no significant differences in
haemodynamic variables, incidence of arrhythmias, myocardial ischaemia or
and lengths of stay in the ICU and hospital between the two groups.
Conclusion: In patients undergoing coronary bypass graft surgery,
continuous administration of sevoflurane as a sedative in the ICU for at
least 4 h postoperatively did not yield significant improvements in the
extent and time course of myocardial damage biomarkers compared to
propofol. 2012 Copyright European Society of Anaesthesiology.

<13>
Accession Number
2013034546
Authors
Samiei N. Kashfi F. Khamoushi A. Hosseini S. Ghavidel A.A. Taheripanah R.
Mirmesdagh Y.
Institution
(Samiei, Kashfi, Khamoushi, Hosseini, Ghavidel, Mirmesdagh) Heart Valve
Disease Research Center, Rajaei Cardiovascular Medical and Research
Center, Tehran University of Medical Sciences, Vali-Asr Avenue, Tehran,
Iran, Islamic Republic of
(Kashfi) Reproductive Epidemiology Research Center, Roy an Institute,
ACECR, Tehran, Iran, Islamic Republic of
(Taheripanah) Imam Hossein Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Pregnancy outcome after mechanical mitral valve replacement: A prospective
study.
Source
Journal of Tehran University Heart Center. 7 (3) (pp 117-120), 2012. Date
of Publication: Summer 2012.
Publisher
Tehran Heart Center (North Kargar Street, Tehran 1411713138, Iran, Islamic
Republic of)
Abstract
Background: Pregnant patients with mechanical heart valves require
anticoagulation. The risk of bleeding and embryopathy associated with oral
anticoagulants must be weighed against the risk of valve thrombosis.
Methods: In this prospective study, undertaken between 1999 and 2009, 53
pregnancies (47 women with mechanical mitral valves; 29.8 +/- 4.8 years
old) were studied. Patients were divided into two groups: group I (n = 43)
received Warfarin throughout the pregnancy, while group 11 (n = 10)
received Heparin in the first trimester and then Warfarin until the 36th
week. Results: Thirty-two (60.4%) pregnancies resulted in live births,
whereas 18 (34%) abortions, 2 (3.8%) stillbirths, and one (1.9%) maternal
death occurred. In group I, there were 26 (60.5%) live births, one (2.3%)
stillbirth, and 15 (34.9%) abortions. In group II, there were 6 (60%) live
births, one (10%) stillbirth, and 3 (30%) abortions. There were no
significant differences between the two groups in terms offetal outcome.
Thirty-nine (90.7%) of the pregnancies in group I and 50% of those in
group II (p value = 0.001) were without complications. There were no
congenital malformations in the two groups. Conclusion: Fetal outcome was
almost the same between the Warfarin and Heparin regimens. In maternal
outcome, the Warfarin regimen is safer than Heparin.

<14>
Accession Number
2013026922
Authors
El Tahan M.R. Khidr A.M.
Institution
(El Tahan, Khidr) Department of Anesthesiology, King Fahd Hospital,
University of Dammam, Al Aqrabiah Street, Al Khubar 31952, Saudi Arabia
(El Tahan) Cardiothoracic Anesthesia Unit, Mansoura University, Mansoura
City, Egypt
Title
Low target sufentanil effect-site concentrations allow early extubation
after valve surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (1) (pp 63-70),
2013. Date of Publication: February 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To test the ability of low sufentanil effect-site
concentrations (Ce) to shorten the time to tracheal extubation after valve
surgery. Design: A prospective, randomized, blinded, controlled study.
Setting: A single university hospital. Participants: Forty-eight patients
scheduled for valve surgery under target-controlled propofol infusion.
Interventions: After ethical committee approval, patients were allocated
randomly to receive sufentanil concentrations of 0.2, 0.3, or 0.4 ng/mL (n
= 16 per group) during target-controlled propofol infusion. Measurements
and Main Results: Times to spontaneous eye opening, return of spontaneous
breathing and extubation; number of changes and cumulative doses of
propofol and sufentanil; incidences of light anesthesia and myocardial
ischemia; intensive care unit and hospital stays; and costs of propofol,
sufentanil, and ventilation were recorded. Compared with the sufentanil
0.4-ng/mL group, 0.2- and 0.3-ng/mL groups had shorter times to eye
opening (24.8 min [SD 7.8] and 52.6 min [12.5] v 85.6 min [10.0],
respectively), spontaneous breathing (32.7 min [19.9] and 70.1 min [27.2]
v 137.5 min [20.8], respectively), and extubation (112.2 min [16.9] and
161.9 min [32.9] v 271.3 min [27.4], respectively; p < 0.001), more
frequent changes in propofol concentrations (p < 0.001), higher cumulative
propofol doses, lower cumulative sufentanil doses, and 33% to 44% lower
total cost (p < 0.001). Incidences of light anesthesia and myocardial
ischemia and intensive care unit and hospital stays were similar for all
groups. Conclusions: Compared with sufentanil Ce of 0.4 ng/mL, lower
concentrations (0.2 and 0.3 ng/mL) promoted faster recovery and shorter
times to extubation after valve surgery performed under target-controlled
propofol infusion. 2012 Elsevier Inc.

