EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2013074483
Authors
Alam M. Huang H.D. Shahzad S.A. Kar B. Virani S.S. Rogers P.A. Paniagua D.
Bozkurt B. Palacios I. Kleiman N.S. Jneid H.
Institution
(Alam, Huang, Virani, Rogers, Paniagua, Bozkurt, Jneid) Baylor College of
Medicine, Houston, TX, United States
(Shahzad) Al-Noor Specialist Hospital, Makkah, Saudi Arabia
(Kar, Virani, Paniagua, Bozkurt, Jneid) Michael E. DeBakey VA Medical
Center, Houston, TX, United States
(Palacios) Cardiac Unit, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, United States
(Kleiman) Methodist DeBakey Heart and Vascular Center, Houston, TX, United
States
(Kleiman) Weill Cornell Medical College, New York, NY, United States
Title
Percutaneous coronary intervention vs. coronary artery bypass graft
surgery for unprotected left main coronary artery disease in the
drug-eluting stents era - An aggregate data meta-analysis of 11,148
patients.
Source
Circulation Journal. 77 (2) (pp 372-382), 2013. Date of Publication: 2013.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Patients with unprotected left main coronary artery (LMCA)
disease are increasingly treated with percutaneous coronary intervention
(PCI) using drug-eluting stents (DES), but its benefits compared with
coronary artery bypass grafting (CABG) remain controversial. We
hypothesized that PCI with DES for unprotected LMCA disease is safe and
effective compared with CABG. Methods and Results: We performed aggregate
data meta-analyses of clinical outcomes [death; non-fatal myocardial
infarction (MI); stroke; repeat revascularization; and major adverse
cardiac and cerebrovascular events (MACCE)] in studies comparing PCI with
DES vs. CABG in patients with LMCA disease. A comprehensive literature
search (01/01/2003 to 12/01/2011) identified 27 studies comparing PCI and
CABG (11,148 patients). Summary odds ratios (OR) were calculated using a
random-effects model. At 30 days, PCI for unprotected LMCA disease was
associated with lower MACCE [odds ratio (OR) 0.57, 95% confidence interval
(CI) 0.36-0.89) and stroke rates (OR 0.22, 95% CI 0.11-0.44) compared with
CABG. At 12 months, the PCI group experienced higher rates of repeat
revascularization (OR 3.72, 95% CI 2.75-5.03), but lower rates of stroke
(OR 0.25, 95% CI 0.14-0.44) and all-cause death (OR 0.69, 95% CI
0.49-0.97). At the longest follow-up of 60 months, PCI was associated with
equivalent mortality, lower rates of stroke (OR 0.42, 95% CI 0.28-0.62)
and higher rates of MACCE (OR 1.30, 95% CI 1.10- 1.55) and repeat
revascularization (OR 3.54, 95% CI 2.75-4.54). Conclusions: In the DES
era, PCI for unprotected LMCA disease is associated with equivalent
mortality and MI, lower stroke rates and higher rates of repeat
revascularization compared with CABG.

<2>
Accession Number
2013077113
Authors
Anderson J.L.
Institution
(Anderson) ACCF/AHA Task Force on Practice Guidelines, United States
Title
2013 ACCF/AHA guideline for the management of ST-elevation myocardial
infarction: A report of the American College of Cardiology
Foundation/American Heart Association Task Force on practice guidelines.
Source
Circulation. 127 (4) (pp e362-e425), 2013. Date of Publication: 29 Jan
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<3>
[Use Link to view the full text]
Accession Number
2013072144
Authors
Benedetto U. Angeloni E. Melina G. Danesi T.H. Di Bartolomeo R.
Lechiancole A. Refice S. Roscitano A. Comito C. Sinatra R.
Institution
(Benedetto, Angeloni, Melina, Danesi, Di Bartolomeo, Lechiancole, Refice,
Roscitano, Comito, Sinatra) Department of Cardiac Surgery, University of
Rome Sapienza, Policlinico S. Andrea, Via di Grottarossa 1039, Rome, Italy
Title
N-3 Polyunsaturated fatty acids for the prevention of postoperative atrial
fibrillation: A meta-analysis of randomized controlled trials.
Source
Journal of Cardiovascular Medicine. 14 (2) (pp 104-109), 2013. Date of
Publication: February 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND: n-3 Polyunsaturated fatty acids (n-3 PUFAs) have been proposed
as prophylactic therapy in the prevention of postoperative atrial
fibrillation (POAF) in patients undergoing cardiac surgery. We conducted a
meta-analysis of randomized controlled trials to better clarify this
issue. METHODS: An electronic database search for randomized controlled
trials on the effect of n-3 PUFAS on POAF was conducted, limited to
English language publications until December 2010. For each study, data
regarding the incidence of POAF were used to generate risk ratio (<1,
favors n-3 PUFA; >1, favors placebo). Pooled summary effect estimate was
calculated by means of a fixed or random effect according to
heterogeneity. Meta-regression was used to investigate the effect of
eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) ratio and
preoperative beta-blockers on the effect of n-3 PUFA on POAF. RESULTS:
Three publications were included in the analysis, enrolling a total of 431
patients. Overall incidence of POAF ranged from 24 to 54%. Pooling data,
n-3 PUFA did not show a significant effect on the risk of POAF [risk ratio
0.89; 95% confidence interval (CI) 0.55-1.44; PaS=aS0.63]. However,
meta-regression analysis showed a trend toward a benefit from n-3 PUFA
supplementation when the EPA/DHA ratio was 1:2 (Q modelaS= aS7.4; p
modelaS=aS0. 02) and when preoperative beta-blocker rate was lower (Q
modela S=aS8.0; p modelaS= aS0.01). CONCLUSION: In conclusion, the results
of the present meta-analysis of randomized controlled trials suggest that
preoperative n-3 PUFA therapy may not reduce POAF in patients undergoing
cardiac surgery. However, several aspects may have influenced this
negative result, which need to be investigated. 2013 Italian Federation
of Cardiology.

<4>
Accession Number
2013061271
Authors
Hougaard K.D. Hjort N. Zeidler D. Sorensen L. Norgaard A. Thomsen R.B.
Jonsdottir K. Mouridsen K. Hansen T.M. Cho T.-H. Nielsen T.T. Botker H.E.
Ostergaard L. Andersen G.
Institution
(Hougaard, Thomsen, Andersen) Department of Neurology, Aarhus University
Hospital, Aarhus, Denmark
(Hougaard, Hjort, Zeidler, Sorensen, Jonsdottir, Mouridsen, Ostergaard)
Center of Functionally Integrative Neuroscience, Aarhus University/Aarhus
University Hospital, Aarhus, Denmark
(Norgaard, Ostergaard) Department of Neuroradiology, Aarhus University
Hospital, Aarhus, Denmark
(Hansen) Mobil Emergency Care Unit Aarhus, Aarhus University Hospital,
Aarhus, Denmark
(Cho) Stroke Department, Hopital Neurologique Pierre Wertheimer, Hospices
Civils de Lyon, University of Lyon, Lyon, France
(Nielsen, Botker) Department of Cardiology, Aarhus University Hospital,
Skejby, Skejby, Denmark
Title
Remote ischemic perconditioning in thrombolysed stroke patients:
Randomized study of activating endogenous neuroprotection - design and MRI
measurements.
Source
International Journal of Stroke. 8 (2) (pp 141-146), 2013. Date of
Publication: February 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background: Intravenous administration of alteplase is the only approved
treatment for acute ischemic stroke. Despite the effectiveness of this
treatment, 50% of patients suffer chronic neurological disability, which
may in part be caused by ischemia-reperfusion injury. Remote ischemic
perconditioning, performed as a transient ischemic stimulus by
blood-pressure cuff inflation to an extremity, has proven effective in
attenuating ischemia-reperfusion injury in animal models of stroke. Remote
ischemic perconditioning increases myocardial salvage in patients
undergoing acute revascularization for acute myocardial infarction. To
clarify whether a similar benefit can be obtained in patients undergoing
thrombolysis for acute stroke, we included patients from June 2009 to
January 2011. Aim and design: The aims of the study are: to estimate the
effect of remote ischemic perconditioning as adjunctive therapy to
intravenous alteplase of acute ischemic stroke within the 4-h time window
and to investigate the feasibility of remote ischemic perconditioning
performed during transport to hospital in patients displaying symptoms of
acute stroke. Patients are randomized to remote ischemic perconditioning
in a single-blinded fashion during transportation to hospital. Only
patients with magnetic resonance imaging-proven ischemic stroke, who
subsequently are treated with intravenous alteplase, and in selected cases
additional endovascular treatment, are finally included in the study.
Study outcomes: Primary end-point is penumbral salvage. Penumbra is
defined as hypoperfused yet viable tissue identified as the mismatch
between perfusion-weighted imaging and diffusion-weighted imaging lesion
on magnetic resonance imaging scans. Primary outcome is a mismatch volume
not progressing to infarction on one-month follow-up T2 fluid attenuated
inversion recovery. Secondary end-points include: infarct growth
(expansion of the diffusion-weighted imaging lesion) from baseline to the
24-h and one-month follow-up examination. Infarct growth inside and
outside the acute perfusion-weighted imaging-diffusion-weighted imaging
mismatch zone is quantified by use of coregistration. Clinical outcome
after three-months. The influence of physical activity (Physical Activity
Scale for the Elderly score) on effect of remote ischemic perconditioning.
Feasibility of remote ischemic perconditioning in acute stroke patients.
Summary: This phase 3 trial is the first study in patients with acute
ischemic stroke to evaluate the effect size of remote ischemic
perconditioning as a pretreatment to intravenous alteplase, measured as
penumbral salvage on multimodal magnetic resonance imaging and clinical
outcome after three-months follow-up. 2012 The Authors. International
Journal of Stroke 2012 World Stroke Organization.

