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<1>
Accession Number
2013107816
Authors
Lu Q. Han Y. Cao W. Lei J. Wan Y. Zhao F. Huang L. Li X.
Institution
(Lu, Han, Lei, Zhao, Huang, Li) Department of Thoracic Surgery, Tangdu
Hospital, The Fourth Military Medical University, Xi'an, China
(Cao) Department of Interventional Radiology, Tangdu Hospital, The Fourth
Military Medical University, Xi'an, China
(Wan) Department of Health Statistics and Institute for Health
Informatics, The Fourth Military Medical University, Xi'an, China
Title
Comparison of non-divided intercostal muscle flap and intercostal nerve
cryoanalgesia treatments for post-oesophagectomy neuropathic pain control.
Source
European Journal of Cardio-thoracic Surgery. 43 (3) (pp e64-e70), 2013.
Article Number: ezs645. Date of Publication: March 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: Oesophagectomy is at present considered to be the optimal
curative treatment for patients with severe oesophageal disease.
Postoperative pain, both acute and chronic, plays a significant role in
the quality of life for post-oesophagectomy patients. The present study
compared the effects of two methods-application of a non-divided
intercostal muscle flap (NIMF) and intercostal nerve cryoanalgesia (INC)
treatment-in reducing neuropathic pain in post-oesophagectomy patients.
Methods: From June 2009 to June 2010, a total of 160 patients who
underwent posterolateral thoracotomy and oesophagectomy were subsequently
recruited to our study and divided into NIMF groups and INC groups at
random. Patient follow-up studies were conducted for one year on all the
subjects and the resultant postoperative pain, chronic pain,
rehabilitation and complication scored were measured and documented.
Results: INC treatment was more time-intensive than NIMF treatment (P <
0.05). Also, additional chest tube drainage and subsequent extubation were
often necessary in the INC group (P < 0.001). No statistically significant
differences were found between the two groups regarding the number of
subjects who required oral medication one month postoperative with respect
to pain score. The chronic pain level, as well as the number of patients
requiring oral pain medication, increased significantly by the sixth month
following operation and notably increased until the 12th postoperative
month in the INC group (P < 0.05). Conclusions: Both NIMF and INC
treatments were effective and safe for the treatment of acute pain after
oesophagectomy. NIMF was the better technique in reducing chronic
postoperative pain. The Author 2012. Published by Oxford University Press
on behalf of the European Association for Cardio-Thoracic Surgery. All
rights reserved.

<2>
Accession Number
2013125618
Authors
Johnson N.J. Gaieski D.F. Allen S.R. Perrone J. DeRoos F.
Institution
(Johnson, Gaieski, Perrone, DeRoos) Department of Emergency Medicine,
Perelman School of Medicine, University of Pennsylvania, Ground
Silverstein, 3400 Spruce Street, Philadelphia, PA, United States
(Gaieski) Center for Resuscitation Science, University of Pennsylvania,
Philadelphia, PA, United States
(Allen) Division of Traumatology, Surgical Critical Care, and Emergency
Surgery, Department of Surgery, University of Pennsylvania, Philadelphia,
PA, United States
(Perrone, DeRoos) Division of Medical Toxicology, Department of Emergency
Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
Title
A Review of Emergency Cardiopulmonary Bypass for Severe Poisoning by
Cardiotoxic Drugs.
Source
Journal of Medical Toxicology. 9 (1) (pp 54-60), 2013. Date of
Publication: 2013.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Cardiovascular collapse remains a leading cause of death in severe acute
drug intoxication. Commonly prescribed medications such as
antidysrhythmics, calcium channel antagonists, and beta adrenergic
receptor antagonists can cause refractory cardiovascular collapse in
massive overdose. Emergency cardiopulmonary bypass (ECPB), a modality
originating in cardiac surgery, is a rescue technique that has been
successfully implemented in the treatment of refractory cardiogenic shock
and cardiac arrest unresponsive to traditional medical interventions. More
recently a growing number of animal studies, case reports, and case series
have documented its use in refractory hemodynamic collapse in poisoned
patients. This article will review current ECPB techniques and explore its
growing role in the treatment of severely hemodynamically compromised
poisoned patients. 2012 American College of Medical Toxicology.

