EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2013166580
Authors
Algra S.O. Groeneveld K.M. Schadenberg A.W.L. Haas F. Evens F.C.M.
Meerding J. Koenderman L. Jansen N.J.G. Prakken B.J.
Institution
(Algra, Haas, Evens) Department of Pediatric Cardiothoracic Surgery,
Wilhelmina Children's Hospital, University Medical Center Utrecht,
Lundlaan 6, Utrecht, EA 3584, Netherlands
(Groeneveld, Koenderman) Department of Surgery, University Medical Center
Utrecht, Heidelberglaan 100, Utrecht, CX 3584, Netherlands
(Algra, Schadenberg, Meerding, Prakken) Department of Pediatric
Immunology, Center for Cellular and Molecular Intervention, University
Medical Center Utrecht, Lundlaan 6, Utrecht, EA 3584, Netherlands
(Algra, Schadenberg, Jansen) Pediatric Intensive Care Unit, Wilhelmina
Children's Hospital, University Medical Center Utrecht, Lundlaan 6,
Utrecht, EA 3584, Netherlands
(Algra) Pediatric Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
Title
Cerebral ischemia initiates an immediate innate immune response in
neonates during cardiac surgery.
Source
Journal of Neuroinflammation. 10 , 2013. Article Number: 24. Date of
Publication: 07 Feb 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: A robust inflammatory response occurs in the hours and days
following cerebral ischemia. However, little is known about the immediate
innate immune response in the first minutes after an ischemic insult in
humans. We utilized the use of circulatory arrest during cardiac surgery
to assess this.Methods: Twelve neonates diagnosed with an aortic arch
obstruction underwent cardiac surgery with cardiopulmonary bypass and
approximately 30 minutes of deep hypothermic circulatory arrest (DHCA,
representing cerebral ischemia). Blood samples were drawn from the vena
cava superior immediately after DHCA and at various other time points from
preoperatively to 24 hours after surgery. The innate immune response was
assessed by neutrophil and monocyte count and phenotype using FACS, and
concentrations of cytokines IL-1beta, IL-6, IL-8, IL-10, TNFalpha, sVCAM-1
and MCP-1 were assessed using multiplex immunoassay. Results were compared
to a simultaneously drawn sample from the arterial cannula. Twelve other
neonates were randomly allocated to undergo the same procedure but with
continuous antegrade cerebral perfusion (ACP).Results: Immediately after
cerebral ischemia (DHCA), neutrophil and monocyte counts were higher in
venous blood than arterial (P = 0.03 and P = 0.02 respectively). The
phenotypes of these cells showed an activated state (both P <0.01). Most
striking was the increase in the 'non-classical' monocyte subpopulations
(CD16^intermediate; arterial 6.6% vs. venous 14%; CD16+ 13% vs.
22%, both P <0.01). Also, higher IL-6 and lower sVCAM-1 concentrations
were found in venous blood (both P = 0.03). In contrast, in the ACP group,
all inflammatory parameters remained stable.Conclusions: In neonates,
approximately 30 minutes of cerebral ischemia during deep hypothermia
elicits an immediate innate immune response, especially of the monocyte
compartment. This phenomenon may hold important clues for the
understanding of the inflammatory response to stroke and its potentially
detrimental consequences.Trial registration: ClinicalTrial.gov:
NCT01032876. 2013 Algra et al; licensee BioMed Central Ltd.

<2>
Accession Number
2013171896
Authors
Rodriguez A.E.
Institution
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina
Title
Are drug-eluting stents superior to bare metal stents when compared to
coronary artery bypass surgery? Show me the data.
Source
Cardiovascular Revascularization Medicine. 14 (2) (pp 90-92), 2013. Date
of Publication: March 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Recent randomized trials comparing coronary artery bypass surgery (CABG)
versus drug eluting stents (DES) observed better survival, survival free
of myocardial infarction (MI) and free from death, MI and stroke in
patients with 3-vessel disease and diabetics if they were treated with
DES. In the past, when we used bare metal stent (BMS) and meta-analysis of
randomized trials with BMS and CABG, patients with 3-vessel disease and
those with diabetes at 5 years of follow up had similar incidence of
death, MI and stroke with CABG and BMS. The results reported recently by
the SYNTAX and FREEDOM trials suggested a lack of clinical benefit with
DES compared to BMS. The author in the article compared these recent
results with the above meta-analysis and made an indirect comparison among
DES, BMS and CABG. Reasons for these intriguing findings were discussed,
and also a search for potential solutions was conducted. 2013 Elsevier
Inc.

<3>
Accession Number
2013169848
Authors
Jolicoeur E.M. Banai S. Henry T.D. Schwartz M. Doucet S. White C.J.
Edelman E. Verheye S.
Institution
(Jolicoeur, Doucet) Montreal Heart Institute, Universite de Montreal, 5000
Belanger Street East, Montreal, QC Q H1T 1C8, Canada
(Banai) The Tel Aviv Medical Center, The Tel Aviv University Medical
School, 6 Weizman Street, Tel Aviv 64239, Israel
(Henry) Minneapolis Heart Institute Foundation, Abbott Northwestern
Hospital, 920 East 28th Street, Minneapolis, MN 55407, United States
(Schwartz) Neovasc Inc., 137000 Mayfield Place, Richmond, BC V6V 2E4,
Canada
(White) The John Ochsner Heart and Vascular Institute, Ochsner Clinical
School, The University of Queensland School of Medicine, 1514 Jefferson
Highway, New Orleans, LA 70121, United States
(Edelman) Harvard-MIT Division of Health Sciences and Technology, 77
Massachusetts Avenue, Cambridge, MA 02139, United States
(Edelman) Cardiovascular Division Brigham and Women's Hospital, Harvard
Medical School, 75 Francis Street, Boston, MA 02115, United States
(Verheye) Antwerp Cardiovascular Institute, ZNA Middelheim Hospital,
Lindendreef 1, 2020, Antwerpen 22, Belgium
Title
A phase II, sham-controlled, double-blinded study testing the safety and
efficacy of the coronary sinus reducer in patients with refractory angina:
Study protocol for a randomized controlled trial.
Source
Trials. 14 (1) , 2013. Article Number: 46. Date of Publication: 15 Feb
2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: A growing population of patients lives with severe coronary
artery disease not amenable to coronary revascularization and with
refractory angina despite optimal medical therapy. Percutaneous reduction
of the coronary sinus is an emerging treatment for myocardial ischemia
that increases coronary sinus pressure to promote a transcollateral
redistribution of coronary artery in-flow from nonischemic to ischemic
subendocardial territories. A first-in-man study has demonstrated that the
percutaneous reduction of the coronary sinus can be performed safely in
such patients. The COSIRA trial seeks to assess whether a percutaneous
reduction of the coronary sinus can improve the symptoms of refractory
angina in patients with limited revascularization options. Methods/Design:
The COSIRA trial is a phase II double-blind, sham-controlled, randomized
parallel trial comparing the percutaneously implanted coronary sinus
Reducer (Neovasc Inc, Richmond, BC, Canada) to a sham implantation in 124
patients enrolled in Canada, Belgium, England, Scotland, Sweden and
Denmark. All patients need to have stable Canadian Cardiovascular Society
(CCS) class III or IV angina despite optimal medical therapy, with
evidence of reversible ischemia related to disease in the left coronary
artery, and a left ventricular ejection fraction >25%. Participants
experiencing an improvement in their angina >=2 CCS classes six months
after the randomization will meet the primary efficacy endpoint. The
secondary objective of this trial is to test whether coronary sinus
Reducer implantation will improve left ventricular ischemia, as measured
by the improvement in dobutamine echocardiogram wall motion score index
and in time to 1 mm ST-segment depression from baseline to six-month
post-implantation. Discussion: Based on previous observations, the COSIRA
is expected to provide a significant positive result or an informative
null result upon which rational development decisions can be based.
Patient safety is a central concern and extensive monitoring should allow
an appropriate investigation of the safety related to the coronary sinus
Reducer.Trial registration: ClinicalTrials.gov identifier - NCT01205893.
2013 Jolicoeur et al; licensee BioMed Central Ltd.

<4>
Accession Number
2013171831
Authors
Ghroubi S. Elleuch W. Abid L. Abdenadher M. Kammoun S. Elleuch M.H.
Institution
(Ghroubi, Elleuch, Elleuch) Departement de medecine physique et
reeducation fonctionnelle, Hopital universitaire Habib Bourguiba, Sfax,
Tunisia
(Abdenadher) Departement de chirurgie cardiovasculaire et thoracique,
Hopital universitaire Habib Bourguiba, Sfax, Tunisia
(Abid, Kammoun) Departement de cardiologie, Hopital universitaire Hedi
Chaker, Sfax, Tunisia
Title
Effects of a low-intensity dynamic-resistance training protocol using an
isokinetic dynamometer on muscular strength and aerobic capacity after
coronary artery bypass grafting.
Source
Annals of Physical and Rehabilitation Medicine. 56 (2) (pp 85-101), 2013.
Date of Publication: March 2013.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Objective: Study the effect of muscle strength training on muscle
strength, maximal oxygen uptake (VO₂max), hemodynamic and
anthropometric parameters as well as quality of life after coronary artery
bypass grafting (CABG). Methods: After CABG surgery, 32 patients were
randomized into two groups. The first group was to perform aerobic-type
training with a cycle ergometer (AT = 16). The second group was to perform
low-intensity muscle strength training of the quadriceps and hamstrings
using an isokinetic dynamometer (i.e. 20 to 30% of peak torque) (ST = 16).
Before and after the strength training program we conducted a stress test,
evaluation of isokinetic force production, 6-minute walking test, body
impedance analysis (BIA) and SF-36 quality of life test. Results: Compared
to the AT group, the ST group showed better results with improved
quadriceps strength (48.2% vs. 8.2%), VO₂max (P<.001) and
diastolic blood pressure at rest (P=0.01). Quality of life improved in
both groups. Conclusion: The dynamic-resistance muscle strength training
protocol using isokinetic dynamometer can safely (i.e. without clinical
symptoms or changes to the ECG and arterial blood pressure) improve muscle
strength and VO₂max without any major risks in patients
post-CABG. These findings should encourage additional studies to validate
the relevance of these strength training modalities in rehabilitation
centers. 2012 Elsevier Masson SAS.

<5>
Accession Number
2013132397
Authors
Taggart D.P.
Institution
(Taggart) Nuffield Department of Surgical Sciences, Oxford University,
John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
Title
CABG or stents in coronary artery disease: End of the debate?.
Source
The Lancet. 381 (9867) (pp 605-607), 2013. Date of Publication: February
2013.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)

<6>
Accession Number
2013132396
Authors
Mohr F.W. Morice M.-C. Kappetein A.P. Feldman T.E. Stahle E. Colombo A.
MacK M.J. Holmes Jr. D.R. Morel M.-A. Van Dyck N. Houle V.M. Dawkins K.D.
Serruys P.W.
Institution
(Mohr) Herzzentrum Universitat Leipzig, 04289 Leipzig, Germany
(Morice) Hopital Prive Jacques Cartier, Massy, France
(Kappetein, Serruys) Erasmus University Medical Center Rotterdam,
Rotterdam, Netherlands
(Feldman) Evanston Hospital, Evanston, IL, United States
(Stahle) University Hospital Uppsala, Uppsala, Sweden
(Colombo) San Raffaele Scientific Institute, Milan, Italy
(MacK) Heart Hospital Baylor Plano, Baylor Healthcare System, Dallas, TX,
United States
(Holmes Jr.) Mayo Clinic, Rochester, MN, United States
(Morel) Cardialysis, Rotterdam, Netherlands
(Van Dyck, Houle, Dawkins) Boston Scientific, Natick, MA, United States
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention in patients with three-vessel disease and left main coronary
disease: 5-year follow-up of the randomised, clinical SYNTAX trial.
Source
The Lancet. 381 (9867) (pp 629-638), 2013. Date of Publication: February
2013.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Background We report the 5-year results of the SYNTAX trial, which
compared coronary artery bypass graft surgery (CABG) with percutaneous
coronary intervention (PCI) for the treatment of patients with left main
coronary disease or three-vessel disease, to confirm findings at 1 and 3
years. Methods The randomised, clinical SYNTAX trial with nested
registries took place in 85 centres in the USA and Europe. A cardiac
surgeon and interventional cardiologist at each centre assessed
consecutive patients with de-novo three-vessel disease or left main
coronary disease to determine suitability for study treatments. Eligible
patients suitable for either treatment were randomly assigned (1:1) by an
interactive voice response system to either PCI with a first-generation
paclitaxel-eluting stent or to CABG. Patients suitable for only one
treatment option were entered into either the PCI-only or CABG-only
registries. We analysed a composite rate of major adverse cardiac and
cerebrovascular events (MACCE) at 5-year follow-up by Kaplan-Meier
analysis on an intention-to-treat basis. This study is registered with
ClinicalTrials.gov, number NCT00114972. Findings 1800 patients were
randomly assigned to CABG (n=897) or PCI (n=903). More patients who were
assigned to CABG withdrew consent than did those assigned to PCI (50 vs
11). After 5 years' follow-up, Kaplan-Meier estimates of MACCE were 26*9%
in the CABG group and 37*3% in the PCI group (p<0*0001). Estimates of
myocardial infarction (3*8% in the CABG group vs 9*7% in the PCI group;
p<0*0001) and repeat revascularisation (13*7% vs 25*9%; p<0*0001) were
significantly increased with PCI versus CABG. All-cause death (11*4% in
the CABG group vs 13*9% in the PCI group; p=0*10) and stroke (3*7% vs
2*4%; p=0*09) were not significantly different between groups. 28*6% of
patients in the CABG group with low SYNTAX scores had MACCE versus 32*1%
of patients in the PCI group (p=0*43) and 31*0% in the CABG group with
left main coronary disease had MACCE versus 36*9% in the PCI group
(p=0*12); however, in patients with intermediate or high SYNTAX scores,
MACCE was significantly increased with PCI (intermediate score, 25*8% of
the CABG group vs 36*0% of the PCI group; p=0*008; high score, 26*8% vs
44*0%; p<0*0001). Interpretation CABG should remain the standard of care
for patients with complex lesions (high or intermediate SYNTAX scores).
For patients with less complex disease (low SYNTAX scores) or left main
coronary disease (low or intermediate SYNTAX scores), PCI is an acceptable
alternative. All patients with complex multivessel coronary artery disease
should be reviewed and discussed by both a cardiac surgeon and
interventional cardiologist to reach consensus on optimum treatment.
Funding Boston Scientific.