<5>
Accession Number
2012742443
Authors
Head S.J. Mack M.J. Holmes Jr. D.R. Mohr F.W. Morice M.-C. Serruys P.W.
Kappetein A.P.
Institution
(Head, Kappetein) Department of Cardio-thoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Mack) The Heart Hospital, Baylor Health Care System, Plano, TX, United
States
(Holmes Jr.) Department of Cardiovascular Disease, Mayo Clinic Rochester,
Rochester, MN, United States
(Mohr) Department of Cardiac Surgery, Heart Cente, University Leipzig,
Leipzig, Germany
(Morice) Department of Cardiology, Institut Hospitalier Jacques Cartier,
Massy, France
(Serruys) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
Title
Incidence, predictors and outcomes of incomplete revascularization after
percutaneous coronary intervention and coronary artery bypass grafting: A
subgroup analysis of 3-year SYNTAX data.
Source
European Journal of Cardio-thoracic Surgery. 41 (3) (pp 535-541), 2012.
Date of Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objective: To assess whether incomplete revascularization by percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG) has
an effect on long-term outcomes. Methods: During a heart team discussion
to evaluate whether patients were eligible for randomization in the SYNTAX
trial, both the cardiologist and surgeon agreed on which vessels needed
revascularization. This statement was compared with the actual
revascularization after treatment. Incomplete revascularization was
defined as when a preoperatively identified vessel with a lesion was not
revascularized. Outcomes were major adverse cardiac or cerebrovascular
events (MACCE), the composite safety endpoint of death/ stroke/myocardial
infarction (MI), and individual MACCE components death, MI and repeat
revascularization at 3 years. Predictors of incomplete revascularization
were explored. Results: Incomplete revascularization was found in 43.3%
(388/896) PCI and 36.8% (320/870) CABG patients. Patients with complete
revascularization by PCI had lower rates of MACCE (66.5 versus 76.2%,
P<0.001), the composite safety endpoint (83.4 versus 87.9%,P=0.05) and
repeat revascularization (75.5 versus 83.9%, P<0.001), but not death and
MI. In the CABG group, no difference in outcomes was seen between
incomplete and complete revascularization groups. Incomplete
revascularization was identified as independent predictor of MACCE in PCI
(HR=1.55, 95% CI 1.15-2.08,P=0.004) but not CABG patients. Independent
predictors of incomplete revascularization by PCI were hyperlipidaemia
(OR=1.59, 95% CI 1.04-2.42, P=0.031), a total occlusion (OR=2.46, 95% CI
1.66-3.64, P< 0.001) and the number of vessels (OR =1.58, 95% CI
1.41-1.77, P< 0.001). Independent predictors of incomplete
revascularization by CABG were unstable angina (OR =1.42, 95% CI
1.02-1.98,P=0.038), diffuse disease or narrowed (<2 mm) segment distal to
the lesion (OR=1.87, 95% CI 1.31-2.69,P =0.001) and the number of vessels
(OR =1.70, 95% CI 1.53-1.89, P < 0.001). Conclusions: Despite the
hypothesis-generating nature of this data, this study demonstrates that
incomplete revascularization is associated with adverse events during
follow-up after PCI but not CABG. The Author 2011. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<6>
Accession Number
2012742442
Authors
Litton E. Ho K.W.
Institution
(Litton, Ho) Department of Intensive Care Medicine, Royal Perth Hospital,
Perth, WA, Australia
(Litton) School of Medicine and Pharmacology, University of Western
Australia, Perth, WA, Australia
(Ho) School of Population Health, University of Western Australia, Perth,
WA, Australia
Title
The use of pre-operative brain natriuretic peptides as a predictor of
adverse outcomes after cardiac surgery: A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 41 (3) (pp 525-534), 2012.
Date of Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
The objective of this systematic review was to assess whether
pre-operative brain natriuretic peptide (BNP) and N-terminal pro-B-type
natriuretic peptide (NT pro-BNP) are independent predictors of adverse
outcomes after cardiac surgery. MEDLINE, Embase and the Cochrane
Controlled Trials Register databases were searched. Eligible studies
included observational or randomized control trials measuring natriuretic
peptide concentrations before induction of anaesthesia for cardiac
surgery. Two investigators independently extracted the data and assessed
the validity of the included studies. The predictive ability of
pre-operative BNP or NT pro-BNP on mortality, post-operative atrial
fibrillation (AF) and intra-aortic balloon pump (IABP) requirement was
meta-analysed. The association between BNP or NT pro-BNP and other
outcomes was systematically summarized. A total of 4933 patients from 22
studies were considered in the systematic review. Ten studies with one or
more outcomes of interest were included in the meta-analyses. The strength
of association between pre-operative natriuretic peptide levels and
adverse outcomes after surgery was variable, as was the size and quality
of the included studies. The summary areas under the receiver operating
characteristic curve for mortality, post-operative AF and post-operative
IABP requirement were 0.61 (95% confidence interval [CI] 0.51-0.70), 0.61
(95% CI 0.58-0.64) and 0.81 (95% CI 0.73-0.89), respectively. With the
limited data available, the associations between pre-operative natriuretic
peptide levels and adverse outcomes after cardiac surgery were moderate.
Future studies should assess whether pre-operative natriuretic peptides
can provide additional independent predictive information to
well-validated prognostic scores of cardiac surgery. The Author 2011.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
2013060145
Authors
Soltanzadeh M. Ebad A. Pipelzadeh M.R. Tabatabaei S.K. Dehghani
Firouzabadi M. Vasigh A. Soltanzadeh M.A. Heidari A. Ramazani A. Haybar H.
Institution
(Soltanzadeh, Ebad, Pipelzadeh, Tabatabaei, Dehghani Firouzabadi, Vasigh)
Department of Anesthesiology, Imam Khomeini Hospital, Ahwaz Jundishapur
University of Medical sciences, Ahwaz, Iran, Islamic Republic of
(Soltanzadeh) Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
(Heidari, Ramazani) Department of Cardiac surgery, Imam Khomeini Hospital,
Ahwaz Jundishapur University of Medical sciences, Ahwaz, Iran, Islamic
Republic of
(Haybar) Department of Cardiology, Imam Khomeini Hospital, Ahwaz
Jundishapur University of Medical sciences, Ahwaz, Iran, Islamic Republic
of
Title
Gabapentin may relieve post-coronary artery bypass graft pain: A double
blind randomized clinical trial.
Source
International Cardiovascular Research Journal. 5 (3) (pp 79-82), 2011.
Date of Publication: 2011.
Publisher
Iranian Cardiovascular Research Journal (Zand Ave., Shiraz, Iran, Islamic
Republic of)
Abstract
Background: One of the most common complaints after coronary artery bypass
graft (CABG) is postoperative pain. Gabapentin is an anticonvulsant and
antineuralgic agent. Objective: To evaluate the analgesic effect of
preemptive gabapentin on post-operative pain and morphine consumption
after cardiac surgery. Methods: A double-blind randomized clinical trial
was conducted on 60 male candidates for CABG. The patients were divided
into two groups-the gabapentin (n=30) and the control group (n=30). The
test group received 800 mg gabapentin orally two hours before the surgery
followed by 400 mg of the drug two hours post-extubation. The control
group received placebo instead. Then severity of pain was recorded
according to an 11-point visual analog pain scale. The amount of morphine
consumed, its side effects and hemodynamic changes were also recorded
during and at 2, 6, 12, 18 and 24 hours after extubation. Results: The
mean+/-SD cumulative morphine consumption at the first 24 hours after
extubation in gabapentin group was 0.9+/-1.5 mg while it was 1.5+/-4 mg
for the control group. Therefore, gabapentin group consumed 38% less than
the control group (P=0.01). The pain scores during rest and coughing at 2,
6, and 12 hours after extubation were also significantly lower in the
gabapentin group compared with the control group (P=0.02). The mean+/-SD
mechanical ventilation time was 5.4+/-1.7 hours for gabapentin group and
1.6+/-4.4 hours for the control group (P=0.035). The other variables
including hemodynamic changes (HR, SBP and DBP), and incidence of nausea,
vomiting and respiratory depression showed no significant difference
between the studied groups within 24 hours after extubation. Conclusion:
Oral pre-medication with gabapentin before CABG significantly reduces
post-operative pain and morphine consumption in adult cardiac surgery.