<3>
Accession Number
2013096776
Authors
Messori A. Trippoli S. Biancari F.
Institution
(Messori, Trippoli) HTA Unit, Estav Centro Toscana, Regional Health
Service, Firenze and Prato, Italy
(Biancari) Department of Surgery, Oulu University Hospital, Oulu, Finland
Title
Early and intermediate survival after transcatheter aortic valve
implantation: Systematic review and meta-analysis of 14 studies.
Source
BMJ Open. 3 (1) , 2013. Article Number: e001770. Date of Publication:
2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: Transcatheter aortic valve implants (TAVIs) is indicated as an
alternative to surgical valve replacement for patients unfit for surgery.
No systematic review has studied survival after 2 years and limited
information is available on between-study heterogeneity. Objectives: A
systematic review and meta-analysis on intermediate survival after TAVI.
Data sources: PubMed, EMBASE, Scopus and references of selected articles.
Study eligibility criteria: Clinical studies evaluating TAVI, published
between 2010 and 2012, reporting survival at 2 or more years.
Participants: About 3500 patients from 14 studies. Study appraisal and
synthesis methods: Proportion meta-analysis with 95% CI and heterogeneity
assessment (I2 and Cochran's Q). Metaregression analysis was performed as
well. Results: Pooled immediate postoperative death rate was 7.8% (95% CI
6.2% to 9.8%, I2=40.8%; Cochran's Q=97.7 with 92.9 df, p<0.0001) and
stroke rate was 3.8% (95% CI 2.8% to 5.0%, I2=34.3%; Cochran's Q=96.5 with
92.9 df, p<0.0001). Pooled death rates at 1, 2 and 3 years were 23.2%,
31.0% and 38.6%, respectively. Among studies reporting on concomitant
percutaneous coronary intervention, pooled death rates at 30 days, 1 year
and 2 years were 6.3%, 17.8% and 25.8%, respectively. Limitations:
Although our analysis examined a total of about 3500 patients, only a
minority of these were actually followed up after 2 years. Conclusions:
Pooled survival rates after TAVI (at 2 years:69.0%; at 3 years:61.4%) can
be considered excellent, particularly in the light of the high-risk
profile of this patient population. Implications of key findings: The
favourable intermediate outcome in patients subjected to TAVI seems to
justify its use in patients unfit for surgery. Such pooled results
indicate that TAVI is a valid alternative to surgical valve replacement,
but lack of data on late durability after TAVI prevents its use in
low-risk patients with long expectancy of life.

<4>
Accession Number
2013107761
Authors
Zheng H. Xue S. Lian F. Huang R.-T. Hu Z.-L. Wang Y.-Y.
Institution
(Zheng, Xue, Lian, Huang, Hu, Wang) Department of Cardiovascular Surgery,
Renji Hospital, Shanghai Jiao Tong University School of Medicine,
Shanghai, China
Title
Meta-analysis of clinical studies comparing coronary artery bypass
grafting with percutaneous coronary intervention in patients with
end-stage renal disease.
Source
European Journal of Cardio-thoracic Surgery. 43 (3) (pp 459-467), 2013.
Article Number: ezs360. Date of Publication: March 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
End-stage renal disease (ESRD) patients are at high risk for coronary
artery disease (CAD). The optimal revascularization strategy remains
unknown. We performed a meta-analysis of retrospective observational
trials to compare coronary artery bypass grafting (CABG) with percutaneous
coronary intervention (PCI) for ESRD patients with CAD. A search of
published reports was conducted to identify clinical studies comparing
CABG with PCI in ESRD patients with CAD with a minimal follow-up of 12
months. Sixteen studies included 32 350 ESRD patients with
revascularization. Compared with PCI, CABG was associated with a lower
risk for late mortality [relative risk (RR) 0.90, 95% confidence interval
(CI) 0.87-0.93], myocardial infarction event (RR 0.64, 95% CI: 0.61-0.68),
repeat revascularization event (RR 0.22, 95% CI: 0.16-0.31) and cumulative
events (RR 0.69, 95% CI: 0.65-0.73), despite having a higher risk for
early mortality (RR 1.98, 95% CI: 1.51-2.60). In conclusion, the long-term
results of PCI in ESRD patients are dismal, and CABG is significantly
superior to PCI in this subset of patients. The Author 2012. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<5>
Accession Number
2013104308
Authors
Loughran J.H. Chugh A.R. Ismail I. Bolli R.
Institution
(Loughran, Chugh, Bolli) Division of Cardiovascular Medicine, University
of Louisville, ACB Bldg, 550 S Jackson Street, Louisville KY 40202, United
States
(Ismail) School of Medicine, University of Louisville, Louisville KY,
United States
Title
Stem cell therapy: Promising treatment in heart failure?.
Source
Current Heart Failure Reports. 10 (1) (pp 73-80), 2013. Date of
Publication: 2013.
Publisher
Current Science Inc. (400 Market Street, Suite 700, Philadelphia PA 19106,
United States)
Abstract
Cardiac repair through the use of regenerative medicine has been a
considerable research focus over the last decade. Several stem cell types
have been investigated over this timeframe as potential candidates to
target post-infarction heart failure. The progression of investigation
through the rigors of clinical trial design has provided some answers as
to the potential clinical utility of this therapy; although there are many
questions that remain. This review will concentrate on the clinical trial
results of stem cell therapy for cardiac repair since the turn of the
century and discuss some of the points that need clarification before this
form of therapy can be considered for widespread applicability. 2013
Springer Science+Business Media New York.