<7>
Accession Number
2013132395
Authors
Farooq V. Van Klaveren D. Steyerberg E.W. Meliga E. Vergouwe Y. Chieffo A.
Kappetein A.P. Colombo A. Holmes Jr. D.R. MacK M. Feldman T. Morice M.-C.
Stahle E. Onuma Y. Morel M.-A. Garcia-Garcia H.M. Van Es G.A. Dawkins K.D.
Mohr F.W. Serruys P.W.
Institution
(Farooq, Onuma, Garcia-Garcia, Serruys) Thoraxcenter, Erasmus University
Medical Center, Rotterdam, Netherlands
(Van Klaveren, Steyerberg, Vergouwe) Department of Public Health, Erasmus
University Medical Center, Rotterdam, Netherlands
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Meliga) AO Ordine Mauriziano Umberto i, Turin, Italy
(Chieffo, Colombo) San Raffaele Scientific Institute, Milan, Italy
(Holmes Jr.) Mayo Clinic, Rochester, MN, United States
(MacK) Heart Hospital Baylor Plano, Baylor Healthcare System, Dallas, TX,
United States
(Feldman) Evanston Hospital, Evanston, IL, United States
(Morice) Hopital Prive Jacques Cartier, Massy, France
(Stahle) University Hospital Uppsala, Uppsala, Sweden
(Morel, Garcia-Garcia, Van Es) Cardialysis, Rotterdam, Netherlands
(Dawkins) Boston Scientific Corporation, Natick, MA, United States
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
Anatomical and clinical characteristics to guide decision making between
coronary artery bypass surgery and percutaneous coronary intervention for
individual patients: Development and validation of SYNTAX score II.
Source
The Lancet. 381 (9867) (pp 639-650), 2013. Date of Publication: February
2013.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Background The anatomical SYNTAX score is advocated in European and US
guidelines as an instrument to help clinicians decide the optimum
revascularisation method in patients with complex coronary artery disease.
The absence of an individualised approach and of clinical variables to
guide decision making between coronary artery bypass graft surgery (CABG)
and percutaneous coronary intervention (PCI) are limitations of the SYNTAX
score. SYNTAX score II aimed to overcome these limitations. Methods SYNTAX
score II was developed by applying a Cox proportional hazards model to
results of the randomised all comers SYNTAX trial (n=1800). Baseline
features with strong associations to 4-year mortality in either the CABG
or the PCI settings (interactions), or in both (predictive accuracy), were
added to the anatomical SYNTAX score. Comparisons of 4-year mortality
predictions between CABG and PCI were made for each patient.
Discriminatory performance was quantified by concordance statistics and
internally validated with bootstrap resampling. External validation was
done in the multinational all comers DELTA registry (n=2891), a
heterogeneous population that included patients with three-vessel disease
(26%) or complex coronary artery disease (anatomical SYNTAX score.33, 30%)
who underwent CABG or PCI. The SYNTAX trial is registered with
ClinicalTrials.gov, number NCT00114972. Findings SYNTAX score II contained
eight predictors: anatomical SYNTAX score, age, creatinine clearance, left
ventricular ejection fraction (LVEF), presence of unprotected left main
coronary artery (ULMCA) disease, peripheral vascular disease, female sex,
and chronic obstructive pulmonary disease (COPD). SYNTAX score II
significantly predicted a difference in 4-year mortality between patients
undergoing CABG and those undergoing PCI (p_interaction 0.0037).
To achieve similar 4-year mortality after CABG or PCI, younger patients,
women, and patients with reduced LVEF required lower anatomical SYNTAX
scores, whereas older patients, patients with ULMCA disease, and those
with COPD, required higher anatomical SYNTAX scores. Presence of diabetes
was not important for decision making between CABG and PCI
(p_interaction 0.67). SYNTAX score II discriminated well in all
patients who underwent CABG or PCI, with concordance indices for internal
(SYNTAX trial) validation of 0.725 and for external (DELTA registry)
validation of 0.716, which were substantially higher than for the
anatomical SYNTAX score alone (concordance indices of 0.567 and 0.612,
respectively). A nomogram was constructed that allowed for an accurate
individualised prediction of 4-year mortality in patients proposing to
undergo CABG or PCI. Interpretation Long-term (4-year) mortality in
patients with complex coronary artery disease can be well predicted by a
combination of anatomical and clinical factors in SYNTAX score II. SYNTAX
score II can better guide decision making between CABG and PCI than the
original anatomical SYNTAX score. Funding Boston Scientific Corporation.

<8>
Accession Number
2013142877
Authors
Kim K.H. Choi H.G. Jung Y.H.
Institution
(Kim, Choi, Jung) Department of Otolaryngology-Head and Neck Surgery,
College of Medicine, Seoul National University Hospital, 101 Daehak-ro,
Jongno-gu, Seoul 110-744, South Korea
(Kim, Choi, Jung) Department of Otolaryngology-Head and Neck Surgery,
Seoul National University, Boramae Hospital, Seoul, South Korea
Title
Head and neck robotic surgery: Pros and Cons.
Source
Head and Neck Oncology. 5 (3) , 2013. Article Number: 4. Date of
Publication: 27 Feb 2013.
Publisher
OA Publishing London (Second Floor, 10-12 Maclise Road, London, England
W140PR, United States)
Abstract
Robotic surgery was introduced to the head and neck area in 2005,
following urologic, gynecologic, and cardiothoracic robotic procedures. It
has subsequently become very widely used. We review the benefits and
concerns of robotic surgery, along with the development history focusing
on head and neck procedures. While continued refinements to robotic
surgery will likely overcoming its present limitations, patients need to
be apprised of the current limitations as well as the evidence regarding
its technical and oncologic safety.

<9>
Accession Number
2013132390
Authors
Smits P.C. Hofma S. Togni M. Vazquez N. Valdes M. Voudris V. Slagboom T.
Goy J.-J. Vuillomenet A. Serra A. Nouche R.T. Den Heijer P. Van Der Ent M.
Institution
(Smits, Van Der Ent) Department of Cardiology, Maasstad Ziekenhuis,
Maasstadweg 21, 3079 DZ Rotterdam, Netherlands
(Hofma) Department of Cardiology, Medisch Centrum Leeuwarden, Leeuwarden,
Netherlands
(Togni, Goy) Department of Cardiology, HOpital Cantonal de Fribourg,
Fribourg, Switzerland
(Vazquez) Department of Cardiology, Hospitalario Juan Canalejo, Coruna,
Spain
(Valdes) Department of Cardiology, Hospital Virgen Arrixaca, Murcia, Spain
(Voudris) Department of Cardiology, Onassis Cardiac Surgery Centre,
Athens, Greece
(Slagboom) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Vuillomenet) Department of Cardiology, Kantonsspital Aarau, Aarau,
Switzerland
(Serra) Department of Cardiology, Hospital Del Mar, Barcelona, Spain
(Serra) Department of Cardiology, Hospital Sant Pau, Barcelona, Spain
(Nouche) Department of Cardiology, Hospital de Santiago de Compostela,
Santiagio de Compostela, Spain
(Den Heijer) Department of Cardiology, Amphia Ziekenhuis, Breda,
Netherlands
Title
Abluminal biodegradable polymer biolimus-eluting stent versus durable
polymer everolimus-eluting stent (COMPARE II): A randomised, controlled,
non-inferiority trial.
Source
The Lancet. 381 (9867) (pp 651-660), 2013. Date of Publication: February
2013.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Background Drug-eluting stents with durable biocompatible or biodegradable
polymers have been developed to address the risk of thrombosis associated
with first-generation drug-eluting stents. We aimed to compare the safety
and efficacy of a biodegradable polymer-coated biolimus-eluting stent with
a thin-strut everolimus-eluting stent coated with a durable biocompatible
polymer. Methods This open-label, prospective, randomised, controlled,
non-inferiority trial was undertaken at 12 sites across Europe. We used
limited exclusion criteria (age p>18 years, life expectancy p>5 years,
reference vessel diameter 2*0-4*0 mm) to enrol patients eligible for
percutaneous coronary intervention. Patients were randomly allocated (2:1)
by computer-generated random numbers to receive either a biodegradable
polymer biolimus-eluting stent (Nobori, Terumo, Tokyo, Japan) or a durable
fluoropolymer-based everolimus-eluting stent (Xience V or Prime, Abbott
Vascular, Santa Clara, CA, USA, or Promus, Boston Scientific, Natick, MA,
USA). The primary endpoint was a composite of safety (cardiac death and
non-fatal myocardial infarction) and efficacy (clinically indicated target
vessel revascularisation) at 12 months, analysed by intention to treat.
Patients received dual antiplatelet therapy for 12 months after discharge.
The trial is registered with ClinicalTrials.gov, number NCT01233453.
Findings From Jan 12, 2009, to Feb 7, 2011, we enrolled 2707 patients
(4025 lesions), 1795 of whom were assigned to receive the biolimus-eluting
stent (2638 lesions) and 912 to an everolimus-eluting stent (1387
lesions). 2688 (99*3%) patients completed 12 months' follow-up.
Significantly more patients in the biolimus-eluting stent group received a
non-assigned stent than did those in the everolimus-eluting stent group
(105 [5*9%] vs 19 [2*1%]; p<0*0001). The primary endpoint occurred in 93
(5*2%) patients in the biolimus-eluting stent group and 44 (4*8%) patients
in the everolimus-eluting stent group at 12 months (relative risk 1*07
[95% CI 0*75-1*52]; p _{non-inferiorityp}<0*0001). Analysis per
protocol did not change the outcome of this trial
(p_{non-inferiorityp}<0*0001). Interpretation Biodegradable
polymer biolimus-eluting stents are as safe and efficacious as the current
standard of a thin-strut everolimus-eluting stent with a durable
biocompatible polymer. We need to follow-up patients for longer to show
whether the biolimus-eluting stent reduces the risk of stent thrombosis
after 1 year when compared with the everolimus-eluting stent. Funding
Terumo Europe (Leuven, Belgium) and the Research Foundation of the
Cardiology Department, Maasstad Hospital (Rotterdam, Netherlands).

<10>
Accession Number
2013107255
Authors
Bilinska M. Kosydar-Piechna M. Mikulski T. Piotrowicz E. Gasiorowska A.
Piotrowski W. Nazar K. Piotrowicz R.
Institution
(Bilinska) Department of Cardiac Arrhythmia, Institute of Cardiology,
Warsaw, Poland
(Kosydar-Piechna, Piotrowicz, Piotrowicz) Department of Cardiac
Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology,
Warsaw, Poland
(Piotrowski) Department of Epidemiology, Cardiovascular Disease Prevention
and Health Promotion, Institute of Cardiology, Warsaw, Poland
(Mikulski, Gasiorowska, Nazar) Department of Applied Physiology,
Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw,
Poland
Title
Influence of aerobic training on neurohormonal and hemodynamic responses
to head-up tilt test and on autonomic nervous activity at rest and after
exercise in patients after bypass surgery.
Source
Cardiology Journal. 20 (1) (pp 17-24), 2013. Date of Publication: 2013.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Little is known about the influence of aerobic training on the
neurohormonal and hemodynamic responses to head-up tilt (HUT) and on
autonomic balance at rest and after exercise in optimally treated, low
risk post-coronary artery bypass grafting (CABG) patients. Methods: One
hundred male patients, mean age 56 +/- 6 years, 3 months after CABG, were
randomized to either 6-week training on cycloergometer, 3 times a week, at
70-80% of max tolerated heart rate (HR) (training group, n = 50) or to a
control group (n = 50). At baseline and at the end of the study, all
patients underwent: (1) cardiopulmonary exercise test with HR recovery
(HRR) assessment; (2) 60% HUT during which HR, blood pressure (BP), stroke
volume (SV by impedance cardiography) were monitored and blood samples
were taken for determination of plasma catecholamines and ANP levels, and
plasma renin activity; (3) assessment of HR variability (HRV) in the time
and frequency domains at rest. Results: During the final tests,
HUT-induced changes in HR, BP, SV, cardiac output, total peripheral
resistance, and noradrenaline were significantly lower in training group
than in controls. In addition, after training faster post-exercise HRR,
increased SDNN and a tendency towards an increase in the high frequency
HRV power spectrum were found. Conclusions: Aerobic training improved
neurohormonal and hemodynamic responses to head-up tilt test and favorably
modified sympatho-vagal balance in low risk post-CABG patients. 2013 Via
Medica.

<11>
Accession Number
23302601
Authors
Engels G.E. Gu Y.J. van Oeveren W. Rakhorst G. Mariani M.A. Erasmus M.E.
Institution
(Engels) HaemoScan B,V, Groningen, The Netherlands.
Title
The utility of lung epithelium specific biomarkers in cardiac surgery: a
comparison of biomarker profiles in on- and off-pump coronary bypass
surgery.
Source
Journal of cardiothoracic surgery. 8 (1) (pp 4), 2013. Date of
Publication: 2013.
Abstract
Despite continuous improvements in materials and perfusion techniques,
cardiac surgery still causes lung injury and a delay of pulmonary
recovery. Currently, there is no gold standard for quantifying cardiac
surgery induced lung injury and dysfunction. Adding objective measures,
such as plasma biomarkers, could be of great use here. In this study the
utility of lung epithelium specific proteins as biomarkers for lung
dysfunction was evaluated. Serial measurements of plasma concentrations of
Clara cell 16 kD (CC16) protein, Surfactant protein D (SP-D), Elastase and
Myeloperoxidase were performed on blood samples from 40 patients who
underwent coronary artery bypass grafting with cardiopulmonary bypass
(CABG, n = 20) or without cardiopulmonary bypass (OPCAB, n = 20). The
increase of SP-D and CC16 between pre-operative concentrations and
concentrations at the end of cardiopulmonary bypass, correlated with the
Aa-O2 gradient at 1 hour on the ICU (Rs = 0.409, p = .016 and Rs = 0.343,
p = .043, respectively).Furthermore, SP-D and CC16 were higher in CABG
than in OPCAB at the end of surgery [8.96 vs. 4.91 ng/mL, p = .042 and 92
vs. 113%, p = .007, respectively]. After 24 h both biomarkers returned to
their baseline values. Our results show that increases in plasma of SP-D
and CC16 correlate with clinical lung injury after coronary artery bypass
surgery. Therefore, lung epithelium specific proteins seem to be a useful
biomarker for measuring lung injury in the setting of cardiac surgery.

<12>
Accession Number
2013148428
Authors
ten Cate T.J.F. Kelder J.C. Plokker H.W.M. Verzijlbergen J.F. van Hemel
N.M.
Institution
(ten Cate, Verzijlbergen) Department of Nuclear Medicine, St. Antonius
Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM Nieuwegein, Netherlands
(ten Cate, Kelder, Plokker) Department of Cardiology, St. Antonius
Hospital, Nieuwegein, Nieuwegein, Netherlands
(van Hemel) Utrecht University, Utrecht, Netherlands
Title
Patients with left bundle branch block pattern and high cardiac risk
myocardial SPECT: Does the current management suffice?.
Source
Netherlands Heart Journal. 21 (3) (pp 118-124), 2013. Date of Publication:
March 2013.
Publisher
Bohn Stafleu van Loghum (P.O. Box 75971, Amsterdam 1070 A2, Netherlands)
Abstract
Introduction Myocardial perfusion SPECT (MPS) is frequently used for
cardiovascular risk stratification. The significance of MPS in patients
with abnormal electrical ventricular activation is often questionable.
This review assesses the value of MPS for risk stratification of patients
with intrinsic left bundle branch block or that due to right ventricular
apical pacing. Methods We reviewed the literature by a search of the
MEDLINE database (January 1980 to September 2010). The terms prognosis or
prognostic value were combined with SPECT and LBBB or pacing or
pacemakers. MPS was categorised as low and high risk according to the
original definitions. Results We identified 11 studies suitable for
review. A lowrisk MPS is associated with a low risk of cardiac events
whereas high-risk MPS carries a 4.8-fold increased risk, 95% CI [3.2 -
7.2] (p<0.0001). Despite secondary prevention and an improved medical and
interventional care, these figures have hardly changed over time.
Conclusion and clinical implications A low-risk MPS permits a policy of
watchful waiting whereas a high-risk MPS requires further analysis and
treatment. The persistent high cardiac death and acute myocardial
infarction rate after a high-risk MPS suggest that the current management
of these patients does not suffice and needs reconsideration. Springer
Media / Bohn Stafleu van Loghum 2011.

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<1>
[Use Link to view the full text]
Accession Number
2013140847
Authors
Agarwal S. Nuttall G.A. Johnson M.E. Hanson A.C. Oliver W.C.
Institution
(Agarwal) Department of Anesthesiology, Detroit Medical Center, Detroit,
MI, United States
(Nuttall, Johnson, Oliver) Department of Anesthesiology, College of
Medicine, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, United
States
(Hanson) Department of Biostatistics, College of Medicine, Mayo Clinic,
Rochester, MN, United States
Title
A prospective, randomized, blinded study of continuous ropivacaine
infusion in the median sternotomy incision following cardiac surgery.
Source
Regional Anesthesia and Pain Medicine. 38 (2) (pp 145-150), 2013. Date of
Publication: March-April 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective: The aim of this prospective, randomized, double-blind, placebo
controlled trial was to evaluate the safety and efficacy of continuous
ropivacaine infusion of into the sternal wound. Methods: We planned to
enroll 200 patients scheduled for various cardiac surgical procedures into
the study. Patients, in a double-blind randomized fashion, were given
either normal saline or 0.3% ropivacaine through 2 subcutaneous multiport
catheters placed on either side of the sternal split at an infusion rate
of 4 mL/h for 64 hours. The efficacy outcomes measured were time to
extubation of the trachea, intensive care unit and hospital stay duration,
pain scores, and narcotic usage. The safety outcomes measured were
systemic local anesthetic toxicity, major cardiac complications, and wound
infection. MEASUREMENTS AND MAIN Results: The data safety monitoring board
stopped the study after enrolling 85 patients because of excessive sternal
wound infections (9%, n = 44) in the ropivacaine group. This rate of
infection was not statistically different from the control group (0%, n =
41, P = 0.12), but it was statistically different from our historical
incidence of sternal wound infection (1.9%, no = 6381, P = 0.002). There
was also a lack of evidence of efficacy for time to extubation of the
trachea, narcotic usage, and pain control. Conclusions: The phase III
trial did not show improvement in time to extubation of the trachea or
pain control in the 0.3% ropivacaine group, but it was stopped early by
the data safety monitoring board. 2013 by American Society of Regional
Anesthesia and Pain Medicine.