<8>
Accession Number
2013057028
Authors
Zheng Q.-F. Wang J.-J. Ying M.-G. Liu S.-Y.
Institution
(Zheng, Ying, Liu) Department of Thoracic Surgery, Teaching Hospital of
Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou,
China
(Wang) Department of Thoracic Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
Title
Omentoplasty in preventing anastomotic leakage of oesophagogastrostomy
following radical oesophagectomy with three-field lymphadenectomy.
Source
European Journal of Cardio-thoracic Surgery. 43 (2) (pp 274-278), 2013.
Article Number: ezs285. Date of Publication: February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: Anastomotic leakage is a major cause of mortality in
oesophageal surgery. Whether omentoplasty after oesophagogastrostomy could
reduce anastomotic leakage is still controversial. The aim of this study
is to investigate the function of omentoplasty to reinforce cervical
oesophagogastrostomy after radical oesophagectomy with three-field
lymphadenectomy. METHODS: A total of 184 patients who underwent radical
oesophagectomy with three-field lymphadenectomy took part in this
prospective study. Patients were randomized to receive either the
omentoplasty or non-omentoplasty. In the omentoplasty group, the omentum
was wrapped around the oesophagogastric anastomosis after
oesophagogastrostomy. Age, gender, location of carcinoma, stage, body mass
index, diabetes, coronary artery disease, peripheral vascular disease and
performance of omentoplasty were recorded. The anastomotic leakage and
stricture and recurrence site were followed up for three years after the
operation. RESULTS: The two groups were comparable in terms of age,
gender, location of carcinoma, stage, body mass index, diabetes, coronary
artery disease and peripheral vascular disease (P > 0.05). In contrast to
the non-omentoplasty group with a postoperative anastomotic leakage rate
of 9.8%, the omentoplasty subjects demonstrated a significantly lower rate
of 3.3% (P < 0.05). No lethal leakage was found in the omentoplasty group,
while two non-omentoplasty patients developed incurable empyema and
mediastinitis due to leakage and ultimately died. The rate of incidence of
anastomotic stricture in the omentoplasty and non-omentoplasty groups were
4.3% and 2.2% respectively. Of the five cases of death during the hospital
stay, two were found in the omentoplasty group and three in
non-omentoplasty. There was no significant difference of lethal leakage,
stricture and death rate between the two groups (P > 0.05). The hospital
stay was significantly longer for non-omentoplasty patients, compared with
that for the omentoplasty subjects (P < 0.05). Tumour recurrence in
lymphatic- or haematogenous metastasis was similar in both groups (P >
0.05). CONCLUSION: Omentoplasty may prevent anastomotic leakage of
oesophagogastrostomy following radical oesophagectomy with three-field
lymphadenectomy. The Author 2012. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<9>
Accession Number
2013068117
Authors
Silinskie K.M. Kirshner R. Hite M.S.
Institution
(Silinskie) Clinical Pharmacy Specialist, General Hospital, Rochester, NY,
United States
(Kirshner) Chief of Cardiothoracic Surgery, General Hospital, Rochester,
United States
(Hite) Clinical Pharmacy Specialist, General Hospital, Rochester, United
States
Title
Converting continuous insulin infusion to subcutaneous insulin glargine
after cardiac surgery using percentage-based versus weight-based dosing: A
pilot trial.
Source
Annals of Pharmacotherapy. 47 (1) (pp 20-28), 2013. Date of Publication:
January 2013.
Publisher
Harvey Whitney Books Company (8044 Montgomery Road, Suite 415, Cincinnati
OH 45236, United States)
Abstract
OBJECTIVE: To compare the efficacy and safety of dosing insulin glargine
by weight versus percentage of TDI in cardiac surgery patients
transitioning from continuous insulin infusion to subcutaneous insulin.
METHODS: We conducted a prospective, randomized, open-label, pilot study.
Study patients who had a preoperative weight less than 100 kg and were
receiving at least 6 hours of a continuous insulin infusion were
randomized to receive either 50% of their TDI requirement or 0.5 units/kg
of glargine as a one-time dose 2 hours before stopping the continuous
insulin infusion. All patients were administered subcutaneous corrective
insulin. Blood glucose monitoring occurred before each meal, at bedtime,
and with morning laboratory tests for 24 hours after administration of the
glargine dose. RESULTS: A total of 200 blood glucose measurements were
performed in each group. The percentage of blood glucose measurements in
target range (80-140 mg/dL) was similar between the weight-based group and
the percentage-based group (66% vs 64%, p = 0.75). Median blood glucose
after transition was 120 mg/dL (interquartile range [IQR] 99-147) in the
weight-based group compared to 127 mg/dL (IQR 107-149; p = 0.03) in the
percentage-based group. The median glargine dose was higher in the
weight-based group (41 units; IQR 36-44) than in the weight-based group
(24 units; IQR 14-30, p < 0.001). The rate of hypoglycemia (blood glucose
<60 mg/dL) was 2.5% in each group. CONCLUSIONS: In this small cohort,
dosing insulin glargine by weight proved to be safe, but larger scale
studies are needed before adopting weight-based dosing in this patient
population. 1967-2013 Harvey Whitney Books Co. All rights reserved.

<10>
Accession Number
2013061294
Authors
Marti C.N. Georgiopoulou V.V. Giamouzis G. Cole R.T. Deka A. Tang W.H.W.
Dunbar S.B. Smith A.L. Kalogeropoulos A.P. Butler J.
Institution
(Marti, Georgiopoulou, Cole, Deka, Smith, Kalogeropoulos, Butler) Division
of Cardiology, Emory University, Atlanta, GA, United States
(Giamouzis) Division of Cardiology, University of Thessaly, Larisa, Greece
(Tang) Division of Cardiology, Cleveland Clinic Foundation, Cleveland, OH,
United States
(Dunbar) School of Nursing, Emory University, Atlanta, GA, United States
Title
Patient-Reported Selective Adherence to Heart Failure Self-Care
Recommendations: A Prospective Cohort Study: The Atlanta Cardiomyopathy
Consortium.
Source
Congestive Heart Failure. 19 (1) (pp 16-24), 2013. Date of Publication:
January/February 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Simultaneous adherence with multiple self-care instructions among heart
failure (HF) patients is not well described. Patient-reported adherence to
8 recommendations related to exercise, alcohol, medications, smoking,
diet, weight, and symptoms was assessed among 308 HF patients using the
Medical Outcomes Study Specific Adherence Scale questionnaire (0="never"
to 5="always," maximum score=40). A baseline cumulative score of >=32/40
(average >=80%) defined good adherence. Clinical events
(death/transplantation/ventricular assist device), resource utilization,
functional capacity (6-minute walk distance), and health status (Kansas
City Cardiomyopathy Questionnaire [KCCQ]) were compared among patients
with and without good adherence. The mean follow-up was 2.0+/-1.0years,
and adherence ranged from 26.3% (exercise) to 89.9% (medications). A
cumulative score indicating good adherence was reported by 35.7%, whereas
good adherence with every behavior was reported by 9.1% of patients. Good
adherence was associated with fewer hospitalizations (all-cause 87.8 vs
107.6; P=.018; HF 29.6 vs 43.8; P=.007) and hospitalized days (all-cause
422 vs 465; P=.015; HF 228 vs 282; P<.001) per 100-person-years and better
health status (KCCQ overall score 70.1+/-24.6 vs 63.8+/-22.8; P=.011).
Adherence was not associated with clinical events or functional capacity.
Patient-reported adherence with HF self-care recommendations is alarmingly
low and selective. Good adherence was associated with lower resource
utilization and better health status. 2012 Wiley Periodicals, Inc.