<6>
[Use Link to view the full text]
Accession Number
2013110550
Authors
Gordon R.J. Weinberg A.D. Pagani F.D. Slaughter M.S. Pappas P.S. Naka Y.
Goldstein D.J. Dembitsky W.P. Giacalone J.C. Ferrante J. Ascheim D.D.
Moskowitz A.J. Rose E.A. Gelijns A.C. Lowy F.D.
Institution
(Gordon) Departments of Medicine, Columbia University College of
Physicians, New York, NY, United States
(Naka) Departments of Surgery, Columbia University College of Physicians,
New York, NY, United States
(Giacalone, Lowy) Departments of Pathology, Columbia University College of
Physicians, New York, NY, United States
(Gordon) Department of Epidemiology, Columbia University Mailman School of
Public Health, New York, NY, United States
(Weinberg, Ferrante, Ascheim, Moskowitz, Rose) International Center for
Health Outcomes and Innovation Research, Department of Health Evidence and
Policy, United States
(Ascheim) Zena and Michael A. Wiener Cardiovascular Institute, United
States
(Gelijns) Mount Sinai School of Medicine, New York, NY, United States
(Pagani) Department of Cardiac Surgery, University of Michigan Health
Systems, Ann Arbor, United States
(Slaughter) Division of Thoracic and Cardiovascular Surgery, University of
Louisville, Louisville, KY, United States
(Pappas) Department of Cardiovascular Surgery, Advocate Christ Medical
Center, Oak Lawn, IL, United States
(Goldstein) Montefiore Medical Center, Bronx, NY, United States
(Dembitsky) Sharp Memorial Hospital, San Diego, CA, United States
Title
Prospective, multicenter study of ventricular assist device infections.
Source
Circulation. 127 (6) (pp 691-702), 2013. Date of Publication: 12 Feb 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Ventricular assist devices (VADs) improve survival and quality
of life in patients with advanced heart failure, but their use is
frequently complicated by infection. There are limited data on the
microbiology and epidemiology of these infections. Methods and Results-One
hundred fifty patients scheduled for VAD implantation were enrolled
(2006-2008) at 11 US cardiac centers and followed prospectively until
transplantation, explantation for recovery, death, or for 1 year.
Eightysix patients (57%) received HeartMate II devices. Data were
collected on potential preoperative, intraoperative, and postoperative
risk factors for infection. Clinical, laboratory, and microbiological data
were collected for suspected infections and evaluated by an infectious
diseases specialist. Thirty-three patients (22%) developed 34 VAD-related
infections with an incidence rate of 0.10 per 100 person-days (95%
confidence interval, 0.073-0.142). The median time to infection was 68
days. The driveline was the most commonly infected site (n=28); 18 (64%)
were associated with invasive disease. Staphylococci were the most common
pathogen (47%), but pseudomonas or other Gram-negative bacteria caused 32%
of infections. A history of depression and elevated baseline serum
creatinine were independent predictors of VAD infection (adjusted hazard
ratio=2.8 [P=0.007] and 1.7 [P=0.023], respectively). The HeartMate II was
not associated with a decreased risk of infection. VAD infection increased
1-year mortality (adjusted hazard ratio=5.6; P<0.0001). Conclusions-This
prospective, multicenter study demonstrates that infection frequently
complicates VAD placement and is a continuing problem despite the use of
newer, smaller devices. Depression and renal dysfunction may increase the
risk of VAD infection. VAD infection is a serious consequence because it
adversely affects patient survival. Clinical Trial Registration-URL:
http://www.clinicaltrials.gov. Unique identifier: NCT01471795.
(Circulation. 2013;127:691-702.). 2013 American Heart Association, Inc.

<7>
[Use Link to view the full text]
Accession Number
2013110548
Authors
Kohli P. Wallentin L. Reyes E. Horrow J. Husted S. Angiolillo D.J.
Ardissino D. Maurer G. Morais J. Nicolau J.C. Oto A. Storey R.F. James
S.K. Cannon C.P.
Institution
(Kohli, Cannon) Cardiovascular Division, TIMI Study Group, Brigham and
Women's Hospital and Harvard Medical School, Boston, MA, United States
(Kohli) Division of Cardiology, University of California San Francisco,
San Francisco, CA, United States
(Wallentin) Department of Medical Sciences, Uppsala Clinical Research
Center, Uppsala University, Sweden
(Reyes) Duke Clinical Research Institute, Durham, NC, United States
(Horrow) AstraZeneca R and D, Wilmington, DE, United States
(Husted) Department of Cardiology, Arhus University Hospital, Arhus,
Denmark
(Angiolillo) Cardiovascular Division, University of Florida College of
Medicine, Jacksonville, FL, United States
(Ardissino) Azienda Ospedaliero Universitaria di Parma, Parma, Italy
(Maurer) Division of Cardiology, Medical University of Vienna, Austria
(Morais) Santo Andre's Hospital, Leiria, Portugal
(Nicolau) Heart Institute University of Sao Paulo Medical School, Sao
Paulo, Brazil
(Oto) Hacettepe University Faculty of Medicine, Ankara, Turkey
(James) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
Title
Reduction in first and recurrent cardiovascular events with ticagrelor
compared with clopidogrel in the PLATO study.
Source
Circulation. 127 (6) (pp 673-680), 2013. Date of Publication: 12 Feb 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-We sought to evaluate the effect of potent platelet inhibition
after acute coronary syndrome on total (ie, first and recurrent)
occurrences of any of the primary outcome events (eg, cardiovascular
death, myocardial infarction, and stroke) as well as on other ischemic
events, such as urgent revascularization, (severe) recurrent ischemia,
transient ischemic attacks, and arterial thrombotic events. Methods and
Results-In the PLATelet inhibition and patient Outcomes (PLATO) study, 18
624 patients presenting with acute coronary syndromes randomly received
ticagrelor (n=9333) or clopidogrel (n=9291). Cox proportional hazard
models were used to calculate time to first event and hazard ratios. Total
events were compared using a Poisson regression model, and time to second
event or death was calculated with the Wei Lin Weissfeld method. Patients
randomized to ticagrelor had 1057 total primary end point events versus
1225 for patients on clopidogrel (rate ratio, 0.86; 95% confidence
interval, 0.79-0.93; P=0.003). The number of additional events was
numerically lower for ticagrelor (189 versus 205; P=0.40), resulting in a
hazard for time to second event/death of 0.80 (95% confidence interval,
0.70-0.90; P<0.001) and a number needed to treat of 54. For cardiovascular
death/myocardial infarction/stroke/(severe) recurrent ischemia/transient
ischemic attack/arterial thrombotic events, total events were fewer with
ticagrelor (2030 versus 2290; rate ratio, 0.88; 95% confidence interval,
0.82-0.95; P<0.001), with fewer recurrent events with ticagrelor (740
versus 834; P=0.01) and a highly significant concurrent reduction in
hazard for time to second event or death of 0.83 (95% confidence interval,
0.75-0.91; P<0.001). Recurrent PLATO major or Thrombolysis in Myocardial
Infarction (TIMI) major non-coronary artery bypass graft bleeding events
were infrequent and not different between the two therapies (P=0.96 and
0.38, respectively). Conclusions-In PLATO, treatment with ticagrelor
compared with clopidogrel resulted in a reduction in total events,
including first and subsequent recurrent cardiovascular events, when
compared with clopidogrel. These types of analyses demonstrate an even
greater absolute benefit of ticagrelor over clopidogrel than previously
reported. Clinical Trial Registration-URL: http://www.clinicaltrials.gov/.
Unique identifier: NCT00391872. (Circulation. 2013;127:673-680.). 2013
American Heart Association, Inc.