<2>
Accession Number
2013119642
Authors
Batchelor W.B. Ellis S.G. Ormiston J.A. Stone G.W. Joshi A.A. Wang H.
Underwood P.L.
Institution
(Batchelor) Florida State University, College of Medicine, Tallahassee,
FL, United States
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Ormiston) Mercy Angiography Unit, Mercy Hospital, Auckland, New Zealand
(Stone) Cardiovascular Research Foundation, New York. NY, United States
(Joshi, Wang, Underwood) Boston Scientific Corporation, Natick, MA, United
States
(Underwood) Boston Scientific Corporation, 100 Boston Scientific Way,
Marlborough, MA 01752, United States
(Underwood) Southern Medical Group, P.A., 1300 Medical Dr., Tallahassee,
FL 32308, United States
Title
Racial differences in long-term outcomes after percutaneous coronary
intervention with paclitaxel-eluting coronary stents.
Source
Journal of Interventional Cardiology. 26 (1) (pp 49-57), 2013. Date of
Publication: February 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objectives To assess the influence of race on long-term outcomes following
percutaneous coronary intervention (PCI) with paclitaxel-eluting stents
(PES). Background Data on the influence of race on long-term outcomes
following PCI with drug-eluting stents are limited because of severe
underrepresentation of minority populations in randomized trials. Methods
We compared 5-year outcomes of 2,301 Whites, 127 Blacks, and 169 Asians
treated with PES in the TAXUS IV, V, and ATLAS trials. Outcomes were
adjusted using a propensity score logistic regression model with 1:4
matching. Results Blacks were more likely than Whites to be female, have a
history of hypertension, diabetes mellitus, congestive heart failure, and
stroke, but were less likely to have prior coronary artery disease.
Compared with Whites, Asians were younger, more likely to be male, have
stable angina, and left anterior descending disease, and less likely to
have silent ischemia, previous coronary artery bypass surgery, prior
coronary artery disease, diabetes mellitus, peripheral vascular disease,
and to receive glycoprotein IIb/IIIa inhibitors. Despite higher
antiplatelet compliance, the adjusted 5-year rates of myocardial
infarction (15.4% vs. 5.4%, P < 0.001) and stent thrombosis (5.6% vs.
1.1%, P = 0.002) were higher in Blacks than Whites. Despite lower
antiplatelet compliance, Asians had no differences in myocardial
infarction and stent thrombosis compared with Whites. Mortality and
revascularization rates were similar between the three groups. Conclusions
The long-term risk of major thrombotic events after PCI with PES was
higher in Blacks, but not Asians, compared with Whites. The mechanisms
underlying these racial differences warrant further investigation. (J
Interven Cardiol 2013;26:49-57) 2012, Wiley Periodicals, Inc.

<3>
Accession Number
2013131603
Authors
Roe Y.L. Zeitz C.J. Mittinty M.N. McDermott R.A. Chew D.P.
Institution
(Roe) School of Health Sciences, University of South Australia, Australia
(Zeitz) Division of Medicine, The Queen Elizabeth Hospital, Australia
(Mittinty) School of Population Health and Clinical Practice, University
of Adelaide, Australia
(McDermott) Public Health Group, Sansom Institute, University of South
Australia, Australia
(Chew) Department of Cardiology, Flinders University, Flinders Medical
Centre, Adelaide, SA, Australia
Title
Impact of age, gender and indigenous status on access to diagnostic
coronary angiography for patients presenting with non-ST segment elevation
acute coronary syndromes in Australia.
Source
Internal Medicine Journal. 43 (3) (pp 317-322), 2013. Date of Publication:
March 2013.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Using Australian guidelines for management of acute coronary syndromes, we
investigated the proportion of high-risk patients enrolled in the Acute
Coronary Syndromes Prospective Audit registry who received a coronary
angiogram. A prospective nationwide multicentre registry involving 39
Australian hospitals was used. The study cohort were patients with
high-risk clinical features without ST segment elevation (n = 1948)
admitted from emergency departments between 1 November 2005 and 31 July
2007. Eighty nine per cent of patients with ST segment elevation
myocardial infarction and only 53% of eligible patients with high-risk
acute coronary syndromes with no ST elevation received a diagnostic
angiogram. Increasing age was associated with lower rates of angiography;
a high-risk patient at the age of >=70 years was 19% less likely to
receive an angiogram than one at the age of <70 years (risk ratio (RR) =
0.81 95% confidence interval (CI) 0.76, 0.76). Women were 26% less likely
than men to receive an angiogram (RR = 0.74; 95% CI = 0.65, 0.83). The
adjusted RR from the multivariate analysis suggests that a patient at the
age of >=70 years was 35% less likely to receive an angiogram than one at
the age of <70 years (RR = 0.65, 95% CI = 0.60, 0.73), and that women were
13% less likely than men to receive an angiogram (RR = 0.87, 95% CI =
0.80, 0.96). Indigenous patients were as likely to access angiography as
eligible non-indigenous patients (RR = 1.03, 95% CI 0.85, 1.25). There is
underinvestigation of high-risk patients without ST segment elevation in
Australian hospitals, particularly for women and older patients.
Indigenous patients are younger and have poorer risk profiles, and
represent a group that would benefit from greater investment in prevention
strategies. 2013 Royal Australasian College of Physicians.

<4>
Accession Number
2013145371
Authors
Kim N.-Y. Shim J.-K. Bang S.-O. Sim J.-S. Song J.-W. Kwak Y.-L.
Institution
(Kim, Shim, Bang, Sim, Song, Kwak) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Shim, Bang, Song, Kwak) Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
Title
Effects of ulinastatin on coagulation in high-risk patients undergoing
off-pump coronary artery bypass graft surgery.
Source
Korean Journal of Anesthesiology. 64 (2) (pp 105-111), 2013. Date of
Publication: February 2013.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: Both systemic inflammatory reaction and regional myocardial
ischemia/reperfusion injury may elicit hypercoagulability after off-pump
coronary artery bypass grafting (OPCAB). We investigated the influence of
ulinastatin, which suppresses the activity of polymorphonuclear leukocyte
elastase and production of pro-inflammatory cytokines, on coagulation in
patients with elevated high-sensitivity C-reactive protein (hsCRP)
undergoing OPCAB. Methods: Fifty patients whose preoperative hsCRP > 3.0
mg/L were randomly allocated into the ulinastatin (600,000 U) or control
group. Serum concentrations of thrombin-antithrombin complex (TAT) and
prothrombin fragment 1+2 (F1+2) were measured preoperatively, immediately
after surgery, and at 24 h after surgery, respectively. Secondary
endpoints included platelet factor (PF)-4, amount of blood loss, and
transfusion requirement. Results: All baseline values of TAT, F1+2, and
PF-4 were higher than the normal range in both groups. F1+2 was elevated
in both groups at immediate, and at 24 h after surgery as compared to
baseline value, without any significant intergroup differences. Remaining
coagulation parameters, transfusion requirement and blood loss during
operation and postoperative 24 h were not different between the two
groups. Conclusions: Intraoperative administration of ulinastatin did not
convey beneficial influence in terms of coagulation and blood loss in
high-risk patients with elevated hsCRP undergoing multivessel OPCAB, who
already exhibited hypercoagulability before surgery. the Korean Society
of Anesthesiologists, 2013.

<5>
Accession Number
2013141258
Authors
Shi J. Wang G. Lv H. Yuan S. Wang Y. Ji H. Li L.
Institution
(Shi, Wang, Lv, Yuan, Ji, Li) Department of Anesthesiology and Critical
Care, Fuwai Hospital, Chinese Academy of Medical Sciences, 167 Bei Lishi
Rd, Beijing, 100037, China
(Wang) Department of Biostatistics, Peking Union Medical College, Chinese
Academy of Medical Sciences, Beijing, China
Title
Tranexamic acid in on-pump coronary artery bypass grafting without
clopidogrel and aspirin cessation: Randomized trial and 1-year follow-up.
Source
Annals of Thoracic Surgery. 95 (3) (pp 795-802), 2013. Date of
Publication: March 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Dual antiplatelet therapy is widely used in patients with
coronary artery disease and increases the risk of excessive bleeding and
transfusion in those undergoing coronary artery bypass grafting (CABG).
Methods: The study was a prospective, randomized, double-blinded and
placebo-controlled trial. Patients undergoing primary and isolated on-pump
CABG with their last dose of clopidogrel and aspirin less than 7 days
preoperatively were randomly assigned to receive tranexamic acid (15 mg/kg
before surgical incision and 15 mg/kg after protamine neutralization) or a
corresponding volume of saline solution. The primary outcome was
allogeneic erythrocyte transfusion. Results: Randomly assigned
participants were 120 adults among whom 117 were analyzed, 58 in the
tranexamic acid group and 59 in the placebo group. As compared with
placebo, tranexamic acid reduced allogeneic erythrocyte requirement - both
the volume transfused (4.84 +/- 5.85 versus 9.36 +/- 11.41 units; mean
difference -4.52 units; 95% interval confidence [CI], -7.85 to -1.19
units; p < 0.001) and the ratio exposed (72.4% versus 91.5%; risk
difference in percentage point, -19.1; 95% CI, -32.6 to -5.59; relative
risk, 0.79; 95% CI, 0.66 to 0.94; p = 0.007) - blood loss (1069.1 +/-
565.5 mL versus 1449.8 +/- 899.8 mL; mean difference, -380.7 mL; 95% CI,
-656.4 to -104.9 mL; p = 0.005), major bleeding (50.0% versus 78.0%; risk
difference, -28.0; 95% CI, -44.6 to -11.3; relative risk, 0.64; 95% CI,
0.48 to 0.86; p = 0.002), and reoperation (0.0% versus 10.2%; risk
difference, -10.2; 95% CI, -17.9 to -2.46; relative risk, 0.08; 95% CI,
0.00 to 1.36; p = 0.01). Conclusions: Tranexamic acid significantly
reduced blood loss, major bleeding, reoperation, and allogeneic
transfusion in patients undergoing primary and isolated on-pump CABG
without clopidogrel and aspirin cessation. 2013 The Society of Thoracic
Surgeons.

<6>
[Use Link to view the full text]
Accession Number
2013140790
Authors
Guethoff S. Meiser B.M. Groetzner J. Eifert S. Grinninger C. Ueberfuhr P.
Reichart B. Hagl C. Kaczmarek I.
Institution
(Guethoff, Groetzner, Eifert, Ueberfuhr, Reichart, Hagl, Kaczmarek)
Department of Cardiac Surgery, University of Munich (LMU), Marchioninistr.
15, 81377 Munchen, Germany
(Meiser, Grinninger, Kaczmarek) Transplantation Center Munich, University
of Munich (LMU), Munich, Germany
Title
Ten-year results of a randomized trial comparing tacrolimus versus
cyclosporine a in combination with mycophenolate mofetil after heart
transplantation.
Source
Transplantation. 95 (4) (pp 629-634), 2013. Date of Publication: 27 Feb
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Long-term results of prospective randomized trials comparing
triple immunosuppressive strategies combining tacrolimus (TAC) or
cyclosporine A (CsA) with mycophenolate mofetil (MMF) and steroids after
heart transplantation (HTX) are rarely published. Therefore, we collected
long-term follow-up data of an intervention cohort 10 years after
randomization. Methods: Ten-year follow-up data of 60 patients included in
a prospective, randomized trial between 1998 and 2000 were analyzed as
intention-to-treat (TAC-MMF n=30; CsA-MMF n=30). Baseline characteristics
were well balanced. Cardiac allograft vasculopathy (CAV) was graduated in
accordance with the new ISHLT classification. Results: Survival at 1, 5,
and 10 years was 96.7%, 80.0%, and 66.7% for TAC-MMF and 90.0%, 83.3%, and
80.0% for CsA-MMF (P=ns). Freedom from acute rejection (AR) was
significantly higher in TAC-MMF versus CsA-MMF (65.5% vs. 21.7%, log-rank
8.3, P=0.004). Freedom from ISHLT>=CAV1 after 5 and 10 years was in
TAC-MMF 64.0% and 45.8%, and in CsA-MMF 36.0% (log-rank 3.0, P=0.085) and
8.0% (log-rank 9.0, P=0.003). No difference in long-term results for
freedom from coronary angioplasty or stenting, renal dysfunction, diabetes
mellitus, CMV infection, or malignancy was detected. Conclusion:
Cross-over effects because of treatment switch may result in impairment of
significance between the groups. The long-term analysis resulted in a
significant difference in manifestation of CAV between the groups after 10
years. Less rejection in the TAC-group might have contributed to the lower
incidence of CAV. Superior freedom from AR and CAV in the TAC-MMF group
did not result in better long-term survival. 2013 by Lippincott Williams
& Wilkins.

<7>
Accession Number
2013146803
Authors
Shang Q.-H. Xu H. Lu X.-Y. Wen C. Shi D.-Z. Chen K.-J.
Institution
(Shang) Beijing University of Chinese Medicine, Beijing (100029), China
(Xu, Lu, Wen) National Integrative Medicine Center for Cardiovascular
Diseases, China-Japan Friendship Hospital, Beijing (100029), China
(Shi, Chen) Xiyuan Hospital, China Academy of Chinese Medical Sciences,
Beijing (100091), China
Title
A multi-center randomized double-blind placebo-controlled trial of
Xiongshao Capsule in preventing restenosis after percutaneous coronary
intervention: A subgroup analysis of senile patients.
Source
Chinese Journal of Integrative Medicine. 17 (9) (pp 669-674), 2011. Date
of Publication: 2011.
Publisher
Chinese Journal of Integrated Traditional and (1 Caochang, Xiyuan, Beijing
100091, China)
Abstract
Objective: To evaluate the safety and efficacy of Xiongshao Capsule (XS),
consisting of Chuangxiongol and paeoniflorin, in preventing restenosis
after percutaneous coronary intervention (PCI) in senile coronary heart
disease (CHD) patients. Methods: A multi-center, randomized, double-blind,
placebo-controlled trial was conducted. A total of 335 CHD patients were
randomly assigned to treatment with oral administration of XS, or a
placebo for 6 months after successful PCI. A clinical follow-up was
performed at 1, 3 and 6 months after PCI and an angiographic follow-up was
scheduled at 6 months. The primary endpoint was angiographic restenosis
defined as a luminal stenosis 50% in follow-up. The secondary endpoints
were combined incidence of death, target lesion nonfatal myocardial
infarction, repeat target-vessel angioplasty, and coronary artery bypass
graft surgery (CABG). The follow-up for the above clinical endpoint events
was continued to 1 year after PCI. Results: The subgroup analysis of 152
senile patients (68 cases angiographic follow-up) showed that the
restenosis rates tended to reduce in the XS group as compared with that in
the placebo group (24.32% vs. 38.71%, P > 0.05), and the minimum lumen
diameter (MLD) significantly increased in the follow-up (2.15 +/- 0.84 for
XS vs. 1.73 +/- 0.91 for placebo, P < 0.05). The incidence of recurrent
angina at 3 and 6 months after PCI was also significantly reduced in the
XS group (4.11% and 12.33%) as compared with those in the placebo group
(17.72% and 43.04%), but there was no significant difference in the
combined incidence of clinical outcomes (6.85% in the XS group vs. 11.39%
in the placebo group, P > 0.05). No significant adverse reactions occurred
within the 6-month follow-up period in the XS group. Conclusion:
Administration of XS in addition to standardized Western medication for 6
months is demonstrated to be safe and effective in reducing post-PCI
recurrent angina and inhibiting luminal restenosis after PCI in senile CHD
patients. 2011 The Chinese Journal of Integrated Traditional and Western
Medicine Press and Springer-Verlag Berlin Heidelberg.