<11>
Accession Number
2013058797
Authors
Goh S. Prior D. Newcomb A. McLellan A. MacK J. Callaghan S. Dimitriou J.
Rosalion A. Nixon I. Yii M.
Institution
(Goh, Newcomb, Dimitriou, Rosalion, Nixon, Yii) Department of
Cardiothoracic Surgery, St Vincent's Hospital, University of Melbourne,
Melbourne, VIC, Australia
(Prior, McLellan) Department of Cardiology, St Vincent's Hospital,
University of Melbourne, Melbourne, VIC, Australia
(Prior, MacK, Callaghan) Department of Medicine, St Vincent's Hospital,
University of Melbourne, Melbourne, VIC, Australia
Title
Surgical ventricular restoration procedure: Single-center comparison of
Surgical Treatment of Ischemic Heart Failure (STICH) versus non-STICH
patients.
Source
Annals of Thoracic Surgery. 95 (2) (pp 506-512), 2013. Date of
Publication: February 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Surgical ventricular restoration (SVR) was conceived to
improve hemodynamic and clinical outcomes in ischemic cardiomyopathy. The
Surgical Treatment of Ischemic Heart Failure (STICH) trial has
conclusively shown no additional benefits of SVR when routinely combined
with coronary artery bypass surgery. However, the STICH study did not
include a registry arm for SVR-eligible patients who were not randomized.
This study describes the SVR experience in a single center when
participating in the STICH study, to better understand the role of SVR in
current clinical practice. Methods: All patients receiving SVR between
2002 and 2006 were prospectively followed. Patients were divided into
STICH SVR (SSVR) and non-STICH SVR (NSSVR) groups. The SSVR patients
received SVR as randomized in STICH. The NSSVR patients were evaluated for
eligibility to participate in the STICH trial, and the reasons for not
participating were analyzed. Baseline demographics, echocardiographic
data, and clinical outcomes were compared. Results: Nine NSSVR patients
were compared with 12 SSVR patients. Only 1 NSSVR patient did not fulfill
entry criteria into the STICH trial for randomization. The main reason for
performing SVR outside of the STICH study was dominant heart failure
symptom associated with enlarged left ventricle. The NSSVR group had more
anterior wall asynergy (60% vs 45%, p < 0.001), larger preoperative heart
volumes (left ventricular end-diastolic volume index 108 mL/m²
vs 69 mL/m², p < 0.05) and larger volume reductions (34% vs
11%, p = 0.06). At 6.5-year follow-up, 83% SSVR and 89% NSSVR patients are
alive. Conclusions: At our institution, patients eligible but not
randomized into STICH, had larger preoperative heart volumes and larger
volume reduction with SVR. The STICH study may not have included patients
most likely to benefit from SVR. 2013 The Society of Thoracic Surgeons.

<12>
Accession Number
2013058766
Authors
Cook R.C. Yamashita M.H. Kearns M. Ramanathan K. Gin K. Humphries K.H.
Institution
(Cook, Yamashita, Kearns) Division of Cardiovascular Surgery, University
of British Columbia, Vancouver, BC, Canada
(Ramanathan, Gin, Humphries) Division of Cardiology, University of British
Columbia, Vancouver, BC, Canada
Title
Prophylactic magnesium does not prevent atrial fibrillation after cardiac
surgery: A meta-analysis.
Source
Annals of Thoracic Surgery. 95 (2) (pp 533-541), 2013. Date of
Publication: February 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Atrial fibrillation (AF) is a common complication after
cardiac surgery. Previous meta-analyses have concluded prophylactic
magnesium (Mg) prevents postoperative AF, although with a significant
degree of heterogeneity among included studies. Recently, the largest
randomized, controlled trial published to date (but not included in prior
published meta-analyses) concluded that Mg sulfate is not protective
against AF after cardiac surgery. The objective of this study was to
conduct a new meta-analysis including the results of new Mg trials not
included in previous meta-analyses, and to investigate the potential
causes and effects of significant heterogeneity observed in previously
published meta-analyses. Methods: The MEDLINE, EMBASE, and CENTRAL
databases were searched for relevant studies published up to March 31,
2012. Pooled odds ratios of occurrence of AF were calculated using
random-effects models. Heterogeneity was assessed as significant using the
I² statistic. Results: Egger's and funnel plots demonstrated
biases toward stronger and more positive effects of Mg in smaller studies.
When the analysis was restricted to the five double-blind,
intention-to-treat studies in which AF was the primary outcome (Mg arm, n
= 710; control arm, n = 713), Mg did not prevent postoperative AF (odds
ratio, 0.94; p = 0.77), and heterogeneity was no longer significant
(I² = 40%; p = 0.15). Conclusions: This meta-analysis,
restricted to well-conducted trials, does not support the prophylactic use
of Mg to prevent AF after cardiac surgery. Prior meta-analyses have drawn
conclusions from simple random-effects models with significant
heterogeneity. However, this approach leaves important residual
heterogeneity and overemphasizes the strongly positive effects of smaller
studies. 2013 The Society of Thoracic Surgeons.

<13>
Accession Number
2013058758
Authors
Gaudino M. Anselmi A. Pavone N. Massetti M.
Institution
(Gaudino, Anselmi, Pavone, Massetti) Division of Cardiac Surgery, Catholic
University, Largo A. Gemelli 8, 00168 Rome, Italy
Title
Constrictive pericarditis after cardiac surgery.
Source
Annals of Thoracic Surgery. 95 (2) (pp 731-736), 2013. Date of
Publication: February 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Constrictive pericarditis may develop as a midterm or late complication of
cardiac surgery. Owing to limited incidence and scarce reports in the
literature the pathophysiologic determinants of such conditions are
scarcely known, although a number of mechanisms have been implicated. This
disease often poses major diagnostic issues as its clinical picture at
presentation is nonspecific, may develop at any moment during the
postoperative follow-up, and transthoracic echocardiography may be not
suggestive of the diagnosis. The present paper aims at critically revising
the available literature on the topic, emphasizing the need to keep a high
level of suspicion for all surgeons and physicians involved in the
long-term care of cardiac surgery patients. 2013 The Society of Thoracic
Surgeons.

<14>
Accession Number
2013060838
Authors
Hijazi E.M. Musleh G.S.
Institution
(Hijazi, Musleh) Princess Muna AL-Hussein Cardiac Center, King Abdullah
University Hospital, Faculty of Medicine, Jordan University of Science and
Technology, Jordan
Title
Clopidogrel within few hours of coronary artery bypass grafting does
significantly increase the risk of bleeding.
Source
Cardiology Research. 3 (5) (pp 209-213), 2012. Date of Publication: 2012.
Publisher
Elmer Press (8230 Boul Taschereau, CP 50577,Brossard, Quebec J4X 2S0,
Canada)
Abstract
Background: Postoperative bleeding after coronary artery surgery is partly
related to platelet dysfunction. The aim of this study was to evaluate the
effects of a single loading dose of clopidogrel (300 mg) before coronary
angiography on bleeding and use of blood and blood products after
emergency coronary artery bypass surgery (CABG). Methods: This is a
nonrandomized observational prospective study between January, 2006 till
December 2009, at a university hospital, we compare the results of a
cohort of 65 patients who received 300 mg clopidogrel during coronary
angiography that was followed by emergency CABG (group A or study group)
to a cohort of 206 patients who underwent elective coronary artery bypass
surgery during the same period by the same surgeons in whom clopidogrel
was stopped 7 days before surgery (Group B or control group). Emergency
surgery was done because of critical coronary anatomy or because of
ongoing chest pain. All patients in the two groups were kept on 100 mg of
aspirin until the day of surgery. Outcome data used to compare the two
groups, Chest tube drainage in first 12 hours (12 h), need for
re-exploration and use of blood and blood product transfusion were
prospectively collected. Results: Postoperative bleeding, reoperation
rates for bleeding and use of blood products are significantly more in
those who received a loading dose of clopedogril within few hours of CABG
(group A) compared to those who stopped clopedogril for a week before
CABG. Conclusions: Preoperative 300 mg of clopidogrel is associated with
significant increase in post operative bleeding, need for surgical
exploration and use of blood and blood product transfusion after CABG.
The authors.