<8>
Accession Number
2013106595
Authors
Deppe A.-C. Liakopoulos O.J. Choi Y.-H. Slottosch I. Kuhn E.W. Scherner M.
Stange S. Wahlers T.
Institution
(Deppe, Liakopoulos, Choi, Slottosch, Kuhn, Scherner, Stange, Wahlers)
Department of Cardiothoracic Surgery, Heart Center of the University of
Cologne, Kerpener Strase 62, 50924 Cologne, Germany
(Choi) Center of Molecular Medicine Cologne, University of Cologne,
Cologne, Germany
Title
Endoscopic vein harvesting for coronary artery bypass grafting: A
systematic review with meta-analysis of 27,789 patients.
Source
Journal of Surgical Research. 180 (1) (pp 114-124), 2013. Date of
Publication: March 2013.
Publisher
Academic Press Inc. (1250 Sixth Avenue, San Diego, California CA 92101,
United States)
Abstract
Background: To determine the current strength of evidence for or against
endoscopic vein harvesting (EVH) in patients undergoing coronary artery
bypass grafting (CABG). Materials and Methods: A meta-analysis of
randomized controlled trials (RCT) and observational trials (OT) was
performed that reported the impact of EVH on adverse clinical outcomes
after CABG. Analyzed postoperative outcomes included wound infection,
postoperative pain, myocardial infarction (MI), vein graft failure, length
of hospital stay, and mortality. Pooled treatment effects (OR or weighted
mean difference (WMD), 95%CI) were assessed using a fixed or random
effects model. Results: A total of 27,789 patients from 43 studies (16
RCT, 27 OT) were identified who underwent saphenectomy by endoscopic (46%;
n = 12,822) or conventional technique (54%; n = 14,967). Pooled effect
estimates revealed a reduced incidence (P < 0.001) for wound infections
(OR 0.27; 95% CI 0.22 to 0.32), pain (WMD -1.26, 95% CI -2.07 to -0.44; P
= 0.0026), and length of hospital stay (WMD -0.6 d, 95% CI -1.08 to -0.12;
P = 0.0152). EVH was associated to an increase of the odds for vein graft
failure (OR 1.38; 95% CI 1.01 to 1.88; P = 0.0433), a finding that lost
statistical difference after pooled analysis of RCT and studies with high
methodological quality. Similarly, graft-related endpoints, including
mortality and MI, did not differ between the harvesting techniques.
Conclusion: The present systematic review underscores the safety of EVH in
patients undergoing CABG. EVH reduces leg wound infections without
increasing the midterm risk for vein graft failure, MI, or mortality.
2013 Elsevier Inc. All rights reserved.