<8>
Accession Number
2013144911
Authors
Karlilar B. Tunc M. Gunal Sazak H. Telatar A. Savkilioglu E. Karabulut E.
Institution
(Karlilar) Clinic of Anesthesiology and Reanimation, Umut Surgical Medical
Center, Mersin, Turkey
(Tunc, Gunal Sazak, Savkilioglu) Anesthesiology and Reanimation, Ataturk
Pulmonary Diseases and Surgery Training and Research Hospital, Ankara,
Turkey
(Telatar) Anesthesiology and Reanimation, Sinop State Hospital, Sinop,
Turkey
(Karabulut) Department of biostatistics, Hacettepe University, Faculty of
Medicine, Ankara, Turkey
Title
Effects of epidural bupivacaine on the doses of propofol, alfentanil,
vecuronium, and neuromuscular block: A prospective randomized,
single-blind clinical study.
Source
Turkiye Klinikleri Journal of Medical Sciences. 33 (2) (pp 306-313), 2013.
Date of Publication: 2013.
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Objective: This study was planned to ascertain the effects of epidural
bupivacaine on the doses of propofol, alfentanil and vecuronium used for
the maintenance for general anesthesia in patients receiving thoracic
epidural anesthesia (TEA) combined with total intravenous anesthesia
(TIVA) in thoracic surgery. In addition, the impacts of TEA on duration,
intensity, reversal and the characteristics of residual block related to
vecuronium-induced neuromuscular blockade was investigated. Material and
Methods: Thirty patients scheduled for thoracic surgery were randomly
assigned into two groups. Group 1 received TIVA combined with TEA, whereas
Group 2 obtained TIVA solely. Epidural bupivacaine (0.375%) was given 6
mL/h following 1.5 mL/segment bupivacaine (0.5%) bolus in Group 1. General
anesthesia was provided with propofol, alfentanil and vecuronium in both
groups. Propofol dose was adjusted to maintain bispectral index (BIS)
value between 45 and 60, whereas alfentanil dose was titrated according to
the hemodynamic parameters. Following neuromuscular monitoring and
stabilization of response to the neuromuscular stimulus, 0.1 mg/kg
vecuronium was injected intravenously in 5 seconds. The responses to train
of four (TOF) stimulation (TOF1 and TOF2), posttetanic count (PTC), and
TOF rate (TOFR) values were recorded. The neuromuscular blockade was
reversed after closure of surgical incision and the fourth response to TOF
during recovery. The residual block was assessed in surgical intensive
care unit for 30 minutes. Results: Alfentanil amount used in the
maintenance was significantly less in Group 1 compared to Group 2
(p<0.05), whereas there was no difference between the groups for propofol
and vecuronium doses (p>0.05). There was no statistically significant
difference between the groups with respect to the onset time of
vecuronium, TOF1 time following induction, and duration of the clinical
effects of vecuronium used for induction and maintenance (p>0.05).
Conclusion: It was demonstrated that epidural bupivacaine decreased the
requirement of alfentanil without alterations in propofol and vecuronium
doses in patients undergoing thoracic surgery in our study. We also
suggest that in the present dose, epidural bupivacaine has no effect on
duration, intensity, reversal or the characteristics of residual block
related to vecuronium-induced neuromuscular blockade. 2013 by Turkiye
Klinikleri.

<9>
Accession Number
2013136857
Authors
Kamalesh M. Sharp T.G. Tang X.C. Shunk K. Ward H.B. Walsh J. King III S.
Colling C. Moritz T. Stroupe K. Reda D.
Institution
(Kamalesh, Sharp, Walsh) Roudebush VA Medical Center, School of Medicine,
Indiana University, 1481 West 10th Street, Indianapolis, IN 46202, United
States
(Tang, Moritz, Stroupe, Reda) Hines VA Cooperative Studies Program
Coordinating Center, Hines, IL, United States
(Shunk) University of California, San Francisco, VA Medical Center, San
Francisco, CA, United States
(Ward) University of Minnesota Medical Center, Minneapolis, MN, United
States
(King III) Saint Joseph's Heart and Vascular Institute, Atlanta, GA,
United States
(Colling) Cooperative Studies Program Clinical Research Pharmacy
Coordinating Center, Albuquerque, NM, United States
Title
Percutaneous coronary intervention versus coronary bypass surgery in
United States veterans with diabetes.
Source
Journal of the American College of Cardiology. 61 (8) (pp 808-816), 2013.
Date of Publication: 26 Feb 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to determine the optimal coronary
revascularization strategy in patients with diabetes with severe coronary
disease. Background: Although subgroup analyses from large trials,
databases, and meta-analyses have found better survival for patients with
diabetes with complex coronary artery disease when treated with surgery, a
randomized trial comparing interventions exclusively with drug-eluting
stents and surgery in patients with diabetes with high-risk coronary
artery disease has not yet been reported. Methods: In a prospective,
multicenter study, 198 eligible patients with diabetes with severe
coronary artery disease were randomly assigned to either coronary artery
bypass grafting (CABG) (n = 97) or percutaneous coronary intervention
(PCI) with drug-eluting stents (n = 101) and followed for at least 2
years. The primary outcome measure was a composite of nonfatal myocardial
infarction or death. Secondary outcome measures included all-cause
mortality, cardiac mortality, nonfatal myocardial infarction, and stroke.
Results: The study was stopped because of slow recruitment after enrolling
only 25% of the intended sample size, leaving it severely underpowered for
the primary composite endpoint of death plus nonfatal myocardial
infarction (hazard ratio: 0.89; 95% confidence interval: 0.47 to 1.71).
However, after a mean follow-up period of 2 years, all-cause mortality was
5.0% for CABG and 21% for PCI (hazard ratio: 0.30; 95% confidence
interval: 0.11 to 0.80), while the risk for nonfatal myocardial infarction
was 15% for CABG and 6.2% for PCI (hazard ratio: 3.32; 95% confidence
interval: 1.07 to 10.30). Conclusions: This study was severely
underpowered for its primary endpoint, and therefore no firm conclusions
about the comparative effectiveness of CABG and PCI are possible. There
were interesting differences in the components of the primary endpoint.
However, the confidence intervals are very large, and the findings must be
viewed as hypothesis generating only. (Coronary Artery Revascularization
in Diabetes; NCT00326196) 2013 American College of Cardiology Foundation.

<10>
Accession Number
2013147529
Authors
Hakim F.A. Krishnaswamy C. Mookadam F.
Institution
(Hakim, Krishnaswamy, Mookadam) Department of Cardiovascular Diseases,
Mayo Clinic Arizona, College of Medicine, 13400 E Shea Blvd, Scottsdale,
AZ 85255, United States
Title
Mitral arcade in adults - A systematic overview.
Source
Echocardiography. 30 (3) (pp 354-359), 2013. Date of Publication: March
2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Mitral arcade (MA) is a rare congenital anomaly of the mitral valve and
its tensor apparatus. This condition has been reported primarily in
children younger than 3 years of age. MA is characterized by elongated
papillary muscles connected to each other and to the tip of anterior
mitral leaflet by a bridge of fibrous tissue. Because of progressive
mitral regurgitation and/or mitral stenosis, survival into adulthood is
rare. Not much is known about MA in the adult population. In this review
we address the demographic features, clinical presentation, diagnosis,
treatment, and outcome of this congenital anomaly in adult patients.
2013, Wiley Periodicals, Inc.

<11>
Accession Number
2013136870
Authors
Hulten E. Pickett C. Bittencourt M.S. Villines T.C. Petrillo S. Di Carli
M.F. Blankstein R.
Institution
(Hulten, Bittencourt, Di Carli, Blankstein) Noninvasive Cardiovascular
Imaging Program, Departments of Medicine (Cardiovascular Division) and
Radiology, Brigham and Women's Hospital and Harvard Medical School, 75
Francis Street, Boston, MA 02115, United States
(Pickett, Villines) Department of Medicine (Cardiology Service), Walter
Reed National Military Medical Center, Bethesda, MD, United States
(Petrillo) Department of Radiology, Mid-Atlantic Permanente Medical Group,
Rockville, MD, United States
Title
Outcomes after coronary computed tomography angiography in the emergency
department: A systematic review and meta-analysis of randomized,
controlled trials.
Source
Journal of the American College of Cardiology. 61 (8) (pp 880-892), 2013.
Date of Publication: 26 Feb 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The aim of the study was to systematically review and perform
a meta-analysis of randomized, controlled trials of coronary computed
tomography angiography (CCTA) versus usual care (UC) triage of acute chest
pain in the emergency department (ED). Background: CCTA allows rapid
evaluation of patients presenting to the ED with acute chest pain
syndromes; however, the impact of such testing on patient management and
downstream testing has emerged as a concern. Methods: We systematically
searched for randomized, controlled trials of CCTA in the ED and performed
a meta-analysis of clinical outcomes. Results: Four randomized, controlled
trials were included, with 1,869 patients undergoing CCTA and 1,397
undergoing UC. There were no deaths and no difference in the incidence of
myocardial infarction, post-discharge ED visits, or rehospitalizations.
Four studies reported decreased length of stay with CCTA and 3 reported
cost savings; 8.4% of patients undergoing CCTA versus 6.3% of those
receiving UC underwent invasive coronary angiography (ICA), whereas 4.6%
of patients undergoing CCTA versus 2.6% of those receiving UC underwent
coronary revascularization. The odds ratio of ICA for CCTA patients versus
UC patients was 1.36 (95% confidence interval [CI]: 1.03 to 1.80, p =
0.030), and for revascularization, it was 1.81 (95% CI: 1.20 to 2.72, p =
0.004). The absolute increase in ICA after CCTA was 21 per 1,000 CCTA
patients (95% CI: 1.8 to 44.9), and the number needed to scan was 48. The
absolute increase in revascularization after CCTA was 20 per 1,000
patients (95% CI: 5.0 to 41.4); the number needed to scan was 50. Both
percutaneous coronary intervention and coronary artery bypass graft
surgery independently contributed to the significant increase in
revascularization. Conclusions: Compared with UC, the use of CCTA in the
ED is associated with decreased ED cost and length of stay but increased
ICA and revascularization. 2013 American College of Cardiology
Foundation.

<12>
Accession Number
2013147512
Authors
Eroglu E. Cakal S.D. Cakal B. Dundar C. Alici G. Ozkan B. Yazicioglu M.V.
Tigen K. Esen A.M.
Institution
(Eroglu) Department of Cardiology, Yeditepe University Hospital, Devlet
Yolu, Ankara Cad No: 102/104, 34752 Kozyatagi, Istanbul, Turkey
(Cakal, Cakal, Dundar, Alici, Ozkan, Yazicioglu, Tigen, Esen) Department
of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital,
Istanbul, Turkey
Title
Time course of right ventricular remodeling after percutaneous atrial
septal defect closure: Assessment of regional deformation properties with
two-dimensional strain and strain rate imaging.
Source
Echocardiography. 30 (3) (pp 324-330), 2013. Date of Publication: March
2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Quantitative assessment of the right ventricular (RV) function
in atrial septal defect (ASD) patients before and after closure remains
difficult. The aim of this study was to assess the regional RV function in
ASD patients, to evaluate the extent and time course of RV remodeling
following ASD closure, and to investigate whether any regional difference
exists in RV remodeling. Methods: Twenty patients with ASD and 20
age-matched controls were included. All underwent standard
echocardiography and two-dimensional strain (S) and strain rate (SR)
imaging by speckle tracking before, and 24 hours and 1 month after the
defect closure. Results: Right ventricular S was higher in ASD patients
except apical lateral segment S, which was lower when compared with
controls. There was no difference in RV SR between ASD patients and
controls. RV septal S and SR, and lateral SR decreased in 24 hours after
the procedure and remained the same at 1 month. RV lateral basal and mid S
decreased and apical S increased in 24 hours after the closure. All 3
segments showed some more increase at 1 month. RV apical S showed strong
correlations with systolic pulmonary artery pressure and global RV
systolic function indices. Conclusions: Chronic volume overload in ASD
patients causes alterations in RV deformation. Percutaneous closure
results in rapid remodeling and normalization of RV deformation. The major
geometrical and deformational changes are completed in 24 hours. Lateral
wall S seems to reflect the RV deformational changes due to volume loading
and unloading better than SR in ASD patients. 2012, Wiley Periodicals,
Inc.

<13>
Accession Number
2013118719
Authors
Khalil M.A. Al-Agaty A.E. Ali W.G. Abdel Azeem M.S.
Institution
(Khalil, Al-Agaty, Ali) Department of Anesthesia, Faculty of Medicine,
Cairo University, Giza, Egypt
(Khalil) Department of Anesthesia, Saad Specialist Hospital, Prince Faisal
Bin Fahad Street, Al-Khobar 30353, Saudi Arabia
(Abdel Azeem) Department of Critical Care, Faculty of Medicine, Cairo
University, Giza, Egypt
Title
A comparative study between amiodarone and magnesium sulfate as
antiarrhythmic agents for prophylaxis against atrial fibrillation
following lobectomy.
Source
Journal of Anesthesia. 27 (1) (pp 56-61), 2013. Date of Publication:
February 2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: Atrial fibrillations are common after thoracic surgery.
Amiodarone and magnesium sulfate have been used for the management of
atrial fibrillation following cardiac and non-cardiac surgery. However, to
our knowledge, comparisons of both drugs with each other and with a
control group in relation to the prevention of AF following lung surgery
have not been performed. Our primary aim in this study was to
prospectively evaluate the prophylactic effects of magnesium sulfate and
amiodarone used separately and compare them with a control group analyzed
retrospectively during and following lobectomy surgeries. Patients and
methods: The prophylactic value of amiodarone (group A; 219 patients)
administered as an intravenous infusion (15 mg/kg for 48 h
postoperatively) after a loading dose (5 mg/kg) was compared with
magnesium sulfate (group M; 219 patients) administered intravenously as a
loading dose (80 mg/kg magnesium sulfate over 30 min preoperatively) and
then as an intravenous infusion (8 mg/kg/h for 48 h) in 438 patients
undergoing lobectomy. These two groups were compared with a control group
of 219 patients who were analyzed retrospectively. Results: The results
showed significantly lower incidences of AF in groups A and M when
compared with group C (P < 0.05). There was no significant difference
between the amiodarone and magnesium sulfate groups. However, the
incidence of postoperative AF was lower in the amiodarone group, where
only 21 (10 %) patients developed AF in comparison to 27 (12.5 %) patients
in the magnesium sulfate group. Group C showed a higher incidence, 44
(20.5 %) patients, when compared with both groups. In addition, there were
significant differences between the three groups concerning intensive care
unit (ICU) and total hospital stays (P < 0.05). Conclusion: Our study
showed that during the intra- and postoperative periods, both amiodarone
and magnesium sulfate are effective at preventing the incidence of atrial
fibrillation following lung resection surgery in comparison to the control
group. 2012 Japanese Society of Anesthesiologists.