<15>
Accession Number
2013060163
Authors
Shahbazi S. Zeighami D. Allahyary E. Alipour A. Esmaeeli M.J. Ghaneie M.
Institution
(Shahbazi, Zeighami, Allahyary, Esmaeeli, Ghaneie) Shiraz Anesthesiology
and Critical Care Research Center, Nutrition and Health School, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Alipour) Epidemiologic Department, Nutrition and Health School, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
Effect of colloid versus crystalloid administration of cardiopulmonary
bypass prime solution on tissue and organ perfusion.
Source
International Cardiovascular Research Journal. 5 (1) (pp 24-31), 2011.
Date of Publication: 2011.
Publisher
Iranian Cardiovascular Research Journal (Zand Ave., Shiraz, Iran, Islamic
Republic of)
Abstract
Background: We evaluated the effects of tissue and organ perfusion during
and after coronary artery bypass graft surgery with either colloid
(Voluven) or crystalloid (Lactated ringer's) as prime solution. Methods:
In this prospective randomized-controlled trial study, 70 patients
undergoing on-pump coronary artery bypass graft surgery were randomly
assigned to receive either colloid (Voluven) or crystalloid (Lactated
ringer's) as prime solution, for initiation of cardiopulmonary bypass
machine procedure. Tissue and organ perfusion markers including lactate,
troponin I, liver and renal function tests and electrolytes were measured
sequentially, before induction (T₁) to second days after
surgery (T₅). Results: With exception of chloride and potassium
levels no significant differences detected in other measurements, and the
laboratory results were entirely identical in both procedures. Conclusion:
There was no significant difference between Voluven (hydroxyethyl starch,
HES 130/0.4) and crystalloid (Lactated ringer's) as priming solution on
the basis of organ and tissue perfusion tests assessment.

<16>
Accession Number
2013060151
Authors
Kojuri J. Moaref A. Dehghani P.
Institution
(Kojuri, Moaref, Dehghani) Cardiovascular Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
The improvement of myocardial function by granulocyte colony stimulating
factor following acute anterior myocardial infarction: A double blind
placebo controlled study.
Source
International Cardiovascular Research Journal. 5 (2) (pp 42-49), 2011.
Date of Publication: 2011.
Publisher
Iranian Cardiovascular Research Journal (Zand Ave., Shiraz, Iran, Islamic
Republic of)
Abstract
Background: In patients with acute myocardial infarction (AMI),
reperfusion of the occluded infarct-related artery significantly improves
acute and late clinical outcome. There is increasing evidence that
transplantation of autologous stem cells improves cardiac function after
AMI. For propagation of peripheral blood stem cells, application of
granulocyte-colony stimulating factor (G-CSF) has been shown to be
feasible, effective, and safe. Methods: Ten patients in the treatment
group and 10 patients in the control group were enrolled in this
prospective, randomized controlled and double blind study. Two weeks after
myocardial infarction that was followed by successful recanalization and
stent implantation, the patients of the treatment group received 10 mug/kg
body weight per day (divided BID) G-CSF subcutaneously for a maximum
duration of 5.0 days. In both groups, ejection fraction was evaluated with
echocardiography and cardiac perfusion scans 10 days and 6 months after
myocardial infarction. The Tei index was measured by echocardiography.
Results: No severe side effects of G-CSF treatment were observed. There
was no significant improvement of left ventricular ejection fraction when
the G-CSF treated group was compared to the control group (P=0.821 for
cardiac scan and P=0.705 for echocardiography). Changes in Tei index was
not significant in the treatment group (P=0.815); however, it was
significantly deteriorated in the control group (P=0.005). Conclusion: In
patients with acute anterior myocardial infarction, treatment with G-CSF,
is feasible and safe and seems to be effective in improving global cardiac
function without affecting the ejection fraction under clinical
conditions.

<17>
Accession Number
2013057552
Authors
He Z. Yang L. Tian J. Yang K. Wu J. Yao Y.
Institution
(He, Yang) First Clinical Medical School, Lanzhou University, Lanzhou,
China
(He, Tian, Yang) Evidence-Based Medicine Center, Lanzhou University,
Lanzhou, China
(Wu) School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
(Yao) Department of Cardiology, First Hospital of Lanzhou University,
Lanzhou, China
Title
Efficacy and Safety of Omega-3 Fatty Acids for the Prevention of Atrial
Fibrillation: A Meta-analysis.
Source
Canadian Journal of Cardiology. 29 (2) (pp 196-203), 2013. Date of
Publication: February 2013.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
Background: The effects of omega-3 fatty acids (PUFA) on the prevention of
atrial fibrillation (AF) appear to contrast between several randomized
controlled trials (RCTs). Therefore, we performed a meta-analysis to
assess the efficacy and safety of PUFA for the primary and secondary
prevention of AF. Methods: PubMed, EMBASE, Web of Science, Cochrane
Library and the Chinese Biomedical Literature Database were searched for
randomized controlled trials (published up to January 2012) that compared
PUFA with control. All statistical analyses were performed with RevMan
(version 5.1; The Cochrane Collaboration, Oxford, United Kingdom).
Results: For primary prevention after open heart surgery: 6 studies with
928 patients were designed to evaluate the effects of PUFA on the
incidence of postoperative AF. The use of PUFA significantly reduced the
incidence of postoperative AF (odds ratio [OR] 0.66; 95% confidence
interval [CI], 0.49 to 0.88; P = 0.004); there was no difference in
complications or adverse events (OR, 1.24; 95% CI, 0.58-2.62; P = 0.58).
For secondary prevention, we analyzed 5 studies involving 1256 patients
designed to evaluate the effects of PUFA therapy on AF. The use of PUFA
did not significantly reduce the recurrence of AF (OR, 0.74; 95% CI,
0.39-1.42; P = 0.37); no difference was observed in complications or
adverse events (OR, 1.10; 95% CI, 0.78-1.57; P = 0.58). Conclusions: The
meta-analysis shows that PUFA therapy is significantly associated with a
decreased odds of incidence of AF after open heart surgery, but there is
no significant difference in recurrence of AF between PUFA and control
groups. PUFA is well-tolerated, with no difference in complications or
adverse events between PUFA and control groups. 2013 Canadian
Cardiovascular Society.

<18>
Accession Number
2013069267
Authors
Khan M.F. Wendel C.S. Movahed M.R.
Institution
(Khan) Department of Medicine, Southern Arizona VA Health Care System,
University of Arizona, 3601 South 6th Avenue (SAVAHCS, 1-11C), Tucson, AZ
85723, United States
(Wendel) Department of Research and Development, Southern Arizona VA
Health Care System, Tucson, AZ, United States
(Movahed) Department of Medicine, Division of Cardiology, University of
Arizona, Tucson, AZ, United States
Title
Prevention of post-coronary artery bypass grafting (CABG) atrial
fibrillation: Efficacy of prophylactic beta-blockers in the modern era: A
meta-analysis of latest randomized controlled trials.
Source
Annals of Noninvasive Electrocardiology. 18 (1) (pp 58-68), 2013. Date of
Publication: January 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background Atrial fibrillation/flutter (AF) is a common complication of
open heart surgery and ACC/AHA guidelines strongly recommend the use of
prophylactic beta-blockers (BB) for its prevention. Several recent
studies, however, have failed to show the desired protective effects of BB
against post-coronary artery bypass grafting (CABG) AF. As the protocols
of CABG, medical management of CAD (coronary artery disease) and
demographic features of the patients undergoing open heart surgery have
evolved significantly over the last two decades, we decided to perform a
review of evidence from latest randomized controlled trials (RCTs) to
confirm the efficacy of prophylactic BB. Methods We searched for RCTs
comparing the efficacy of prophylactic BB versus placebo/control against
post-CABG AF. We limited our search to 1995 till present to reflect
ongoing advancements in the protocols of CABG and the medical management
of CAD. Initially, 34 trials were selected; however after certain
exclusions only 10 RCTs were included in the final analysis. Results
Prophylactic BB decreased the incidence of post-CABG AF from 32.8% in the
control group to 20% in the prophylactic group with risk ratio (RR) of
0.50 with 95% CI of 0.36-0.69, P value < 0.001. In a subgroup analysis,
carvedilol appears to be superior to metoprolol for the prevention of
postoperative AF. Conclusions Despite several limitations, this analysis
confirms the efficacy of prophylactic BB against post-CABG AF in this era.
We recommend continuing perioperative BB in the open heart surgery
patients in the absence of contraindications. 2012, Wiley Periodicals,
Inc.