<9>
Accession Number
2013111375
Authors
Kaczmarek I. Zaruba M.-M. Beiras-Fernandez A. Reimann R. Nickel T.
Grinninger C. Sadoni S. Hagl C. Meiser B.
Institution
(Kaczmarek, Zaruba, Reimann, Grinninger, Sadoni, Meiser) Transplantation
Center Munich, Ludwig-Maximilians-University, Grosshadern University
Hospital, Marchioninistrasse 15, 81377 Munich, Germany
(Kaczmarek, Hagl) Department of Cardiac Surgery,
Ludwig-Maximilians-University, Munich, Germany
(Zaruba, Nickel, Grinninger) Medical Department i, Klinikum Grosshadern,
Ludwig-Maximilians-University, Munich, Germany
(Beiras-Fernandez) Department of Thoracic and Cardiovascular Surgery,
Johann Wolfgang Goethe-University, Frankfurt, Germany
Title
Tacrolimus with mycophenolate mofetil or sirolimus compared with
calcineurin inhibitor-free immunosuppression (sirolimus/mycophenolate
mofetil) after heart transplantation: 5-year results.
Source
Journal of Heart and Lung Transplantation. 32 (3) (pp 277-284), 2013. Date
of Publication: March 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Despite improvements in immunosuppressive therapy, the most
advantageous combination for cardiac transplant recipients has not been
established. This randomized controlled trial was performed to evaluate
the efficacy and safety of 3 immunosuppressive protocols. Methods: Between
2003 and 2005, 78 de novo cardiac transplant recipients were randomized
2:2:1 to receive steroids and tacrolimus plus mycophenolate mofetil
(TAC/MMI n = 34), TAC and sirolimus (TAC/SRL; n = 29), or SRL and MMF
(SRL/MMF) plus anti-thymocyte globulin (ATG; n = 15). Steroids were
withdrawn after 6 months. Results: The 5-year survival was 85.3% for
TAC/MMF, 93.1% for TAC/SRL, and 86.7% for SRL/MMF (p = 0.31 for TAC/MMF vs
TAC/SIR; p = 0.47 for TAC/MMF vs SIR/MMF and p = 0.86 for TAC/SIR vs
SIR/MMF). Despite the use of ATG, patients in the SRL/MMF group revealed
numerically fewer freedom from acute rejection episodes: TAC/MMF, 82.4%;
TAC/SRL, 85.2%; SRL/MMF, 73.3% (p = 0.33). Mean creatinine at 5 years
revealed preservation of renal function in the SRL/MMF vs the TAC/MMF
group (p = 0.045): TAC/MMF, 1.70+/-0.91 mg/dl; TAC/SRL, 1.44+/-0.65 mg/dl;
and SRL/MMF, 1.25+/-0.46 mg/dl. Freedom from cardiac allograft
vasculopathy was improved in the SRL/MMF group (93.3%) compared with
TAC/MMF (73.5%) and TAC/SRL (80.8%) groups, reaching no statistical
significance. Freedom from cytomegalovirus infection was TAC/MMF, 72.2%;
TAC/SRL, 89.7%; and SRL/MMF, 86.7%. There was a trend toward improved
freedom from cytomegalovirus infection with TAC/SRL vs TAC/MMF (p =
0.076). More frequent discontinuations of study medication occurred in
SRL-based immunosuppression protocols (TAC/SRL vs TAC/MMF, p = 0.034;
SRL/MMF vs TAC/MMF, p = 0.003). Conclusions: The 3 strategies yield no
survival advantage at 5 years, with higher numeric rates of rejection and
adverse effects in the calcineurin inhibitor-free arm. A trend was
observed in favor of freedom from cardiac allograft vasculopathy and
preservation of renal function in the calcineurin inhibitor-free arm.
However, the clinical relevance on outcomes is unclear because only few
patients were receiving the assigned treatment protocols. 2013
International Society for Heart and Lung Transplantation. All rights
reserved.

<10>
Accession Number
2013122763
Authors
Vrtovec B. Sever M. Domanovic D. Lezaic L. Poglajen G. Cernelc P. Haddad
F. Torre-Amione G.
Institution
(Vrtovec, Poglajen) Advanced Heart Failure and Transplantation Center, UMC
Ljubljana, Slovenia
(Sever, Cernelc) Department of Hematology, UMC Ljubljana, Slovenia
(Domanovic) National Blood Transfusion Institute, Ljubljana, Slovenia
(Lezaic) Department of Nuclear Medicine, UMC Ljubljana, Slovenia
(Haddad) Stanford University School of Medicine, Stanford, CA, United
States
(Torre-Amione) Methodist DeBakey Heart Center, Houston, TX, United States
Title
Long-term effects of stem cell transplantation in heart failure.
Source
Zdravniski Vestnik. 81 (SUPPL.2) (pp 373-383), 2013. Date of Publication:
2012.
Publisher
Slovene Medical Society (Dalmatinova 10, Ljubljana 1001, Slovenia)
Abstract
Background: We investigated long-term effects of intracoronary
transplantation of CD₃₄+ cells in patients with dilated
cardiomyopathy (DCM). Methods: Of 110 DCM patients, 55 were randomized to
CD₃₄+ cell transplantation (SC) group, and 55 patients received
no cell therapy (controls). In the SC group, peripheral
CD₃₄+cells were mobilized by G-CSF and collected via apheresis.
Patients underwent myocardial scintigraphy and CD₃₄+ cells were
injected in the artery supplying the segments with reduced viability.
Patients were followed for 5 years. Results: At baseline, the 2 groups did
not differ in age, gender, left ventricular ejection fraction (LVEF), or
NT-proBNP levels. At 5 years, stem cell therapy was associated with an
increase in LVEF (from 24.3 +/- 6.5 % to 30.0 +/- 5.1 %; P = 0.02), an
increase in 6-minute walk distance (from 344 +/- 90 m to 477 +/- 130 m; P
< 0.001), and a decrease in NT-proBNP (from 2322 +/- 1234 pg/mL to 1011
+/- 893 pg/mL; P < 0.01). During followup, 27 (25 %) patients died and 9
(8 %) underwent heart transplantation. Of the 27 deaths, 13 were
attributed to pump failure, and 14 to sudden cardiac death. Total
mortality was lower in SC group (8/55 [14 %]) than in controls (19/55 [35
%]) (P = 0.01). The same was true of pump failure (3/55 [5 %] vs. 10/55
[18 %], P = 0.03), but not of sudden cardiac death (5/55 [9 %] vs. 9/55
[16 %], P = 0.39). SC therapy was an independent predictor of outcome on
multivariable analysis (P = 0.04). Conclusions: Intracoronary stem cell
transplantation may be associated with improved ventricular remodeling,
exercise tolerance, and longterm survival in patients with DCM.