<14>
Accession Number
23440795
Authors
Taylor F. Huffman M.D. Macedo A.F. Moore T.H. Burke M. Davey Smith G. Ward
K. Ebrahim S.
Institution
(Taylor) Department of Non-communicable Disease Epidemiology, London
School of Hygiene and Tropical Medicine, London, UK.
Title
Statins for the primary prevention of cardiovascular disease.
Source
Cochrane database of systematic reviews (Online). 1 (pp CD004816), 2013.
Date of Publication: 2013.
Abstract
Reducing high blood cholesterol, a risk factor for cardiovascular disease
(CVD) events in people with and without a past history of CVD is an
important goal of pharmacotherapy. Statins are the first-choice agents.
Previous reviews of the effects of statins have highlighted their benefits
in people with CVD. The case for primary prevention was uncertain when the
last version of this review was published (2011) and in light of new data
an update of this review is required. To assess the effects, both harms
and benefits, of statins in people with no history of CVD. To avoid
duplication of effort, we checked reference lists of previous systematic
reviews. The searches conducted in 2007 were updated in January 2012. We
searched the Cochrane Central Register of Controlled Trials (CENTRAL) in
The Cochrane Library (2022, Issue 4), MEDLINE OVID (1950 to December Week
4 2011) and EMBASE OVID (1980 to 2012 Week 1).There were no language
restrictions. We included randomised controlled trials of statins versus
placebo or usual care control with minimum treatment duration of one year
and follow-up of six months, in adults with no restrictions on total, low
density lipoprotein (LDL) or high density lipoprotein (HDL) cholesterol
levels, and where 10% or less had a history of CVD. Two review authors
independently selected studies for inclusion and extracted data. Outcomes
included all-cause mortality, fatal and non-fatal CHD, CVD and stroke
events, combined endpoints (fatal and non-fatal CHD, CVD and stroke
events), revascularisation, change in total and LDL cholesterol
concentrations, adverse events, quality of life and costs. Odds ratios
(OR) and risk ratios (RR) were calculated for dichotomous data, and for
continuous data, pooled mean differences (MD) (with 95% confidence
intervals (CI)) were calculated. We contacted trial authors to obtain
missing data. The latest search found four new trials and updated
follow-up data on three trials included in the original review. Eighteen
randomised control trials (19 trial arms; 56,934 participants) were
included. Fourteen trials recruited patients with specific conditions
(raised lipids, diabetes, hypertension, microalbuminuria). All-cause
mortality was reduced by statins (OR 0.86, 95% CI 0.79 to 0.94); as was
combined fatal and non-fatal CVD RR 0.75 (95% CI 0.70 to 0.81), combined
fatal and non-fatal CHD events RR 0.73 (95% CI 0.67 to 0.80) and combined
fatal and non-fatal stroke (RR 0.78, 95% CI 0.68 to 0.89). Reduction of
revascularisation rates (RR 0.62, 95% CI 0.54 to 0.72) was also seen.
Total cholesterol and LDL cholesterol were reduced in all trials but there
was evidence of heterogeneity of effects. There was no evidence of any
serious harm caused by statin prescription. Evidence available to date
showed that primary prevention with statins is likely to be cost-effective
and may improve patient quality of life. Recent findings from the
Cholesterol Treatment Trialists study using individual patient data
meta-analysis indicate that these benefits are similar in people at lower
(< 1% per year) risk of a major cardiovascular event. Reductions in
all-cause mortality, major vascular events and revascularisations were
found with no excess of adverse events among people without evidence of
CVD treated with statins.

<15>
Accession Number
23440790
Authors
Arsenault K.A. Yusuf A.M. Crystal E. Healey J.S. Morillo C.A. Nair G.M.
Whitlock R.P.
Institution
(Arsenault) Department of Surgery, McMaster University, Hamilton, Canada.
Title
Interventions for preventing post-operative atrial fibrillation in
patients undergoing heart surgery.
Source
Cochrane database of systematic reviews (Online). 1 (pp CD003611), 2013.
Date of Publication: 2013.
Abstract
Atrial fibrillation is a common post-operative complication of cardiac
surgery and is associated with an increased risk of post-operative stroke,
increased length of intensive care unit and hospital stays, healthcare
costs and mortality. Numerous trials have evaluated various
pharmacological and non-pharmacological prophylactic interventions for
their efficacy in preventing post-operative atrial fibrillation. We
conducted an update to a 2004 Cochrane systematic review and meta-analysis
of the literature to gain a better understanding of the effectiveness of
these interventions. The primary objective was to assess the effects of
pharmacological and non-pharmacological interventions for preventing
post-operative atrial fibrillation or supraventricular tachycardia after
cardiac surgery. Secondary objectives were to determine the effects on
post-operative stroke or cerebrovascular accident, mortality,
cardiovascular mortality, length of hospital stay and cost of treatment
during the hospital stay. We searched the Cochrane Central Register of
ControlLed Trials (CENTRAL) (Issue 8, 2011), MEDLINE (from 1946 to July
2011), EMBASE (from 1974 to July 2011) and CINAHL (from 1981 to July
2011). We selected randomized controlled trials (RCTs) that included adult
patients undergoing cardiac surgery who were allocated to pharmacological
or non-pharmacological interventions for the prevention of post-operative
atrial fibrillation or supraventricular tachycardia, except digoxin,
potassium (K(+)), or steroids. Two review authors independently abstracted
study data and assessed trial quality. One hundred and eighteen studies
with 138 treatment groups and 17,364 participants were included in this
review. Fifty-seven of these studies were included in the original version
of this review while 61 were added, including 27 on interventions that
were not considered in the original version. Interventions included
amiodarone, beta-blockers, sotalol, magnesium, atrial pacing and posterior
pericardiotomy. Each of the studied interventions significantly reduced
the rate of post-operative atrial fibrillation after cardiac surgery
compared with a control. Beta-blockers (odds ratio (OR) 0.33; 95%
confidence interval) CI 0.26 to 0.43; I(2) = 55%) and sotalol (OR 0.34;
95% CI 0.26 to 0.43; I(2) = 3%) appear to have similar efficacy while
magnesium's efficacy (OR 0.55; 95% CI 0.41 to 0.73; I(2) = 51%) may be
slightly less. Amiodarone (OR 0.43; 95% CI 0.34 to 0.54; I(2) = 63%),
atrial pacing (OR 0.47; 95% CI 0.36 to 0.61; I(2) = 50%) and posterior
pericardiotomy (OR 0.35; 95% CI 0.18 to 0.67; I(2) = 66%) were all found
to be effective. Prophylactic intervention decreased the hospital length
of stay by approximately two-thirds of a day and decreased the cost of
hospital treatment by roughly $1250 US. Intervention was also found to
reduce the odds of post-operative stroke, though this reduction did not
reach statistical significance (OR 0.69; 95% CI 0.47 to 1.01; I(2) = 0%).
No significant effect on all-cause or cardiovascular mortality was
demonstrated. Prophylaxis to prevent atrial fibrillation after cardiac
surgery with any of the studied pharmacological or non-pharmacological
interventions may be favored because of its reduction in the rate of
atrial fibrillation, decrease in the length of stay and cost of hospital
treatment and a possible decrease in the rate of stroke. However, this
review is limited by the quality of the available data and heterogeneity
between the included studies. Selection of appropriate interventions may
depend on the individual patient situation and should take into
consideration adverse effects and the cost associated with each approach.

<16>
Accession Number
71013827
Authors
Kaya S. Coskun R. Gundogan K. Guven M. Sungur M.
Institution
(Kaya, Coskun, Gundogan, Guven, Sungur) Erciyes University Medical School,
Internal Medicine, Kayseri, Turkey
Title
Postoperative high frequency chest wall oscillation therapy in critically
ILL abdominal surgery patients: Randomized controlled study.
Source
Intensive Care Medicine. Conference: 25th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2012 Lisbon Portugal. Conference
Start: 20121013 Conference End: 20121017. Conference Publication:
(var.pagings). 38 (pp S167-S168), 2012. Date of Publication: October
2012.
Publisher
Springer Verlag
Abstract
INTRODUCTION. High frequency chest wall oscillation therapy (HFCWO) is
used for improvement in airway clearance. Postoperative patients requiring
intensive care at risk to develop pneumonia and clearance of secretions
may be difficult due to type of surgery and pain. Enhanced mucociliary
clearance with HFCWO devices previously used in cystic fibrosis COPD and
thoracic surgery patients. OBJECTIVES. We studied short term effects of
HFCWO on postoperative abdominal surgery patients. METHODS. Nonintubated
postoperative abdominal surgery patients requiring intensive care included
into the study. Patients were randomized either to standard chest
physiotherapy group (early mobilization, incentive spirometry, postural
drainage) or standard chest physiotherapy plus HFCWO group. HFCWO was
applied for 10 min at 12 Hz with. Laboratory data were collected for 3
days and the patients were followed until discharge from the hospital.
RESULTS. We included 30 patients to each group. Mean age was 61 +/- 13
years and 33 was male 27 was female. Mean body mass index was 26 +/- 5
kg/m². APACHE II scores were 12 +/- 3 and 10 +/- 3 in control
and therapy groups. Statistically significant difference occurred only in
second day PaO₂, SaO2 and third day arterial pH values which
were clinically insignificant. Mean ICU and hospital stay was 5.2 +/- 2.8,
4.5 +/- 2.6 and 17.9 +/- 14.7, 17.5 +/- 11.0 days in control and therapy
groups respectively (p>0.05). Intubation and mechanical ventilation were
required for 2 patients in control and for 1 patient in therapy groups.
Noninvasive mechanical ventilation was performed in 2 control patients
while it is required for therapy group. Three patients in control group
and 2 patients in therapy group died. Nosocomial pneumonia were developed
in 5 (16.6 %) control group patients and in 2 (6.6 %) therapy group
patients (p>0.05). There were no complications related to HFCWO therapy.
CONCLUSIONS. HCFWO therapy did not help to improve physiological
parameters and has no effect on duration of ICU and hospital stay,
mortality. Number of nosocomial pneumonia attacks were lower with HFCWO
but did not reach to statistical difference. HFCWO is a safe technique
which we did not observe any complications.

<17>
Accession Number
71013650
Authors
Abuella G. Corredor C. Arulkumaran N. Hamilton M. Rhodes A. Cecconi M.
Institution
(Abuella, Corredor, Arulkumaran, Hamilton, Rhodes, Cecconi) St George's
Hospital, Intensive Care Unit, London, United Kingdom
Title
Meta-analysis of goal directed therapy in high-risk patients undergoing
major non-cardiac surgery.
Source
Intensive Care Medicine. Conference: 25th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2012 Lisbon Portugal. Conference
Start: 20121013 Conference End: 20121017. Conference Publication:
(var.pagings). 38 (pp S120), 2012. Date of Publication: October 2012.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Patients with a limited cardiac reserve are less likely to
survive and suffer from more complications after major surgery [1]. By
augmenting DO2I with a combination of intravenous fluids and inotropes
(goal directed therapy; GDT), the postoperative mortality and morbidity of
high-risk patients is reduced. However, not all clinical trails are
consistent with these findings and GDT is not widely practiced.
OBJECTIVES. We hypothesized that GDT results in greatest benefit in terms
of mortality and morbidity in patients with the highest risk of mortality.
METHODS. We performed a systematic search of Medline, Embase and CENTRAL
databases for randomized controlled trials (RCTs) and reviews of GDT in
high-risk surgical patients. To minimize heterogeneity we excluded studies
involving cardiac surgery. Extremely high risk, high risk and intermediate
risk of mortality were defined as>20 %, 5-20 % and<5 % mortality rate in
the control arm of the trials respectively [2]. Metaanalyses were
performed and forest plots drawn using RevMan software. Data are presented
as odd ratios (OR), [95 % confidence intervals (CI)], and p values.
RESULTS. A total of 30 RCTs including 4557 patients were reviewed. All
studies reported mortality. 4 studies (n = 2221) were excluded from
assessment of complication rates as the number of patients with
complications was not reported. The mortality benefit of GDT was confined
to the subgroup of patients at extremely high-risk of death (OR = 0.71,
[0.56-0.90], p<0.00001). Complication rates were reduced in all subgroups
of patients (OR = 0.47, [0.39-0.56], p<0.00001). The benefit was greatest
among patients in the intermediate risk subgroup (OR = 0.41, [0.31-0.54],
p<0.00001), followed by the high risk subgroup (OR = 0.49, [0.36-0.66],
p<0.00001), and the extremely high risk subgroup (Table presented)
CONCLUSIONS. GDT is beneficial in all high-risk patients undergoing major
surgery. The mortality benefit of GDT was confined to the subgroup of
patients at extremely high risk of death. However, the reduction of
complication rates was seen across all subgroups of GDT patients but was
greatest in the intermediate mortality risk group.

<18>
Accession Number
71013501
Authors
Aya H.D. Geisen M. Ebm C. Hamilton M. Rhodes A. Cecconi M.
Institution
(Aya, Geisen, Ebm, Hamilton, Rhodes, Cecconi) St George's Healthcare NHS
Trust, Intensive Care, London, United Kingdom
Title
Goal-directed haemodynamic therapy in cardiac surgical patients:
Systematic review and meta-analysis of randomized controlled trials.
Source
Intensive Care Medicine. Conference: 25th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2012 Lisbon Portugal. Conference
Start: 20121013 Conference End: 20121017. Conference Publication:
(var.pagings). 38 (pp S80), 2012. Date of Publication: October 2012.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Operative and postoperative mortality after cardiac surgery
have decreased throughout the last decades although postoperative
morbidity has been increasing mainly because sicker, older and higher-risk
patients have been treated. Up to 10 %of cardiac surgical patients
experience a complicated postoperative period, with prolonged ICU stay and
poor long-term outcome [1]. Complications after major surgery are
undesirable and potentially avoidable. However, although some evidence
suggest that perioperative monitoring and pre-emptively manipulation of
haemodynamics reduces surgical mortality and morbidity [2], no clear data
are available in cardiac surgical patients, and no systematic
review-meta-analysis to study the effect on mortality, morbidity and
length of stay has been published. OBJECTIVES. The objective of this
review is to perform a meta-analysis on the effects of perioperative
goal-directed hemodynamic therapy (GDT) on mortality, morbidity and length
of hospital stay in cardiac surgical patients. METHODS. A systematic
literature review using MEDLINE, EMBASE and the Cochrane Controlled
Clinical Trial register was conducted. Additional sources were sought from
experts and industry representatives. Inclusion criteria include:
randomized controlled trials, mortality reported as an outcome,
pre-emptive haemodynamic intervention and cardiac surgical population.
Identified studies that fulfilled the entry criteria were examined in full
and subjected to quantifiable analysis, subgroup analysis and sensitivity
analysis where possible. Data synthesis was obtained by using odds ratio
(OR) with 95 % confidence interval (CI) by random-effects model. RESULTS.
From 4980 potential studies, only four studies met all the inclusion
criteria (659 patients). The quantitative analysis showed that the use of
GDT reduced surgical complications rate in 55.5 % (OR 0.36 [0.15, 0.84]; p
= 0,02) and hospital length of stay in 2.45 days, which is the 24 % of
average length of stay [OR -2.21 (-3.84, ,0.57); p = 0.008] when compared
with control group. There was no significant reduction of mortality.
CONCLUSIONS. The use of pre-emptive GDT in cardiac surgical patients
reduces morbidity and hospital length of stay.