<19>
Accession Number
2013015627
Authors
Khatri P.J. Webb J.G. Rodes-Cabau J. Fremes S.E. Ruel M. Lau K. Guo H.
Wijeysundera H.C. Ko D.T.
Institution
(Khatri, Webb, Rodes-Cabau, Fremes, Ruel, Lau, Guo, Wijeysundera, Ko)
University of Toronto, Institute for Clinical Evaluative Sciences, and
Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
(Khatri, Webb, Rodes-Cabau, Fremes, Ruel, Lau, Guo, Wijeysundera, Ko) St.
Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
(Khatri, Webb, Rodes-Cabau, Fremes, Ruel, Lau, Guo, Wijeysundera, Ko)
Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
(Khatri, Webb, Rodes-Cabau, Fremes, Ruel, Lau, Guo, Wijeysundera, Ko)
Division of Cardiac Surgery, University of Ottawa, Ottawa, ON, Canada
Title
Adverse effects associated with transcatheter aortic valve implantation: A
meta-analysis of contemporary studies.
Source
Annals of Internal Medicine. 158 (1) (pp 35-46), 2013. Date of
Publication: 01 Jan 2013.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
an important treatment for patients with severe symptomatic aortic
stenosis who are at high operative risk, but accurate estimates of serious
adverse effects in contemporary practice are not available. Purpose: 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. Data Source: PubMed to 5
May 2012. Study Selection: All studies that included at least 100 patients
who had TAVI and reported at least 1 outcome of interest. Data Extraction:
Two reviewers abstracted the data independently. A random-effects model
was used to combine data on adverse outcomes and conduct stratified
analyses. Data Synthesis: A total of 49 studies enrolling 16 063 patients
met the inclusion criteria. Overall 30-day and 1-year survival after TAVI
were 91.9% (95% CI, 91.1% to 92.8%) and 79.2% (CI, 76.9% to 81.4%),
respectively. Heart block requiring permanent pacemaker implantation was
the most common adverse outcome (13.1%) and was 5 times more common with
the CoreValve (Medtronic, Minneapolis, Minnesota) than the Sapien valve
(Edwards Lifesciences, Irving, California) implanted using the
transarterial route (25.2% vs. 5.0%, respectively). The overall rate of
vascular complications was 10.4% and was highest with transarterial
implantation of the Sapien valve (22.3%). Acute renal failure requiring
renal replacement therapy was the third most common complication,
occurring in 4.9% of patients. Limitation: Rates of major vascular
complications may be overestimated owing to rapidly evolving TAVI
technology. 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 for some adverse effects. Primary Funding
Source: Heart and Stroke Foundation of Canada. 2013 American College of
Physicians.

<20>
Accession Number
2013063388
Authors
Iversen K. Host N. Bruun N.E. Elming H. Pump B. Christensen J.Jo. Gill S.
Rosenvinge F. Wiggers H. Fuursted K. Holst-Hansen C. Korup E. Schonheyder
H.C. Hassager C. Hofsten D. Larsen J.H. Moser C. Ihlemann N. Bundgaard H.
Institution
(Iversen, Hassager, Hofsten, Ihlemann, Bundgaard) Department of
Cardiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
(Host) Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
(Bruun) Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
(Elming, Pump) Department of Cardiology, Roskilde Hospital, Roskilde,
Denmark
(Christensen) Department of Microbiology, Slagelse Hospital, Slagelse,
Denmark
(Gill) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Rosenvinge) Department of Microbiology, Odense University Hospital,
Odense, Denmark
(Wiggers) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Fuursted) Department of Microbiology, Aarhus University Hospital, Aarhus,
Denmark
(Holst-Hansen, Korup) Department of Cardiology, Aarhus University
Hospital, Aalborg, Denmark
(Schonheyder) Department of Microbiology, Aarhus University Hospital,
Aalborg, Denmark
(Larsen) Department of Infectious Diseases, Rigshospitalet, Copenhagen,
Denmark
(Moser) Department of Microbiology, Rigshospitalet, Copenhagen, Denmark
Title
Partial oral treatment of endocarditis.
Source
American Heart Journal. 165 (2) (pp 116-122), 2013. Date of Publication:
February 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background Guidelines for the treatment of left-sided infective
endocarditis (IE) recommend 4 to 6 weeks of intravenous antibiotics.
Conversion from intravenous to oral antibiotics in clinically stabilized
patients could reduce the side effects associated with intravenous
treatment and shorten the length of hospital stay. Evidence supporting
partial oral therapy as an alternative to the routinely recommended
continued parenteral therapy is scarce, although observational data
suggest that this strategy may be safe and effective. Study Design This is
a noninferiority, multicenter, prospective, randomized, open-label study
of partial oral treatment with antibiotics compared with full parenteral
treatment in left-sided IE. Stable patients (n = 400) with streptococci,
staphylococci, or enterococci infecting the mitral valve or the aortic
valve will be included. After a minimum of 10 days of parenteral
treatment, stable patients are randomized to oral therapy or unchanged
parenteral therapy. Recommendations for oral treatment have been developed
based on minimum inhibitory concentrations and pharmacokinetic
calculations. Patients will be followed up for 6 months after completion
of antibiotic therapy. The primary end point is a composition of all-cause
mortality, unplanned cardiac surgery, embolic events, and relapse of
positive blood cultures with the primary pathogen. Conclusion The Partial
Oral Treatment of Endocarditis study tests the hypothesis that partial
oral antibiotic treatment is as efficient and safe as parenteral therapy
in left-sided IE. The trial is justified by a review of the literature, by
pharmacokinetic calculations, and by our own experience. 2013 Mosby, Inc.
All rights reserved.

<21>
Accession Number
2013063372
Authors
Park K.W. Kang S.-H. Velders M.A. Shin D.-H. Hahn S. Lim W.-H. Yang H.-M.
Lee H.-Y. Van Boven A.J. Hofma S.H. Kang H.-J. Koo B.-K. Oh B.-H. Park
Y.-B. Kandzari D.E. Kim H.-S.
Institution
(Park, Kang, Shin, Lim, Yang, Lee, Kang, Koo, Oh, Park, Kim) Department of
Internal Medicine and Cardiovascular Center, Seoul National University
Hospital, 28 Yongong-dong, Chongno-gu, Seoul 110-744, South Korea
(Velders, Van Boven, Hofma) Medical Center Leeuwarden, Leeuwarden,
Netherlands
(Hahn) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul, South Korea, South Korea
(Hahn) Department of Preventive Medicine, Seoul National University
College of Medicine, Seoul, South Korea
(Kandzari) Piedmont Heart Institute, Altanta, GA, United States
Title
Safety and efficacy of everolimus-versus sirolimus-eluting stents: A
systematic review and meta-analysis of 11 randomized trials.
Source
American Heart Journal. 165 (2) (pp 241-250.e4), 2013. Date of
Publication: February 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: While EES have proven superior to paclitaxel-eluting stents,
it remains uncertain whether EES improve clinical outcomes compared to
SES, which are the most efficacious among the first-generation
drug-eluting stents. We performed a meta-analysis of randomized trials
comparing the efficacy and safety of everolimus-eluting stents (EES)
versus sirolimus-eluting stents (SES) in patients undergoing percutaneous
coronary intervention. Methods: From online and offline search until
December 2011, we identified 11 randomized trials (total 12,869 patients).
The primary endpoint was major adverse cardiac events. Results: The risk
of major adverse cardiac events did not differ significantly between the
patients treated with EES versus SES [OR, 0.90 (95% CI, 0.77-1.04); P
=.162]. However, we found a significant reduction in the risk of repeat
revascularization in the EES arm [OR, 0.85 (95% CI, 0.71-1.00); P =.047].
There were no significant differences regarding the risk of cardiac death
[OR, 0.97 (95% CI, 0.74-1.27); P =.834], or myocardial infarction [OR,
0.95 (95% CI, 0.75-1.20), P =.656]. The risk of definite or probable stent
thrombosis tended to be lower [OR, 0.68 (95% CI, 0.45-1.02); P =.065],
while definite ST was significantly lower [OR, 0.44 (95% CI, 0.25-0.80); P
=.007] with EES. Conclusions: In a large systematic overview of
comparative trials involving percutaneous revascularization with
drug-eluting stents, treatment with EES significantly reduced the risk of
repeat revascularization and definite ST compared to SES. We found no
significant differences in the risk of cardiac death or myocardial
infarction. 2013 Mosby, Inc. All rights reserved.