<11>
Accession Number
2013111536
Authors
Kodric M. Trevisan R. Torregiani C. Cifaldi R. Longo C. Cantarutti F.
Confalonieri M.
Institution
(Kodric, Trevisan, Torregiani, Cifaldi, Longo, Cantarutti, Confalonieri)
Department of Pneumology, University Hospital of Cattinara, Trieste, Italy
Title
Inspiratory muscle training for diaphragm dysfunction after cardiac
surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (3) (pp 819-823),
2013. Date of Publication: March 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Diaphragm dysfunction is a complication of cardiac surgery with
partial or absent spontaneous recovery in most cases. Surgical diaphragm
plication represents the only option when symptoms persist. Because
training improves functional nerve recovery after a nerve lesion, we
hypothesized that early diaphragm muscle training may be beneficial.
Methods: A prospective, randomized at 2:1 ratio, controlled trial of
diaphragm training using an adjustable pressure device (Threshold; Philips
Respironics Inc, Murrysville, Pa) versus no training (sham device) was
performed in patients with diaphragm paralysis after major cardiac
surgery. This 1-year study recruited consecutive adult patients with sniff
fluoroscopy-defined diaphragm paralysis after coronary bypass, valve
replacement, or both. The outcome measures were diaphragm function
recovery assessed by sniff fluoroscopy, maximum inspiratory and expiratory
pressures, and lung function tests. Results: A total of 69 patients were
randomized. At 12 months, 52 patients completed the study assessments, 36
in the treatment group and 16 in the control group. Inspiratory muscle
training produced a significant improvement of diaphragm mobility after 12
months (P < .001). Most patients in the training group (77.78%)
experienced a partial improvement (41.67%) or achieved a complete
improvement (36.11%) versus no improvement (87.5%) or partial recovery
(12.5%) among controls. Conclusions: Inspiratory muscle training may
improve inspiratory muscle strength and increases paralyzed diaphragm
mobility. Copyright 2013 by The American Association for Thoracic
Surgery.

<12>
Accession Number
2013093502
Authors
Wu X. Wang C. Zhu J. Zhang C. Zhang Y. Gao Y.
Institution
(Wu, Wang, Zhu, Zhang, Zhang, Gao) Department of Cardiovascular Medicine,
Second Affiliated Hospital of Medical School, Xi'an Jiaotong University,
Xi'an, Shaanxi, 710004, China
Title
Meta-analysis of randomized controlled trials on magnesium in addition to
beta-blocker for prevention of postoperative atrial arrhythmias after
coronary artery bypass grafting.
Source
BMC Cardiovascular Disorders. 13 , 2013. Article Number: 5. Date of
Publication: 23 Jan 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Atrial arrhythmia (AA) is the most common complication after
coronary artery bypass grafting (CABG). Only beta-blockers and amiodarone
have been convincingly shown to decrease its incidence. The effectiveness
of magnesium on this complication is still controversial. This
meta-analysis was performed to evaluate the effect of magnesium as a sole
or adjuvant agent in addition to beta-blocker on suppressing postoperative
AA after CABG.Methods: We searched the PubMed, Medline, ISI Web of
Knowledge, Cochrane library databases and online clinical trial database
up to May 2012. We used random effects model when there was significant
heterogeneity between trials and fixed effects model when heterogeneity
was negligible.Results: Five randomized controlled trials were identified,
enrolling a total of 1251 patients. The combination of magnesium and
beta-blocker did not significantly decrease the incidence of postoperative
AA after CABG versus beta-blocker alone (odds ratio (OR) 1.12, 95%
confidence interval (CI) 0.86-1.47, P = 0.40). Magnesium in addition to
beta-blocker did not significantly affect LOS (weighted mean difference
-0.14 days of stay, 95% CI -0.58 to 0.29, P = 0.24) or the overall
mortality (OR 0.59, 95% CI 0.08-4.56, P = 0.62). However the risk of
postoperative adverse events was higher in the combination of magnesium
and beta-blocker group than beta-blocker alone (OR 2.80, 95% CI 1.66-4.71,
P = 0.0001).Conclusions: This meta-analysis offers the more definitive
evidence against the prophylactic administration of intravenous magnesium
for prevention of AA after CABG when beta-blockers are routinely
administered, and shows an association with more adverse events in those
people who received magnesium. 2013 Wu et al.; licensee BioMed Central
Ltd.