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Total documents retrieved: 19

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<1>
Accession Number
2013138095
Authors
Yousefshahi F. Bashirzadeh M. Abdollahi M. Mojtahedzadeh M. Salehiomran A.
Jalali A. Mazandarani M. Zaare E. Ahadi M.
Institution
(Yousefshahi, Salehiomran, Jalali, Zaare) Tehran Heart Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bashirzadeh, Ahadi) School of Pharmacy, Islamic Azad University of
Pharmaceutical Sciences, Tehran, Iran, Islamic Republic of
(Abdollahi, Mojtahedzadeh, Mazandarani) Faculty of Pharmacy, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Effect of hypertonic saline infusion versus normal saline on serum NGAL
and cystatin C levels in patients undergoing coronary artery bypass graft.
Source
Journal of Tehran University Heart Center. 8 (1) (pp 21-27), 2013. Date of
Publication: 2013.
Publisher
Tehran Heart Center (North Kargar Street, Tehran 1411713138, Iran, Islamic
Republic of)
Abstract
Background: Acute kidney injury (AKI) is a common and life-threatening
complication following coronary artery bypass graft (CABG). Neutrophil
gelatinase-associated lipocalin (NGAL) and Cystatin C have shown to be
good predictive factors for AKI. Recently, there has been a growing
interest in the use of hypertonic saline in cardiac operations. The
purpose of this study was to evaluate the prophylactic anti-inflammatory
effect of hypertonic saline (Group A) infusion versus normal saline (Group
B) on serum NGAL and Cystatin C levels as the two biomarkers of AKI in
CABG patients. Methods: This randomized double-blinded clinical trial
recruited 40 patients undergoing CABG in Tehran Heart Center, Tehran,
Iran. After applying exclusion criteria, the effects of preoperative
hypertonic saline (294 meq Na) versus normal saline (154 meq Na) infusion
on serum NGAL and Cystatin C levels were investigated in three intervals:
before surgery and 24 and 48 hours postoperatively. The probable
intraoperative or postoperative confounders, including pump time,
crossclamp time, heart rate, systolic and diastolic blood pressures,
central venous pressure, arterial pH, partial pressure of arterial oxygen,
fraction of inspired oxygen, blood sugar, Na, K, Mg, hemoglobins, white
blood cells, hematocrits, and platelets, were recorded and compared
between the two groups of study. Results: The study population comprised
40 patients, including 25 (62.5%) males, at a, mean age +/- SD of 61.75
+/- 8.13 years. There were no statistically significant differences
between the patients' basic, intraoperative, and postoperative
characteristics, including intraoperative and postoperative hemodynamic
variables and supports such as inotropic use. Intra-aortic balloon pump
use and mortality were not seen in our cases. Three patients in the normal
saline group and one patient in the hypertonic saline group had serum NGAL
levels greater than 400 ng/ml. Moreover, 10 patients in Group A and 17
patients in group B showed a rise in serum Cystatin C levels above 1.16
mg/dl. Patients with AKI had significantly elevated NGAL and Cystatin C
levels (p value < 0.001), but there were no significant differences in the
decrease in the NGAL level in the hypertonic saline group versus the
normal saline group (230.91 +/- 92.68 vs. 239.74 +/- 116.58 ng/ml,
respectively; p value = 0.792), or in the decrease in the Cystatin C level
in the hypertonic saline group versus the normal saline group (1.05 +/-
0.26 vs. 1.06 +/- 0.31, respectively; p value = 0.874). Conclusion:
Pre-treatment of CABG patients with hypertonic saline had no significant
effect on serum NGAL and Cystatin C levels compared to the normal
saline-receiving group. Our present data, albeit promising, have yet to
fully document outcome differences.

<2>
Accession Number
2013136744
Authors
Vanmassenhove J. Vanholder R. Nagler E. Van Biesen W.
Institution
(Vanmassenhove, Vanholder, Nagler, Van Biesen) Renal Division, Ghent
University Hospital, Ghent, Belgium
Title
Urinary and serum biomarkers for the diagnosis of acute kidney injury: An
in-depth review of the literature.
Source
Nephrology Dialysis Transplantation. 28 (2) (pp 254-273), 2013. Date of
Publication: February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Background Acute kidney injury (AKI) remains associated with high
morbidity and mortality, despite progress in medical care. Although the
RIFLE (Risk, Injury, Failure, Loss, End-Stage Kidney Disease) and AKIN
(Acute Kidney Injury Network) criteria, based on serum creatinine and
urine output, were a step forward in diagnosing AKI, a reliable tool to
differentiate between true parenchymal and pre-renal azotaemia in clinical
practice is still lacking. In the last decade, many papers on the use of
new urinary and serum biomarkers for the diagnosis and prognostication of
AKI have been published. Thus, the question arises which biomarker is a
reliable differential diagnostic tool under which circumstances.MethodsWe
searched Medline from inception to April 2012 using medical subject
heading and text words for AKI and biomarkers [neutrophil
gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1),
Cystatin C, interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-18
(IL-18), N-acetyl-glucosaminidase (NAG), glutathione transferases (GST)
and liver fatty acid binding protein (LFABP)] to identify relevant papers
in five different settings (paediatrics, cardiac surgery, emergency
department, critically ill and contrast-induced nephropathy).ResultsWe
included 87 relevant papers, reporting on 74 studies. Depending upon the
setting, 7-27 different definitions of AKI were used. Reported diagnostic
performance of the different biomarkers was variable from poor to
excellent, and no consistent generalizable conclusions can be drawn on
their diagnostic value.ConclusionsEarly diagnosing of AKI in clinical
conditions by using new serum and urinary biomarkers remains cumbersome,
especially in those settings where timing and aetiology of AKI are not
well defined. Putting too much emphasis on markers that have not
convincingly proven reliability might lead to incorrect interpretation of
clinical trials. Further research in this field is warranted before
biomarkers can be introduced in clinical practice. 2012 The Author.

<3>
Accession Number
2013135946
Authors
Rajpurohit N. Garg N. Garg R. Choudhary A. Fresen J. Boren S. Dellsperger
K.C. Webel R. Aggarwal K. Alpert M.A.
Institution
(Rajpurohit, Choudhary) Department of Internal Medicine, University of
Missouri, One Hospital Drive, Columbia, MO 65212, United States
(Garg, Garg, Dellsperger, Webel, Aggarwal, Alpert) Division of
Cardiovascular Medicine, University of Missouri, Columbia, MO, United
States
(Fresen) Department of Statistics, University of Missouri, Columbia, MO,
United States
(Boren) Department of Health Informatics and Management, University of
Missouri, Columbia, MO, United States
(Dellsperger) Center for Health Care Quality, University of Missouri,
Columbia, MO, United States
Title
Early versus delayed percutaneous coronary intervention for patients with
non-ST segment elevation acute coronary syndrome: A meta-analysis of
randomized controlled clinical trials.
Source
Catheterization and Cardiovascular Interventions. 81 (2) (pp 223-231),
2013. Date of Publication: February 2013.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background: Studies assessing the timing of percutaneous coronary
interventions (PCI) in patients with Non-ST segment elevation Acute
Coronary Syndromes (NSTE-ACS) have failed to generate a consensus on how
early PCI should be performed in such patients. Purpose: This
meta-analysis compares clinical outcomes at 30 days in NSTE-ACS patients
undergoing PCI within 24 hours of presentation (early PCI) with those
receiving PCI more than 24 hours after presentation (delayed PCI). Data
Sources: Data were extracted from searches of MEDLINE (1990-2010) and
Google scholar and from scrutiny of abstract booklets from major
cardiology meetings (1990-2010). Study selection: Randomized clinical
trials (RCTs) that included the composite endpoint of death and non-fatal
myocardial infarction (MI) at 30 days after PCI were considered. Data
Extraction: Two independent reviewers extracted data using standard forms.
The effects of early and delayed PCI were analyzed by calculating pooled
estimates for death, non-fatal MI, bleeding, repeat revascularization and
the composite endpoint of death or non-fatal MI at 30 days. Univariate
analysis of each of these variables was used to create odds ratios. Data
Synthesis: Seven studies with a total of 13,762 patients met the inclusion
criteria. There was no significant difference in the odds of the composite
endpoint of death or non-fatal MI at 30 days between patients undergoing
early PCI and those receiving delayed PCI (OR-0.83, 95%CI 0.62-1.10).
Patients receiving delayed PCI experienced a 33% reduction in the odds of
repeat revascularization at 30 days compared to those undergoing early PCI
(OR-1.33, 95%CI 1.14-1.56, P=0.0004).Conversely, patients undergoing early
PCI experienced lower odds of bleeding than those receiving delayed PCI
(OR-0.76, 95%CI 0.63-0.91, P = 0.0003). Conclusions: In NSTE-ACS patients
early PCI doesn't reduce the odds of the composite endpoint of death or
non-fatal MI at 30 day. This strategy is associated with lower odds of
bleeding and higher odds of repeat revascularization at 30 days than a
strategy of delayed PCI. Copyright 2012 Wiley Periodicals, Inc.

<4>
[Use Link to view the full text]
Accession Number
2013134881
Authors
Thibault B. Harel F. Ducharme A. White M. Ellenbogen K.A. Frasure-Smith N.
Roy D. Philippon F. Dorian P. Talajic M. Dubuc M. Guerra P.G. Macle L.
Rivard L. Andrade J. Khairy P.
Institution
(Thibault, Harel, Ducharme, White, Frasure-Smith, Roy, Talajic, Dubuc,
Guerra, Macle, Rivard, Andrade, Khairy) Montreal Heart Institute,
Universite de Montreal, 5000 Belanger St, Montreal, QC H1T 1C8, Canada
(Ellenbogen) Medical College of Virginia, Richmond, Canada
(Philippon) Institut Universitaire de Cardiologie et Pneumologie,
Universite Laval, Quebec City, Canada
(Dorian) St. Michael's Hospital, University of Toronto, Toronto, ON,
Canada
Title
Cardiac resynchronization therapy in patients with heart failure and a QRS
complex <120 milliseconds: The evaluation of resynchronization therapy for
heart failure (LESSER-EARTH) trial.
Source
Circulation. 127 (8) (pp 873-881), 2013. Date of Publication: 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND - : Although the benefits of cardiac resynchronization therapy
are well established in selected patients with heart failure and a
prolonged QRS duration, salutary effects in patients with narrow QRS
complexes remain to be demonstrated. METHODS AND RESULTS - : The
Evaluation of Resynchronization Therapy for Heart Failure (LESSER-EARTH)
trial is a randomized, double-blind, 12-center study that was designed to
compare the effects of active and inactive cardiac resynchronization
therapy in patients with severe left ventricular dysfunction and a QRS
duration <120 milliseconds. The trial was interrupted prematurely by the
Data Safety and Monitoring Board because of futility and safety concerns
after 85 patients were randomized. Changes in exercise duration after 12
months were no different in patients with and without active cardiac
resynchronization therapy (-0.7 minutes [95% confidence interval (CI),
-2.9 to 1.5] versus 0.8 minutes [95% CI, -1.2 to 2.9]; P=0.31]. Similarly,
no significant differences were observed in left ventricular end-systolic
volumes (-6.4 mL [95% CI, -18.8 to 5.9] versus 3.1 mL [95% CI, -9.2 to
15.5]; P=0.28) and ejection fraction (3.3% [95% CI, 0.7-6.0] versus 2.1%
[95% CI, -0.5 to 4.8]; P=0.52). Moreover, cardiac resynchronization
therapy was associated with a significant reduction in the 6-minute walk
distance (-11.3 m [95% CI, -31.7 to 9.7] versus 25.3 m [95% CI, 6.1-44.5];
P=0.01), an increase in QRS duration (40.2 milliseconds [95% CI,
34.2-46.2] versus 3.4 milliseconds [95% CI, 0.6-6.2]; P<0.0001), and a
nonsignificant trend toward an increase in heart failure-related
hospitalizations (15 hospitalizations in 5 patients versus 4
hospitalizations in 4 patients). CONCLUSIONS - : In patients with a left
ventricular ejection fraction <=35%, symptoms of heart failure, and a QRS
duration <120 milliseconds, cardiac resynchronization therapy did not
improve clinical outcomes or left ventricular remodeling and was
associated with potential harm. CLINICAL TRIAL REGISTRATION: URL:
Http://www.clinicaltrials.gov. Unique identifier: NCT00900549. 2013
American Heart Association, Inc.

<5>
Accession Number
2013128067
Authors
Bronicki R.A. Checchia P.A. Stuart-Killion R.B. Dixon D.J. Backer C.L.
Institution
(Bronicki) Department of Pediatric Critical Care Medicine, Children's
Hospital of Orange County, Orange, CA, United States
(Checchia) Division of Critical Care Medicine, St Louis Children's
Hospital, Washington University, St Louis, MO, United States
(Stuart-Killion) Division of Pediatric Cardiology, Lucile Packard
Children's Hospital, Stanford University, Stanford, CA, United States
(Dixon) Division of Biostatistics, Washington University School of
Medicine, St Louis, MO, United States
(Backer) Division of Cardiovascular-Thoracic Surgery Ann and Robert H.
Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., mc 22, Chicago,
IL 60611-2605, United States
Title
The Effects of Multiple Doses of Glucocorticoids on the Inflammatory
Response to Cardiopulmonary Bypass in Children.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 3 (4) (pp
439-445), 2012. Date of Publication: October 2012.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Background: We previously demonstrated that a dose of glucocorticoids
(GCs) administered prior to cardiopulmonary bypass (CPB) is effective at
suppressing the inflammatory response to CPB and leads to an improved
postoperative course. We evaluated whether an additional dose of GC
administered eight hours prior to CPB would lead to further clinical
benefit. Methods: We conducted a prospective study in which patients were
randomized to receive placebo or GC eight hours prior to CPB, in addition
to a dose of GC administered following induction of anesthesia. We
measured serum inflammatory mediator levels and postoperative clinical
parameters. Results: Thirty-one patients were included in the study.
Eighteen patients received two doses of GC and 13 patients received a
single does of GC. Complement C3a levels were significantly lower at 24
hours following surgery in those patients who received two doses of GC
(3136 +/- 1650 vs 1779 +/- 1616 ng/mL, P = .04). There was no significant
difference in tumor necrosis factor (TNF)-alpha or interleukin (IL)-6
levels at any time between groups. There was no significant difference in
core body temperature or renal function (based on serum creatinine levels)
between groups. There was no significant difference between groups in
duration of mechanical ventilation (2.4 +/- 1.5 vs 3.6 +/- 3.7 days, two
vs one dose, respectively, P = .33) or length of stay in the intensive
care unit ([ICU]; 3.4 +/- 1.4 vs 4.9 +/- 3.6 days, 2 vs 1 dose,
respectively, P = .15). Conclusion: While those patients who received two
doses of GC prior to surgery had significantly less complement activation
postoperatively, clinical outcomes did not differ between groups. We
conclude that the practice of administering an additional dose of GC prior
to CPB is not supported. However, a large randomized study is needed to
conclusively discount the potential benefit of this strategy. The
Author(s) 2012.

<6>
Accession Number
2013129451
Authors
Dango S. Harris S. Offner K. Hennings E. Priebe H.-J. Buerkle H. Passlick
B. Loop T.
Institution
(Dango, Hennings, Passlick) Department of Thoracic Surgery, University
Medical Center, Hugstetter Strasse 55, D-79106 Freiburg, Germany
(Harris, Offner, Priebe, Buerkle, Loop) Department of Anaesthesiology and
Critical Care Medicine, University Medical Center, Hugstetter Strasse 55,
D-79106 Freiburg, Germany
(Dango) Department of General and Visceral Surgery, University Medical
Center Goettingen, Robert-Koch Strasse 40, D-37075 Goettingen, Germany
Title
Combined paravertebral and intrathecal vs thoracic epidural analgesia for
post-thoracotomy pain relief.
Source
British Journal of Anaesthesia. 110 (3) (pp 443-449), 2013. Date of
Publication: March 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundAlthough thoracic epidural analgesia (TEA) is considered the
gold standard for post-thoracotomy pain relief, thoracic paravertebral
block (PVB) and intrathecal opioid (ITO) administration have also been
shown to be efficacious. We hypothesized that the combination of PVB and
ITO provides analgesia comparable with that of TEA.MethodsAfter local
ethics committee approval, 84 consecutive patients undergoing open
thoracic procedures were randomized to the TEA (ropivacaine
0.2%+sufentanil) or the PVB (ropivacaine 0.5%)+ITO (sufentanil+morphine)
group. The primary endpoints were pain intensities at rest and during
coughing/movement at 1, 2, 4, 8, 12, 24, 48, and 72 h after operation
assessed by visual analogue scale (VAS) score. Data were analysed by
multivariate analysis (anova; P<0.05).ResultsPatient and surgical
characteristics were comparable between the groups. The mean and maximal
VAS scores were lower in the TEA (n=43) than in the PVB+ITO group (n=37)
at several time points at rest (P<0.026) and during coughing/movement
(P<0.021). However, in the PVB+ITO group, the mean VAS scores never
exceeded 1.9 and 3.5 at rest and during coughing/movement, respectively;
and the maximal differences between the groups (TEA vs PVB+ITO) in the
maximal VAS scores were only 1.2 (3.4 vs 4.6) at rest, and 1.3 (4.4 vs
5.7) during coughing/movement. ConclusionsAlthough VAS scores were
statistically lower in the TEA compared with the PVB+ITO group at some
observation points, the differences were small and of questionable
clinical relevance. Thus, combined PVB and ITO can be considered a
satisfactory alternative to TEA for post-thoracotomy pain relief.
ClinicalTrials.gov number. The Author [2012].

