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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>
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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.