<13>
Accession Number
2013111887
Authors
Sakaguchi M. Sasaki Y. Hirai H. Hosono M. Nakahira A. Seo H. Suehiro S.
Institution
(Sakaguchi, Sasaki, Hirai, Hosono, Nakahira, Seo, Suehiro) Department of
Cardiovascular Surgery, Osaka City University Graduate School of Medicine,
Osaka, Japan
Title
Efficacy of landiolol hydrochloride for prevention of atrial fibrillation
after heart valve surgery.
Source
International Heart Journal. 53 (6) (pp 359-363), 2012. Date of
Publication: 2012.
Publisher
International Heart Journal Association (7-3-1 Hongo, Bunkyo-ku, Tokyo
113-8655, Japan)
Abstract
The goal of this prospective study was to examine the effects of landiolol
hydrochloride on prevention of atrial fibrillation and on hemodynamics in
the acute postoperative phase after heart valve surgery. The subjects were
60 patients who underwent valve surgery at our hospital from April 2008 to
July 2010. The patients were randomly divided into two groups: the
landiolol group (30 patients) and the control (no landiolol) group (30
patients). In the landiolol group, continuous intravenous landiolol was
initiated immediately on admission to the intensive care unit at a dose of
10 mug/kg/ minute. Occurrence of atrial fibrillation was compared between
the groups over an observation period of 72 hours after surgery. Atrial
fibrillation occurred in 6 patients (20%) in the landiolol group and 16
(53.3%) in the control group during the observation period. Landiolol
hydrochloride significantly reduced the occurrence of atrial fibrillation
in the acute postoperative phase after heart valve surgery. Heart rate was
significantly decreased by landiolol, but aggravation of hemodynamics was
not observed. These results suggest that landiolol is a useful drug for
prevention of atrial fibrillation after valve surgery.

<14>
[Use Link to view the full text]
Accession Number
2013102178
Authors
Kotwal S. Jun M. Sullivan D. Perkovic V. Neal B.
Institution
(Kotwal, Jun, Perkovic, Neal) George Institute for Global Health,
University of Sydney, PO Box M201, Sydney, NSW 2050, Australia
(Sullivan) University of Sydney, Sydney, Australia
Title
Omega 3 fatty acids and cardiovascular outcomes: Systematic review and
meta-analysis.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (6) (pp 808-818),
2012. Date of Publication: November 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Early trials evaluating the effect of omega 3 fatty acids (?-3
FA) reported benefits for mortality and cardiovascular events but recent
larger studies trials have variable findings. We assessed the effects of
?-3 FA on cardiovascular and other important clinical outcomes. Methods
and Results-We searched MEDLINE, EMBASE, and the Cochrane Central Register
of Controlled Trials for all randomized studies using dietary supplements,
dietary interventions, or both. The primary outcome was a composite of
cardiovascular events (mostly myocardial infarction, stroke, and
cardiovascular death). Secondary outcomes were arrhythmia, cerebrovascular
events, hemorrhagic stroke, ischemic stroke, coronary revascularization,
heart failure, total mortality, nonvascular mortality, and end-stage
kidney disease. Twenty studies including 63 030 participants were
included. There was no overall effect of ?-3 FA on composite
cardiovascular events (relative risk [RR]=0.96; 95% confidence interval
[CI], 0.90-1.03; P=0.24) or on total mortality (RR=0.95; 95% CI,
0.86-1.04; P=0.28). ?-3 FA did protect against vascular death (RR=0.86;
95% CI, 0.75-0.99; P=0.03) but not coronary events (RR=0.86; 95% CI,
0.67-1.11; P=0.24). There was no effect on arrhythmia (RR=0.99; 95% CI,
0.85-1.16; P=0.92) or cerebrovascular events (RR=1.03; 95% CI, 0.92-1.16;
P=0.59). Adverse events were more common in the treatment group than the
placebo group (RR=1.18, 95% CI, 1.02-1.37; P=0.03), predominantly because
of an excess of gastrointestinal side effects. Conclusions-?-3 FA may
protect against vascular disease, but the evidence is not clear-cut, and
any benefits are almost certainly not as great as previously believed.
2012 American Heart Association, Inc.

<15>
[Use Link to view the full text]
Accession Number
2013102175
Authors
Pettit S.J. Jhund P.S. Hawkins N.M. Gardner R.S. Haj-Yahia S. McMurray
J.J.V. Petrie M.C.
Institution
(Pettit, Gardner, Haj-Yahia, Petrie) Scottish National Advanced Heart
Failure Service, Golden Jubilee National Hospital, Agamemnon St,
Clydebank, Glasgow, G81 4DY, United Kingdom
(Jhund, McMurray) Institute of Cardiovascular and Medical Sciences, BHF
Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow,
United Kingdom
(Hawkins) Institute of Cardiovascular Medicine and Science, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
Title
How small is too small? A systematic review of center volume and outcome
after cardiac transplantation.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (6) (pp 783-790),
2012. Date of Publication: November 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-The aim of this study was to assess the relationship between
the volume of cardiac transplantation procedures performed in a center and
the outcome after cardiac transplantation. Methods and Results-PubMed,
Embase, and the Cochrane library were searched for articles on the
volume-outcome relationship in cardiac transplantation. Ten studies were
identified, and all adopted a different approach to data analysis and
varied in adjustment for baseline characteristics. The number of patients
in each study ranged from 798 to 14 401, and observed 1-year mortality
ranged from 12.6% to 34%. There was no association between the continuous
variables of center volume and observed mortality. There was a weak
association between the continuous variables of center volume and adjusted
mortality up to 1 year and a stronger association at 5 years. When centers
were grouped in volume categories, low-volume centers had the highest
adjusted mortality, intermediate-volume centers had lower adjusted
mortality, and high-volume centers had the lowest adjusted mortality but
were not significantly better than intermediate-volume centers. Category
limits were arbitrary and varied between studies. Conclusions-There is a
relationship between center volume and mortality in heart transplantation.
The existence of a minimum acceptable center volume or threshold is
unproven. However, a level of 10 to 12 heart transplants per year
corresponds to the upper limit of low-volume categories that may have
relatively higher mortality. It is not known whether outcomes for patients
treated in low-volume transplant centers would be improved by reorganizing
centers to ensure volumes in excess of 10 to 12 heart transplants per
year. 2012 American Heart Association, Inc.