<7>
Accession Number
2013128489
Authors
Eckerle I. Rosenberger K.D. Zwahlen M. Junghanss T.
Institution
(Eckerle, Rosenberger, Junghanss) Section of Clinical Tropical Medicine,
Department of Infectious Diseases, University Hospital Heidelberg,
Heidelberg, Germany
(Eckerle) Institute of Virology, University of Bonn Medical Centre, Bonn,
Germany
(Zwahlen) Institute of Social and Preventive Medicine, University Bern,
Bern, Switzerland
Title
Serologic Vaccination Response after Solid Organ Transplantation: A
Systematic Review.
Source
PLoS ONE. 8 (2) , 2013. Article Number: e56974. Date of Publication: 22
Feb 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: Infectious diseases after solid organ transplantation (SOT)
are one of the major complications in transplantation medicine.
Vaccination-based prevention is desirable, but data on the response to
active vaccination after SOT are conflicting. Methods: In this systematic
review, we identify the serologic response rate of SOT recipients to
post-transplantation vaccination against tetanus, diphtheria, polio,
hepatitis A and B, influenza, Streptococcus pneumoniae, Haemophilus
influenzae, Neisseria meningitides, tick-borne encephalitis, rabies,
varicella, mumps, measles, and rubella. Results: Of the 2478 papers
initially identified, 72 were included in the final review. The most
important findings are that (1) most clinical trials conducted and
published over more than 30 years have all been small and highly
heterogeneous regarding trial design, patient cohorts selected, patient
inclusion criteria, dosing and vaccination schemes, follow up periods and
outcomes assessed, (2) the individual vaccines investigated have been
studied predominately only in one group of SOT recipients, i.e. tetanus,
diphtheria and polio in RTX recipients, hepatitis A exclusively in adult
LTX recipients and mumps, measles and rubella in paediatric LTX
recipients, (3) SOT recipients mount an immune response which is for most
vaccines lower than in healthy controls. The degree to which this response
is impaired varies with the type of vaccine, age and organ transplanted
and (4) for some vaccines antibodies decline rapidly. Conclusion:
Vaccine-based prevention of infectious diseases is far from satisfactory
in SOT recipients. Despite the large number of vaccination studies
preformed over the past decades, knowledge on vaccination response is
still limited. Even though the protection, which can be achieved in SOT
recipients through vaccination, appears encouraging on the basis of
available data, current vaccination guidelines and recommendations for
post-SOT recipients remain poorly supported by evidence. There is an
urgent need to conduct appropriately powered vaccination trials in
well-defined SOT recipient cohorts. 2013 Eckerle et al.

<8>
Accession Number
2013128091
Authors
Babu B. Bhat S. Prabuswamy H.P. Kamalapurkar G. Kumar H.V.J. Libu G.K.
Shilpa S. Lokesh B.K.
Institution
(Babu) Department of Cardiothoracic Surgery, Apollo Hospitals, 154/11,
Bannerghatta Road, Bangalore 560076, India
(Babu, Bhat, Prabuswamy, Kamalapurkar, Kumar, Shilpa) Department of
Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences
and Research, Bangalore, India
(Libu) Department of Community Medicine and Statistics, Karakonam Medical
College, Trivandrum, India
(Lokesh) Department of Perfusion, Sri Jayadeva Institute of Cardiovascular
Sciences and Research, Bangalore, India
Title
Controlling Oxygenation During Initiation of Cardiopulmonary Bypass: Can
It Improve Immediate Postoperative Outcomes in Cyanotic Children
Undergoing Cardiac Surgery? A Prospective Randomized Study.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 3 (3) (pp
310-316), 2012. Date of Publication: July 2012.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Objective: Cardiopulmonary bypass (CPB) initiated with high oxygen levels
may expose cyanotic children to reoxygenation injury. The ideal method of
initiation of bypass to prevent this phenomenon still remains largely
unproven. This study tested the hypothesis that controlling oxygenation
during initiation of CPB improves early postoperative outcomes. Methods:
Thirty-one cyanotic children were randomized to two treatment arms of the
study. In group A (intervention), CPB was initiated with fraction of
inspired oxygen (Fio2) 0.21, and after one minute of full bypass, Fio2 was
increased at increments of 0.1 per minute to reach 0.6. In group B
(hyperoxemic), CPB was initiated using Fio2 > 0.6. Aortic cross clamp time
(minutes), CPB time (minutes), creatine phosphokinase-MB (CPK-MB) levels
(U/L), lactate levels (mmol/L), duration of ventilator support (hours),
inotropic support (hours), and intensive care unit (ICU) stay (hours) as
well as hospital mortality were measured. Results: Levels of CPK-MB (group
A mean = 59.6 U/L, 95% confidence interval [CI]: 45.9-73.3; group B mean =
82.6 U/L, 95% CI: 66.1-99.1, P = .016) and ventilation time (group A
median = 16.5 hours; interquartile range [IQR] = 11.25-23; group B median
= 27.5 hours; IQR = 17-54, P = .045) were significantly lower in the
intervention group. Other parameters showed no significant differences:
CPB time (group A median = 71.5 minutes, IQR = 64-100; group B median =
95.5 minutes, IQR = 58-145, P = .71), cross clamp time (group A mean =
59.2 minutes, 95% CI: 47.6-70.8; group B mean = 66.57 minutes, 95% CI:
47.6-88.5, P =.57), lactate levels (mmol/L; group A median = 1.8, IQR =
1.48-2.59; group B median = 2.1, IQR = 1.29-2.62, P = 1), inotropic
support (group A median = 47.5 hours, IQR = 36-73.75; group B median =
59.5 hours, IQR = 41.75-92.5, P = .27), ICU stay (group A median = 59.5
hours, IQR = 48.25-118.5; group B median = 85 hours, IQR = 47.75-137.50, P
= .21), and mortality (group A n = 2, group B n = 2). Conclusion: A
controlled oxygenation protocol was associated with significantly lower
postoperative CPK-MB levels. Evaluation of other end points including
ventilation times requires a study with larger sample size for validation.
The Author(s) 2012.

<9>
Accession Number
2013123407
Authors
Fukumoto A. Otsuji S. Takiuchi S. Ikushima M. Asano K. Terasoma K.
Hasegawa K. Yabuki M. Higashino Y.
Institution
(Fukumoto, Otsuji, Takiuchi, Ikushima, Asano, Terasoma, Hasegawa, Yabuki,
Higashino) Department of Cardiology, Higashi Takarazuka Satoh Hospital,
2-1 Nagao-cho, Takarazuka, Hyogo, 665-0873, Japan
Title
Comparison of real-world clinical outcomes between Cypher- and
Taxus-eluting stents: The GARA-GARA study.
Source
Cardiovascular Intervention and Therapeutics. 26 (3) (pp 202-208), 2011.
Date of Publication: 2011.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
To evaluate real-world outcomes of PCI in unselected individuals using
sirolimus-eluting (SESs) or paclitaxel-eluting stents (PESs) in a
single-center randomized trial. Eight hundred consecutive patients (919
lesions) with coronary artery disease were randomized to receive SES or
PES implantation. In-hospital, mid-term, and 1-year clinical and
angiographical outcomes in both groups were compared. MACEs were defined
as cardiac death, myocardial infarction, CABG and target vessel
revascularization (TLR). Follow-up angiography was performed in 80. 7% of
patients. The baseline clinical characteristics were similar in both
groups. Pre- and postprocedural reference vessel diameter, minimum length
diameter, and diameter stenosis (%DS) were similar in both groups, as was
incidence of in-hospital and mid-term MACEs. SESs significantly reduced
the risk of TLR, compared with PESs (SES = 5. 5%, PES = 10. 5%). The
superiority of SESs for TLR was also demonstrated with regard to small
vessel lesions (stent diameter <2. 5 mm) (SES = 6. 0%, PES = 15. 9%),
whereas larger vessel (stent diameter >2. 5 mm) lesions did not differ
between groups (SES = 5. 3%, PES = 8. 4%). The safety and efficacy of both
DESs were nearly equivalent. SESs, however, were superior to PESs in
reducing mid-term TLR, particularly in the small vessel lesion subsets.
2011 Japanese Association of Cardiovascular Intervention and Therapeutics.

<10>
Accession Number
2013135039
Authors
Guedon-Moreau L. Lacroix D. Sadoul N. Clementy J. Kouakam C. Hermida J.-S.
Aliot E. Boursier M. Bizeau O. Kacet S.
Institution
(Guedon-Moreau, Lacroix, Kouakam, Kacet) Hopital Cardiologique, Centre
Hospitalier Regional et Universitaire, 59037 Lille, France
(Sadoul, Aliot) Centre Hospitalier Universitaire Brabois, Nancy, France
(Clementy) Centre Hospitalier Universitaire Haut Leveque, Pessac, France
(Hermida) Centre Hospitalier Universitaire, Amiens, France
(Boursier) Centre Hospitalier Regional Bon Secours, Metz, France
(Bizeau) Centre Hospitalier Regional la Source, Orleans, France
Title
A randomized study of remote follow-up of implantable cardioverter
defibrillators: Safety and efficacy report of the ECOST trial.
Source
European Heart Journal. 34 (8) (pp 605-614), 2013. Date of Publication:
February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsThe ECOST trial examined prospectively the long-term safety and
effectiveness of home monitoring (HM) of implantable cardioverter
defibrillators (ICD).Methods and resultsThe trial's primary objective was
to randomly compare the proportions of patients experiencing >=1 major
adverse event (MAE), including deaths from all causes, and cardiovascular,
procedure-related, and device-related MAE associated with HM (active
group) vs. ambulatory follow-ups (control group) in a sample of 433
patients. The 221 patients assigned to the active group were seen once a
year, unless HM reported an ICD dysfunction or a clinical event requiring
an ambulatory visit, while the 212 patients in the control group underwent
ambulatory visits every 6 months. The characteristics of the study groups
were similar. Over a follow-up of 24.2 months, 38.5% of patients in the
active and 41.5% in the control group experienced >=1 MAE (P < 0.05 for
non-inferiority). The overall number of shocks delivered was significantly
lower in the active (n = 193) than in the control (n = 657) group (P <
0.05) and the proportion of patients who received inappropriate shocks was
52% lower in the active (n = 11) than in the control (n = 22) group (P <
0.05). At the end of the follow-up, the battery longevity was longer in
the active group because of a lower number of capacitor charges (499 vs.
2081).ConclusionOur observations indicate that long-term HM of ICD is at
least as safe as standard ambulatory follow-ups with respect to a broad
spectrum of MAE. It also lowered significantly the number of appropriate
and inappropriate shocks delivered, and spared the device battery. 2012
The Author.

<11>
Accession Number
2013127154
Authors
Mirhosseini S.M. Fakhri M. Asadollahi S. Ahmadi Z.H. Farokhi F.R.
Boloursaz M.R. Masjedi M.R.
Institution
(Mirhosseini, Fakhri, Masjedi) Chronic Respiratory Disease Research
Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical
Sciences, Darabad, Tehran, Iran, Islamic Republic of
(Fakhri, Asadollahi) School of Medicine, Shahid Beheshti University of
Medical Science, Tehran, Iran, Islamic Republic of
(Ahmadi) Tracheal Disease Research Center, Masih Daneshvari Hospital,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Farokhi) Telemedicine Research Center, Masih Daneshvari Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Boloursaz) Pediatrics Respiratory Disease Research Center, National
Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Continuous renal replacement therapy versus furosemide for management of
kidney impairment in heart transplant recipients with volume overload.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (3) (pp 314-320),
2013. Date of Publication: March 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives It is unknown whether continuous renal replacement therapy or
furosemide therapy is superior in heart transplant recipients who are in
postoperative kidney insufficiency and volume overload. This prospective
non-randomized, controlled trial investigated the efficacy of the two
Methods after transplantation. Methods We assigned heart transplant
recipients 18 years of age or older who were oliguric (urine output < 400
ml/day); had volume overload and estimated glomerular filtration rate <60
ml/min/1.73 m ² of body surface area calculated with the use of
the Modification of Diet in Renal Disease equation, to designed initiation
of intervention. We followed 30 patients for up to 30 days. The primary
outcome was estimated glomerular filtration rate status after
intervention. Results Between January 2010 and April 2012, a total of 30
adults (mean age: 37 years; 18 men and 12 women) were assessed for entry
in this trial. Continuous renal replacement therapy, when compared with
furosemide, was associated with a significant increase in estimated
glomerular filtration rate of patients after intervention 61 +/- 4.5 vs 55
+/- 8.5l ml/min/1.73 m² (P = 0.02). Moreover, the mean
glomerular filtration rate at discharge time for the continuous renal
replacement therapy group was 72 +/- 7.3 and 58 +/- 7.4 ml/min/1.73
m² for the furosemide group (P < 0.001). During the follow-up
period, 6 of 15 patients in the continuous renal replacement therapy group
(40%) and 4 of 15 in the furosemide group (26.6%) died (P = 0.43).
Conclusions In this study, continuous renal replacement therapy in heart
transplant recipients with reduced kidney function was associated with an
improvement in estimated glomerular filtration rate status in comparison
with furosemide. 2012 The Author.

<12>
Accession Number
2013127151
Authors
Patel A.J. Som R.
Institution
(Patel) Department of Cardiothoracic Surgery, St George's Medical School,
London, United Kingdom
(Som) Department of Vascular Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
Title
What is the optimum prophylaxis against gastrointestinal haemorrhage for
patients undergoing adult cardiac surgery: Histamine receptor antagonists,
or proton-pump inhibitors?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (3) (pp 356-360),
2013. Date of Publication: March 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was what is the optimum prophylaxis against
gastrointestinal haemorrhage for patients undergoing adult cardiac
surgery: histamine receptor antagonists (H₂RA) or proton-pump
inhibitors? A total of 201 papers were found; of which, 8 represented the
best evidence. The authors, date, journal, study type, population, main
outcome measures and Results were tabulated. Only one randomized
controlled trial (RCT) with relevant clinical outcomes was identified. The
rest of the studies consisted of five prospective studies and two
retrospective studies. In the RCT, there were no reported cases of
gastrointestinal haemorrhage in the proton-pump inhibitor cohort, whereas
4 patients taking H₂RA developed it. The rate of active
gastrointestinal ulceration was higher in the H₂RA cohort in
comparison with the proton-pump inhibitor cohort (21.4 vs 4.3%). A
prospective study followed 2285 consecutive patients undergoing cardiac
surgery who received either no prophylaxis, or a proton-pump inhibitor.
Chi-squared analysis showed the risk of bleeding to be lower in those
receiving the proton-pump inhibitor (P < 0.05). Another study of 6316
patients undergoing coronary artery bypass grafting demonstrated a reduced
risk of gastrointestinal bleed with prophylactic intravenous omeprazole
(odds ratio = 0.2; confidence intervals = 0.1-0.8; P < 0.05). One study
successfully showed that proton-pump inhibitors are effective in
adequately suppressing gastric acid levels, regardless of Helicobacter
pylori infection status; conversely, this study suggested that
H₂RAs were not. The evidence for H₂RAs is marginal,
with no study showing a clear benefit. One study showed that ulcer
prophylaxis with H₂RA did not correlate with the clinical
outcome. Another study demonstrated gastric ulceration to be a common
gastrointestinal complication in spite of regular H₂RA use.
There is also evidence to suggest that acid suppression increases the risk
of nosocomial pneumonia, although open heart surgery may be a confounding
factor in this association. Two RCTs showed that H₂RAs may
augment the immune system and reducing stress following cardiac surgery.
Proton-pump inhibitors appear to be the superior agent for prophylaxis
against gastrointestinal bleed in patients undergoing cardiac surgery,
although rigorous comparative data are sparse. Furthermore, level-I
evidence would confirm this. 2012 The Author.