<15>
Accession Number
2013029888
Authors
Jones N.L. Edmonds L. Ghosh S. Klein A.A.
Institution
(Jones, Edmonds, Ghosh, Klein) Papworth Hospital, Cambridge, United
Kingdom
Title
A review of enhanced recovery for thoracic anaesthesia and surgery.
Source
Anaesthesia. 68 (2) (pp 179-189), 2013. Date of Publication: February
2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
During the past decade, there has been a dramatic increase in the number
of thoracic surgical procedures carried out in the UK. The current
financial climate dictates that more efficient use of resources is
necessary to meet escalating demands on healthcare. One potential means to
achieve this is through the introduction of enhanced recovery protocols,
designed to produce productivity savings by driving reduction in length of
stay. These have been promoted by government bodies in a number of
surgical specialties, including colorectal, gynaecological and orthopaedic
surgery. This review focuses on aspects of peri-operative care that might
be incorporated into such a programme for thoracic anaesthesia, for which
an enhanced recovery programme has not yet been introduced in the UK, and
a review of the literature specific to this area of practice has not been
published before. We performed a comprehensive search for published work
relating to the peri-operative management and optimisation of patients
undergoing thoracic surgery, and divided these into appropriate areas of
practice. We have reviewed the specific interventions that may be included
in an enhanced recovery programme, including: pre-optimisation; minimising
fasting time; thrombo-embolic prophylaxis; choice of anaesthetic and
analgesic technique and surgical approach; postoperative rehabilitation;
and chest drain management. Using the currently available evidence, the
design and implementation of an enhanced recovery programme based on this
review in selected patients as a package of care may reduce morbidity and
length of hospital stay, thus maximising utilisation of available
resources. 2012 The Association of Anaesthetists of Great Britain and
Ireland.

<16>
Accession Number
2013021494
Authors
Markar S.R. Sadat U. Edmonds L. Nair S.K.
Institution
(Markar, Edmonds, Nair) Department of Cardiothoracic Surgery, Papworth
Hospital, Papworth Everard, Cambridge, United Kingdom
(Sadat) Department of Vascular Surgery, Addenbrooke's Hospital, Cambridge,
United Kingdom
Title
Mitral valve repair versus replacement in the elderly population.
Source
Journal of Heart Valve Disease. 20 (3) (pp 265-271), 2011. Date of
Publication: May 2011.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: The study aim was to evaluate the
available literature comparing mitral valve repair (MVRep) versus mitral
valve replacement (MVR) in the elderly population, and to provide a pooled
analysis regarding this issue. Methods: Medline, Embase, Cochrane, trial
registries, conference proceedings and reference lists were searched for
trials of MVRep versus MVR surgery in the elderly population. The primary
outcome was 30-day mortality, while secondary outcomes were postoperative
complications and length of hospital stay. Pooled odds ratios were
calculated for categorical outcomes and weighted mean differences for
continuous outcomes. Results: Four studies retrieved were deemed
appropriate for inclusion. The outcome measures used for the analysis
clearly showed a benefit of MVRep in the elderly population with reduced
mortality (pooled Odds Ratio (OR) = 3.97; p = 0.003) and reduced
postoperative complications (pooled OR = 2.35; p = 0.003). There was no
significant difference between the two groups with regards to duration of
hospital stay (weighted mean difference = 0.22; p = 0.18). Conclusion:
With the demonstration of clear advantages of MVRep over MVR in the
elderly population, a randomized trial between the two techniques is not
ethically justifiable. As there are clear advantages to MVRep, it is
recommended that this should be the primary treatment offered in mitral
valve pathology, irrespective of the patient's age. Copyright by ICR
Publishers 2011.

<17>
Accession Number
70975133
Title
British Cardiovascular Society Annual Conference 2012.
Source
Heart. Conference: British Cardiovascular Society Annual Conference 2012
Manchester United Kingdom. Conference Start: 20120528 Conference End:
20120530. Conference Publication: (var.pagings). 98 , 2012. Date of
Publication: May 2012.
Publisher
BMJ Publishing Group
Abstract
The proceedings contain 156 papers. The topics discussed include: unbiased
assessment of symptomatic 'response rate' to cardiac resynchronization
therapy by systematic review of randomized controlled trials (reverse,
miracle, miracle ICD, miracle ICD II, CARE-HF, companion, CONTAK-CD, and
MUSTIC); a gene-based restoration of Akt activity in endothelial
progenitor cells from human subjects at high cardiovascular risk rescues
vascular reparative capacity; a randomized study of temporary epicardial
cardiac resynchronization vs conventional right ventricular pacing in
cardiac surgical patients; simultaneous invasive pressure and flow
measurements during atrioventricular delay improvement reveal a
compensatory peripheral vasodilator response which attenuates the initial
blood pressure increment: implications for the design of optimization
protocols; and cardiac MRI: understanding myocardial motion to predict
remodeling pre cardiac resynchronization therapy.