<22>
Accession Number
2013063371
Authors
Mayosi B.M. Ntsekhe M. Bosch J. Pogue J. Gumedze F. Badri M. Jung H.
Pandie S. Smieja M. Thabane L. Francis V. Thomas K.M. Thomas B. Awotedu
A.A. Magula N.P. Naidoo D.P. Damasceno A. Banda A.C. Mutyaba A. Brown B.
Ntuli P. Mntla P. Ntyintyane L. Ramjee R. Manga P. Kirenga B. Mondo C.
Russell J.B.W. Tsitsi J.M. Peters F. Essop M.R. Barasa A.F. Mijinyawa M.S.
Sani M.U. Olunuga T. Ogah O. Adebiyi A. Aje A. Ansa V. Ojji D. Danbauchi
S. Hakim J. Matenga J. Yusuf S.
Institution
(Mayosi, Ntsekhe, Badri, Pandie, Francis) Department of Medicine, J Floor
Old Groote Schuur Hospital, University of Cape Town, Cape Town, 7925,
South Africa
(Bosch, Pogue, Jung, Smieja, Thabane, Yusuf) McMaster University and the
Population Health Research Institute, Hamilton Health Sciences, Hamilton,
ON, Canada
(Gumedze) Department of Statistical Sciences, University of Cape Town,
Cape Town, South Africa
(Thomas, Thomas, Awotedu) Nelson Mandela Academic Hospital, Mthatha, South
Africa
(Magula, Naidoo) King Edward VIII Hospital, Durban, South Africa
(Damasceno) Hospital Central de Maputo, Maputo, Mozambique
(Banda) Malawi Military Health Services, Lilongwe, Malawi
(Mutyaba, Brown) Provincial and Livingstone Hospitals, Port Elizabeth,
South Africa
(Ntuli, Mntla) Dr George Mukhari Hospital, Pretoria, South Africa
(Ntyintyane, Ramjee, Manga) Charlotte Maxeke Johannesburg Academic
Hospital, Gauteng, South Africa
(Kirenga, Mondo) New Mulago Hospital, Kampala, Uganda
(Russell) Connaught Hospital, Freetown, Sierra Leone
(Tsitsi, Peters, Essop) Chris Hani Baragwanath Hospital, Soweto, South
Africa
(Barasa) Moi Hospital, Eldoret, Kenya
(Mijinyawa, Sani) Aminu Kano Teaching Hospital, Kano, Nigeria
(Olunuga, Ogah) Federal Medical Centre, Abeokuta, Ogun State, Nigeria
(Adebiyi, Aje) University College Hospital, Ibadan, Oyo State, Nigeria
(Ansa) University of Calabar Teaching Hospital, Calabar, Nigeria
(Ojji) Abuja Teaching Hospital, Abuja, Nigeria
(Danbauchi) Ahmadu Bello Teaching Hospital, Zaria, Kaduna State, Nigeria
(Hakim, Matenga) Parirenyatwa Hospital, Harare, Zimbabwe
(Gumedze) College of Medicine, King Saud Bin Abdelaziz University of
Medical Sciences, Riyadh, Saudi Arabia
Title
Rationale and design of the investigation of the management of
pericarditis (IMPI) trial: A 2 x 2 factorial randomized double-blind
multicenter trial of adjunctive prednisolone and Mycobacterium w
immunotherapy in tuberculous pericarditis.
Source
American Heart Journal. 165 (2) (pp 109-115.e3), 2013. Date of
Publication: February 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: In spite of antituberculosis chemotherapy, tuberculous (TB)
pericarditis causes death or disability in nearly half of those affected.
Attenuation of the inflammatory response in TB pericarditis may improve
outcome by reducing cardiac tamponade and pericardial constriction, but
there is uncertainty as to whether adjunctive immunomodulation with
corticosteroids and Mycobacterium w (M. w) can safely reduce mortality and
morbidity. Objectives: The primary objective of the IMPI Trial is to
assess the effectiveness and safety of prednisolone and M. w immunotherapy
in reducing the composite outcome of death, constriction, or cardiac
tamponade requiring pericardial drainage in 1,400 patients with TB
pericardial effusion. Design: The IMPI trial is a multicenter
international randomized double-blind placebo-controlled 2 x 2 factorial
study. Eligible patients are randomly assigned to receive oral
prednisolone or placebo for 6 weeks and M. w injection or placebo for 3
months. Patients are followed up at weeks 2, 4, and 6 and months 3 and 6
during the intervention period and 6-monthly thereafter for up to 4 years.
The primary outcome is the first occurrence of death, pericardial
constriction, or cardiac tamponade requiring pericardiocentesis. The
secondary outcome is safety of immunomodulatory treatment measured by
effect on opportunistic infections (eg, herpes zoster) and malignancy (eg,
Kaposi sarcoma) and impact on measures of immunosuppression and the
incidence of immune reconstitution disease. Conclusions: IMPI is the
largest trial yet conducted comparing adjunctive immunotherapy in
pericarditis. Its results will define the role of adjunctive
corticosteroids and M. w immunotherapy in patients with TB pericardial
effusion. 2013 Mosby, Inc. All rights reserved.

<23>
Accession Number
2013052112
Authors
Lindefjeld D.S. Guarda E. Mendez M. Martinez A. Perez O. Fajuri A.
Marchant E. Aninat M. Torres H. Dussaillant G.
Institution
(Lindefjeld, Guarda, Mendez, Martinez, Perez, Fajuri, Marchant) Hospital
Clinico, Pontificia Universidad Catolica de Chile, Chile
(Lindefjeld, Mendez, Perez) Hospital Dr. Sotero del Rio, Santiago, Chile
(Aninat, Torres) Hospital Dr. Gustavo Fricke, Vina del Mar, Chile
(Dussaillant) Hospital Clinico Universidad de Chile, Santiago, Chile
Title
Microvascular Coronary Flow Comparison in Acute Myocardial Infarction
Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare
Metal Stent. MICAMI-MGUARD.
Source
Cardiovascular Revascularization Medicine. 14 (1) (pp 4-8), 2013. Date of
Publication: January 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: Distal embolization of thrombus/platelet aggregates decreases
myocardial reperfusion during primary percutaneous coronary intervention
(PCI), and is associated with worse immediate and long-term prognosis of
patients with ST-elevation myocardial infarction (STEMI). Objective:
Assess the efficacy of a mesh covered stent (MGuard stent, MGS) in
preventing distal embolization and microvascular reperfusion impairment
during primary PCI, compared with a bare metal stent (BMS). Methods: Forty
patients with STEMI referred for primary PCI were randomized for stenting
the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded
experts performed off-line measurements of angiographic epicardial and
microvascular reperfusion criteria: TIMI flow grade, myocardial blush,
corrected TIMI frame count (cTFC). Results: At baseline clinical,
angiographic and procedural variables were not different between groups.
Post PCI TIMI flow grade was similar in both groups. We observed better
myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs
2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 +/- 4.07 vs BMS 27.35 +/-
7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to
11.46). MGS stent group had a higher percentage of successful angioplasty
(cTFC <= 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute
stent thrombosis (one for each group) at 30. days follow up, but no
clinical events at 6 months follow up. Conclusions: In this exploratory
study, MGS significantly improved microvascular reperfusion criteria
compared with a BMS in primary PCI. However its safety and impact on
clinical outcomes should be verified in larger randomized clinical trials.
2013 Elsevier Inc.

<24>
[Use Link to view the full text]
Accession Number
2013066345
Authors
Chandrasekar S. Loomba R. Shah P. Arora R.
Institution
(Chandrasekar, Loomba, Shah) Chicago Medical School, VA Medical Center,
North Chicago, IL, United States
(Arora) Department of Medicine, VA Medical Center, 3001 Green Bay Road,
North Chicago, IL 60064, United States
Title
The need for novel anticoagulation therapy in acute coronary syndrome.
Source
American Journal of Therapeutics. 20 (1) (pp 61-66), 2013. Date of
Publication: January 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
As acute coronary syndrome (ACS) becomes more common nationwide and
current anticoagulation regimens used in patients with ACS continue to
possess their shortcomings, the need for new anticoagulants is on the
rise. Although heparin and warfarin are used effectively in patients with
ACS, they both have significant side effects and delivery issues. New
factor Xa inhibitors offer an oral alternative that functions early in the
coagulation cascade. The role of these new drugs in ACS is explored here.
Electronic search strategies were used to collect reviews, randomized
controlled trials, and other studies. Databases used included Medline and
Cochrane Library and hand selection. Sources selected were limited to
those that discussed factor Xa inhibitors in the context of ACS. Selected
studies were then assessed for quality and relevance and those deemed
relevant included for analysis. Some of the factor Xa inhibitors such as
rivaroxaban offer anticoagulation as effective as, if not more effective,
heparin and warfarin with lower risks of bleeding and other adverse
effects such as heparin-induced thrombocytopenia. Many of these new agents
also come in oral form, making them easy for patients to manage and use
daily. 2011 Lippincott Williams & Wilkins.