<13>
Accession Number
2013127145
Authors
Moscarelli M. Harling L. Ashrafian H. Athanasiou T.
Institution
(Moscarelli, Harling, Ashrafian, Athanasiou) Department of Surgery and
Cancer, Imperial College London, St Mary's Hospital, South Wharf Road,
London W2 1NY, United Kingdom
Title
Should we consider off-pump coronary artery bypass grafting in patients
with acute coronary syndrome?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (3) (pp 350-355),
2013. Date of Publication: March 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether off-pump coronary
artery bypass (OPCAB) grafting should be considered as an alternative to
the conventional on-pump surgery (ONCAB) in patients presenting with acute
coronary syndrome (ACS) requiring emergency revascularization. Eighty-two
papers were identified by a systematic search, of which nine were judged
to best answer the clinical question. Of these, one was a randomized
controlled trial and the remaining eight were retrospective observational
studies. The author, journal, date, patient group, country of publication,
relevant outcomes, Results and study weaknesses were tabulated. In total,
these nine studies included 3001 patients (n = 817 OPCAB, 2184 ONCAB)
undergoing emergency revascularization in the setting of ACS. The timing
between the onset of ACS and operative intervention ranged from 6 to 72 h.
All cases were categorized as urgent/emergent according to the National
confidential enquiry into patient outcome and death classification of
intervention. Six studies included patients with preoperative cardiogenic
shock; however the majority of patients were haemodynamically stable at
the time of surgery. Three out of nine studies showed an improvement in
30-day mortality with OPCAB although the remaining six reveal no
significant mortality benefit. No difference in long-term mortality was
observed between the two techniques. OPCAB was associated with
significantly fewer grafts per patient (six studies) and less complete
revascularization (two studies). We conclude that whilst OPCAB may have a
beneficial effect on 30-day mortality in haemodynamically stable patients
undergoing emergency revascularization, there is a lack of high-quality
data with clearly defined patient demographics. Future studies must ensure
adequate preoperative matching between OPCAB and ONCAB groups and clearly
categorize haemodynamic status, disease pattern and time to surgery in
order to determine the patients in whom OPCAB may confer the greatest
benefit. 2012 The Author.

<14>
Accession Number
2013127142
Authors
Cao C. Manganas C. Ang S.C. Peeceeyen S. Yan T.D.
Institution
(Cao, Ang, Yan) Collaborative Research (CORE) Group, Sydney, Australia
(Cao, Manganas, Ang, Peeceeyen) Department of Cardiothoracic Surgery, St.
George Hospital, Sydney, NSW, Australia
(Cao, Yan) Systematic Review Group, Baird Institute for Applied Heart and
Lung Surgical Research, Collaborative Research (CORE) Group, Sydney, NSW,
Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
Sydney, NSW, Australia
Title
Video-assisted thoracic surgery versus open thoracotomy for non-small cell
lung cancer: A meta-analysis of propensity score-matched patients.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (3) (pp 244-249),
2013. Date of Publication: March 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives This meta-analysis aimed to compare the perioperative outcomes
of video-assisted thoracic surgery (VATS) with open thoracotomy for
propensity score-matched patients with early-stage non-small cell lung
cancer (NSCLC). Methods Four relevant studies with propensity
score-matched patients were identified from six electronic databases.
Endpoints included perioperative mortality and morbidity, individual
postoperative complications and duration of hospitalization. Results
Results indicate that all-cause perioperative mortality was similar
between VATS and open thoracotomy. However, patients who underwent VATS
were found to have significantly fewer overall complications, and
significantly lower rates of prolonged air leak, pneumonia, atrial
arrhythmias and renal failure. In addition, patients who underwent VATS
had a significantly shorter length of hospitalization compared with those
who underwent open thoracotomy. Conclusions In view of a paucity of
high-level clinical evidence in the form of large, well-designed
randomized controlled trials, propensity score matching may provide the
highest level of evidence to compare VATS with open thoracotomy for
patients with NSCLC. The present meta-analysis demonstrated superior
perioperative outcomes for patients who underwent VATS, including overall
complication rates and duration of hospitalization. 2012 The Author.

<15>
Accession Number
2013123376
Authors
Jouybar R. Kabgani H. Kamalipour H. Shahbazi S. Allahyary E. Rasouli M.
Akhlagh S.H. Shafa M. Ghazinoor M. Moeinvaziri M.T. Khademi S.
Institution
(Jouybar, Kabgani, Shahbazi, Allahyary, Akhlagh, Shafa, Ghazinoor,
Moeinvaziri, Khademi) Shiraz Anesthesiology and Critical Care Research
Center, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
(Kamalipour) Laparoscopy Research Center, Shiraz University of Medical
Sciences, Shiraz, India
(Rasouli) Immunology and Clinical Microbiology Research center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
The perioperative effect of ascorbic acid on inflammatory response in
coronary artery bypass graft surgery; A randomized controlled trial
coronary artery bypass graft surgery.
Source
International Cardiovascular Research Journal. 6 (1) (pp 13-17), 2012.
Date of Publication: 2012.
Publisher
Iranian Cardiovascular Research Journal (Zand Ave., Shiraz, Iran, Islamic
Republic of)
Abstract
Background: Different pharmacological agents may decrease the inflammatory
response during cardiac surgery. The aim of this study was to evaluate the
effect of ascorbic acid as an antioxidant on inflammatory markers
(interleukins 6 and interleukin 8) released during cardiopulmonary bypass.
Method: Forty patients scheduled for elective coronary artery bypass
grafting surgery, were randomly assigned to two groups. The patients in
the case group were given 3 grams ascorbic acid 12-18 hours before
operation and 3 grams during CPB initiation. The patients in the control
group were given the same amounts of normal saline at similar times. Blood
samples were collected 6 hours preoperatively and postoperative serum
interleukin 6 and 8 were measured using enzyme-linked immunosorbent assay
(ELISA). Result: In both groups CPB caused an increase in IL6 and IL8
plasma concentrations compared with baseline levels, but the pattern of
changes at such levels were similar in both groups after receiving
ascorbic acid or placebo. Ascorbic acid did not reduce the inflammatory
cytokines during CPB. Compared to the placebo, ascorbic acid had no
significant effect on hemodynamic parameters such as systolic and
diastolic blood pressure, heart rate, arterial blood gases, BUN,
Creatinine and WBC and platelet counts. Conclusion: Ascorbic acid has no
effect on the reduction of IL6 and IL8 during CPB. Also, it causes no
improvement in hemodynamics, blood gas variables, and the outcomes of
patients undergoing CABG.

<16>
Accession Number
2013128043
Authors
Singh P. Chauhan S. Jain G. Talwar S. Makhija N. Kiran U.
Institution
(Singh, Chauhan, Makhija, Kiran) Department of Cardiac Anaesthesia, All
India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
(Jain) Department of Cardiac Anaesthesia, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi, India
(Talwar) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi, India
Title
Comparison of Cardioprotective Effects of Volatile Anesthetics in Children
Undergoing Ventricular Septal Defect Closure.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 4 (1) (pp
24-29), 2013. Date of Publication: January 2013.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Background: Volatile anesthetic agents may precondition the myocardium and
protect against ischemia and infarction. Preconditioning by volatile
anesthetic agents is well documented in adults but is underinvestigated in
children. The present study compares the effect of preconditioning in
children by three volatile anesthetic agents alongwith several other
variables associated with cardioprotection. Method: Eighty children
scheduled for ventricular septal defect closure under cardioplegic arrest
were assigned to preconditioning for five minutes after commencement of
cardiopulmonary bypass (CPB) with one minimum alveolar concentration
(MAC)of oneof the following agents: isoflurane, sevoflurane, desflurane,
or placebo(oxygen-air mixture).The plasma concentration of creatine
kinaseMB(CK-MB) was determined after initiation ofCPB, and again 6 and 24
hours after admission to the intensive care unit (ICU) after surgery.
Duration of inotropic support, mechanical ventilation, and length of
ICUstay in all the groups were also recorded. Results: Preconditioning
with isoflurane, sevoflurane, and desflurane was associated with
significantly decreased postoperative release of CK-MB as compared to
placebo group at 6 (group 1: 237.2+/-189, group 2: 69.8+/-15.8, group 3:
64.7+/-37.8, and group 4: 70.4+/-26.7) and 24 hours (group 1:
192.4+/-158.2, group 2: 67.7+/-25.0, group 3: 85.7+/-66.8, and group 4:
50.4+/-31.6) after admission toICU. No significant differenceswereobserved
in theCK-MBlevels among the three volatile anesthetic agents.Duration of
inotropic support, mechanical ventilation, and length of ICU stay were
greater in placebo group as compared to other groups without reaching
statistical significance.Conclusion: Volatile anesthetic appear to provide
definite cardioprotection to pediatricmyocardium. No conclusion can be
drawn regarding the best preconditioning agent among isoflurane,
sevoflurane, and desflurane. The Author(s) 2012.

<17>
Accession Number
2013111535
Authors
Jakobsen O. Naesheim T. Aas K.N. Sorlie D. Steensrud T.
Institution
(Jakobsen, Naesheim, Aas, Sorlie, Steensrud) Department of Cardiothoracic
and Vascular Surgery, University Hospital of North Norway, University of
Tromso, 9038 Tromso, Norway
Title
Adenosine instead of supranormal potassium in cardioplegia: It is safe,
efficient, and reduces the incidence of postoperative atrial fibrillation.
A randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (3) (pp 812-818),
2013. Date of Publication: March 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: We aimed to evaluate the efficacy and safety of a cold
crystalloid cardioplegic solution with adenosine (1.2 mmol/L) instead of
supranormal potassium. Methods: Sixty low-risk patients scheduled for
elective coronary artery bypass grafting (CABG) were randomized to receive
standard cold crystalloid hyperkalemic cardioplegia (hyperkalemic group)
or normokalemic cardioplegia in which supranormal potassium was replaced
with 1.2 mmol/L adenosine (adenosine group). End points were postoperative
release of troponin T and creatine kinase MB, hemodynamics measured by
PiCCO arterial thermodilution catheters, perioperative release of markers
of endothelial activation and injury, and clinical course. Results: The
adenosine group had a significantly shorter time to arrest than did the
hyperkalemic group (mean +/- standard deviation, 11 +/- 5 vs 44 +/- 18
seconds; P < .001). Three hearts in the adenosine group were probably not
adequately drained and received additional hyperkalemic cardioplegia to
maintain satisfactory cardioplegic arrest. There were no differences
between groups with respect to perioperative release of markers of
endothelial activation or injury and no differences between groups in
postoperative release of troponin T or creatine kinase MB. Postoperative
hemodynamics including cardiac index were similar between groups. The
incidence of postoperative atrial fibrillation was significantly lower in
the adenosine group than in the hyperkalemic group (4 vs 15; P = .01).
Conclusions: Adenosine instead of hyperkalemia in cold crystalloid
cardioplegia is safe, gives more rapid cardiac arrest, and affords similar
cardioprotection and maintenance of hemodynamic parameters, together with
a marked reduction in the incidence of postoperative atrial fibrillation.
Copyright 2013 by The American Association for Thoracic Surgery.

<18>
Accession Number
2013111519
Authors
Cao C. Manganas C. Bannon P. Vallely M. Yan T.D.
Institution
(Cao, Bannon, Vallely, Yan) Baird Institute for Applied Heart and Lung
Surgical Research, Sydney, Australia
(Cao, Manganas) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, Australia
Title
Drug-eluting stents versus coronary artery bypass graft surgery in left
main coronary artery disease: A meta-analysis of early outcomes from
randomized and nonrandomized studies.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (3) (pp 738-747),
2013. Date of Publication: March 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The present meta-analysis aimed to compare the short-term
safety and efficacy of drug-eluting stents and coronary artery bypass
graft surgery for patients with left main coronary artery disease.
Methods: Fourteen relevant studies were identified from 5 electronic
databases. End points included mortality, stroke, myocardial infarction,
repeat revascularization, and major adverse cardiac and cerebrovascular
events. Results: Results indicate that all-cause mortality was similar
between drug-eluting stents and coronary artery bypass grafting at 30 days
and at follow-up beyond 1 year. Likewise, the incidence of myocardial
infarction was similar between drug-eluting stents and coronary artery
bypass grafting at 12 months and at follow-up beyond 1 year. However,
drug-eluting stents were associated with a lower incidence of all-cause
mortality at 12 months and a higher incidence of myocardial infarction at
30 days compared with coronary artery bypass grafting. Drug-eluting stents
were consistently associated with a higher incidence of repeat
revascularization, whereas coronary artery bypass grafting had a higher
incidence of stroke. The incidence of major adverse cardiac and
cerebrovascular events was similar between the 2 groups at 30 days but
higher for drug-eluting stents at 12 months and beyond. Conclusions:
Patients treated by drug-eluting stents in randomized controlled trials
and observational studies in the current literature are often a
preselected subgroup with less complex lesions compared with the overall
target population. Results drawn from these studies should be viewed with
caution. Coronary artery bypass grafting is associated with a lower
incidence of major adverse cardiac and cerebrovascular events at 1 year
and beyond, and thus should be regarded as the standard of treatment.
However, drug-eluting stents may have a role for selected patients with
percutaneously amenable left main disease who are poor surgical
candidates. Copyright 2013 by The American Association for Thoracic
Surgery.

<19>
Accession Number
71002754
Authors
Haroutiunian S. Nikolajsen L. Finnerup N.B. Jensen T.S.
Institution
(Haroutiunian, Nikolajsen, Finnerup, Jensen) Danish Pain Research Center,
Aarhus University Hospital, Aarhus, Denmark
Title
Systematic review of neuropathic component in persistent postsurgical
pain.
Source
Scandinavian Journal of Pain. Conference: 3rd Annual Scientific Meeting of
the New Scandinavian Association for the Study of Pain, newSASP 2012
Aarhus Denmark. Conference Start: 20120419 Conference End: 20120421.
Conference Publication: (var.pagings). 3 (3) (pp 184), 2012. Date of
Publication: July 2012.
Publisher
Elsevier
Abstract
Background/aims: The aim of the current study was to assess the
neuropathic component of persistent postsurgical pain (PPSP) following
eleven types of surgery. Methods: We performed a systematic PubMed,
CENTRAL and EMBASE search to identify studies on PPSP following (i)
thoracic surgery, (ii) breast surgery, (iii) groin hernia repair, (iv)
prostatectomy, (v) major abdominal surgery, (vi) gynecologic surgery,
(vii) iliac crest bone harvest, (viii) total hip arthroplasty (THA) or
knee arthroplasty (TKA), (ix) varicose vein stripping or ablation, (x)
mandibular sagittal split osteotomy and (xi) donor nephrectomy, and
assessed the prevalence of Probable/Definite neuropathic pain using the
recently published neuropathic pain probability grading criteria [1].
Results:We included 291 relevant papers. Surgeries performed in the
thoracic/breast area resulted in similarly high median PPSP prevalence of
about 30-35%; bone and joint surgeries resulted in similar PPSP prevalence
of about 20%; and surgeries on visceral organs resulted in lower PPSP
prevalence of 10-14%. The reported ranges of PPSP prevalence were very
wide, between 0 and 91%. The prevalence of Probable/Definite neuropathic
pain among patients with PPSP was about 65% after thoracic and breast
surgeries, about 32% after groin hernia repair and gynecologic surgery,
and between 9 and 16% after bone and joint surgeries such as iliac crest
bone harvest and THA/TKA. In varicose vein surgeries and mandibular
sagittal split osteotomies more research is needed to investigate the
contribution of neuropathic pain mechanisms. Conclusion: PPSP after
different surgeries is reported to be commonand often neuropathic. This
systematic review of the literature showed that reported PPSP prevalences
range widely among studies, and only a minority of studies used
methodology that enabled the estimation of Probable/Definite neuropathic
pain prevalence.