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.

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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.