<25>
Accession Number
2013054237
Authors
Abdelmalak B.B. Cata J.P. Bonilla A. You J. Kopyeva T. Vogel J.D. Campbell
S. Sessler D.I.
Institution
(Abdelmalak, Kopyeva) Department of General Anesthesiology, Cleveland
Clinic, 9500 Euclid Ave. E-31, Cleveland, OH 44195, United States
(Abdelmalak, Bonilla, You, Sessler) Department of Outcomes Research,
Cleveland Clinic, 9500 Euclid Ave. P-77, Cleveland, OH 44195, United
States
(Cata) Department of Anesthesiology and Perioperative Medicine, The
University of Texas-MD Anderson Cancer Center, United States
(You) Department of Quantitative Health Sciences, Cleveland Clinic, 9500
Euclid Ave. JJN3-01, Cleveland, OH 44195, United States
(Vogel) Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid
Ave. A-3, Cleveland, OH 44195, United States
(Campbell) Department of Urology, Cleveland Clinic, 9500 Euclid Ave.
Q10-1, Cleveland, OH 44195, United States
(Sessler) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
Title
Intraoperative tissue oxygenation and postoperative outcomes after major
non-cardiac surgery: An observational study.
Source
British Journal of Anaesthesia. 110 (2) (pp 241-249), 2013. Date of
Publication: February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundThe relationship between tissue oxygen saturation () and serious
postoperative complications remains unclear. We tested the hypothesis that
perioperative in patients undergoing major non-cardiac surgery is
inversely related to serious surgical outcomes.MethodsWe enrolled 124
patients, ASA physical status <=IV, having elective major non-cardiac
surgeries with general anaesthesia. An InSpectra Model 650 StO₂
monitor (Hutchinson Technology, Hutchinson, MN, USA) was used to measure
at the thenar eminence throughout surgery and for two postoperative hours.
Our primary outcome was a composite of 30 day mortality and serious
in-hospital complications. The secondary outcome was an a priori subset of
the primary composite outcome representing infectious and wound-healing
complications. Multivariable logistic regression was used to evaluate the
associations between our primary and secondary outcomes and time-weighted
average (TWA) and minimum. ResultsPatients were 61 (12), mean (sd) yr old.
The minimum was inversely associated with our primary composite outcome
(P=0.02). The estimated odds ratio (97.5% CI) of having any major
postoperative morbidity was 0.82 (0.67, 1.00) for a 5% increase in the
minimum. In contrast, TWA was not significantly associated with major
postoperative morbidity (P=0.35). Furthermore, neither TWA (P=0.65) nor
minimum (P=0.70) was significantly associated with wound complications.
ConclusionsMinimum perioperative peripheral tissue oxygenation predicted a
composite of major complications and mortality from major non-cardiac
surgery. This is an observational association and whether clinical
interventions to augment tissue oxygenation will improve outcomes remains
to be determined. 2012 The Author [2012]. Published by Oxford University
Press on behalf of the British Journal of Anaesthesia. All rights
reserved.

<26>
Accession Number
2013065060
Authors
Ezhov M.V. Il'ina L.N. Safarova M.S. Afanasieva O.I. Adamova I.Y.
Atanesyan R.V. Konovalov G.A. Akchurin R.S. Pokrovsky S.N.
Institution
(Ezhov, Il'ina, Safarova, Afanasieva, Adamova, Atanesyan, Akchurin,
Pokrovsky) Cardiology Research Center, 15a, 3rd Cherepkovskaya Street,
121552 Moscow, Russian Federation
(Konovalov) MEDSI Clinic, 3A, Georgian Lane, 123056 Moscow, Russian
Federation
Title
Cascade plasma filtration during the first year after CABG in patients
with hyperlipidemia refractory to statins.
Source
Atherosclerosis Supplements. 14 (1) (pp 101-105), 2013. Date of
Publication: January 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: To evaluate the effect of a 12-month course of weekly lipid
apheresis on vein graft patency after coronary artery bypass grafting
(CABG) in patients with hyperlipidemia refractory to statins. Methods: In
a 12-month prospective controlled clinical trial we enrolled 34 male
patients (mean age 57 +/- 8 years) who passed through successful CABG and
low-density lipoprotein cholesterol (LDL-C) level >2.6 mmol/L prior to the
operation despite statin treatment. Patients were allocated into 2 groups:
active (n = 17, weekly apheresis by cascade plasma filtration (CPF) plus
atorvastatin), and control (n = 17, atorvastatin alone). Graft patency was
evaluated by multislice computed tomography at 3 months and by angiography
at 12 months after an operation. Results: Both groups were comparable in
clinical and biochemical characteristics. During each CPF procedure, LDL-C
level decreased by 64 +/- 9%, apoB - by 65 +/- 8%, Lp(a) - by 52 +/- 15%,;
these changes were significant compared to baseline and the control group.
Mean net difference in LDL-C level between apheresis and control groups
was 1.1 +/- 0.3 mmol/L. Vein graft patency at study end was 88.2% (45 of
51) in the apheresis group versus 72.7% (40 of 55) in the control group (p
= 0.05). Use of apheresis was associated with decreased vein graft
occlusions by 46%: relative risk 0.54; 95% confidence interval 0.27 to
1.02; p = 0.05. Conclusion: Our data suggest that the use of lipoprotein
apheresis with CPF results in a better vein graft patency during the first
year after CABG in patients with hyperlipidemia refractory to statins.
2012 Elsevier Ireland Ltd.

<27>
Accession Number
2013058943
Authors
Abdel-Wahab M. Richardt G. Joachim Buttner H. Toelg R. Geist V. Meinertz
T. Schofer J. King L. Neumann F.-J. Khattab A.A.
Institution
(Abdel-Wahab, Richardt, Toelg, Geist) Herzzentrum Segeberger Kliniken
GmbH, Am Kurpark 1, 23795 Bad Segeberg, Germany
(Joachim Buttner, Neumann) Herzzentrum Bad Krozingen, Bad Krozingen,
Germany
(Meinertz) Universitares Herzzentrum Hamburg Eppendorf, Hamburg, Germany
(Schofer) Universitares Herz-und Gefasszentrum Hamburg GmbH, Hamburg,
Germany
(King) QCA Core Laboratory, International Studies Association Research
Center, Munich, Germany
(Khattab) Cardiology Department, Bern University Hospital, Bern,
Switzerland
Title
High-speed rotational atherectomy before paclitaxel-eluting stent
implantation in complex calcified coronary lesions: The randomized ROTAXUS
(Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native
Coronary Artery Disease) trial.
Source
JACC: Cardiovascular Interventions. 6 (1) (pp 10-19), 2013. Date of
Publication: January 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to determine the effect of rotational
atherectomy (RA) on drug-eluting stent (DES) effectiveness. Background:
DES are frequently used in complex lesions, including calcified stenoses,
which may challenge DES delivery, expansion, and effectiveness. RA can
adequately modify calcified plaques and facilitate stent delivery and
expansion. Its impact on DES effectiveness is widely unknown. Methods: The
ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex
Native Coronary Artery Disease) study randomly assigned 240 patients with
complex calcified native coronary lesions to RA followed by stenting (n =
120) or stenting without RA (n = 120, standard therapy group). Stenting
was performed using a polymer-based slow-release paclitaxel-eluting stent.
The primary endpoint was in-stent late lumen loss at 9 months. Secondary
endpoints included angiographic and strategy success, binary restenosis,
definite stent thrombosis, and major adverse cardiac events at 9 months.
Results: Despite similar baseline characteristics, significantly more
patients in the standard therapy group were crossed over (12.5% vs. 4.2%,
p = 0.02), resulting in higher strategy success in the rotablation group
(92.5% vs. 83.3%, p = 0.03). At 9 months, in-stent late lumen loss was
higher in the rotablation group (0.44 +/- 0.58 vs. 0.31 +/- 0.52, p =
0.04), despite an initially higher acute lumen gain (1.56 +/- 0.43 vs.
1.44 +/- 0.49 mm, p = 0.01). In-stent binary restenosis (11.4% vs. 10.6%,
p = 0.71), target lesion revascularization (11.7% vs. 12.5%, p = 0.84),
definite stent thrombosis (0.8% vs. 0%, p = 1.0), and major adverse
cardiac events (24.2% vs. 28.3%, p = 0.46) were similar in both groups.
Conclusions: Routine lesion preparation using RA did not reduce late lumen
loss of DES at 9 months. Balloon dilation with only provisional
rotablation remains the default strategy for complex calcified lesions
before DES implantation. (Rotational Atherectomy Prior to Taxus Stent
Treatment for Complex Native Coronary Artery Disease. A Multicenter,
Prospective, Randomized Controlled Trial [ROTAXUS]; NCT00380809) 2013
American College of Cardiology Foundation.