<16>
[Use Link to view the full text]
Accession Number
2013102171
Authors
Schneider R.H. Grim C.E. Rainforth M.V. Kotchen T. Nidich S.I.
Gaylord-King C. Salerno J.W. Kotchen J.M. Alexander C.N.
Institution
(Schneider, Rainforth, Nidich, Gaylord-King, Salerno, Alexander) Institute
for Natural Medicine and Prevention, Maharishi University of Management,
Fairfield, IA 52556, United States
(Schneider, Rainforth, Nidich, Gaylord-King, Salerno) Center for Natural
Medicine and Prevention, Maharishi University of Management Research
Institute, Maharishi Vedic City, IA, United States
(Grim, Kotchen, Kotchen) Department of Medicine, Medical College of
Wisconsin, Milwaukee, WI, United States
Title
Stress reduction in the secondary prevention of cardiovascular disease:
Randomized, controlled trial of transcendental meditation and health
education in blacks.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (6) (pp 750-758),
2012. Date of Publication: November 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Blacks have disproportionately high rates of cardiovascular
disease. Psychosocial stress may contribute to this disparity. Previous
trials on stress reduction with the Transcendental Meditation (TM) program
have reported improvements in cardiovascular disease risk factors,
surrogate end points, and mortality in blacks and other populations.
Methods and Results-This was a randomized, controlled trial of 201 black
men and women with coronary heart disease who were randomized to the TM
program or health education. The primary end point was the composite of
all-cause mortality, myocardial infarction, or stroke. Secondary end
points included the composite of cardiovascular mortality,
revascularizations, and cardiovascular hospitalizations; blood pressure;
psychosocial stress factors; and lifestyle behaviors. During an average
follow-up of 5.4 years, there was a 48% risk reduction in the primary end
point in the TM group (hazard ratio, 0.52; 95% confidence interval,
0.29-0.92; P=0.025). The TM group also showed a 24% risk reduction in the
secondary end point (hazard ratio, 0.76; 95% confidence interval,
0.51-0.1.13; P=0.17). There were reductions of 4.9 mm Hg in systolic blood
pressure (95% confidence interval -8.3 to -1.5 mm Hg; P=0.01) and anger
expression (P<0.05 for all scales). Adherence was associated with
survival. Conclusions-A selected mind-body intervention, the TM program,
significantly reduced risk for mortality, myocardial infarction, and
stroke in coronary heart disease patients. These changes were associated
with lower blood pressure and psychosocial stress factors. Therefore, this
practice may be clinically useful in the secondary prevention of
cardiovascular disease. 2012 American Heart Association, Inc.

<17>
Accession Number
2013101529
Authors
Mirhosseini S. Forouzannia S. Ali-Hassan-Sayegh S. Ravan H. Abdollahi M.
Mozayan M.
Institution
(Mirhosseini, Forouzannia) Departments of Cardiac Surgery, Shahid Sadoughi
University of Medical Sciences, Afshar Cardiovascular Hospital, Jomhouri
Blvd, Yazd, Iran, Islamic Republic of
(Ali-Hassan-Sayegh) Departments of Medical and Researcher of Cardiac
Surgery, Yazd Cardiovascular Research Center, Shahid Sadoughi University
of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ravan) Departments of Cardiaology, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Abdollahi) Departments of Anesthesiology, Afshar Hospital, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Mozayan) Department of English Language, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
Title
Preoperative C-reactive protein can predict early clinical outcomes
following elective off-pump CABG surgery in patients with severe left
ventricle dysfunction.
Source
Saudi Journal of Anaesthesia. 6 (4) (pp 327-331), 2012. Date of
Publication: October-December 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Purpose: Atrial fibrillation (AF) is the most common type of arrhythmia
following elective off-pump coronary bypass graft (CABG) surgery,
occurring on the 2 ^nd or 3 ^rd postoperative day.
Postoperative atrial fibrillation and early complications may be the cause
of long term morbidity and mortality after hospital discharge. High
sensitive C-reactive protein (hsCRP) seems to be most significantly
associated with cardiovascular disorders. This study was designed to
evaluate whether preoperative hsCRP (>=3 mg/dl) can predict post-elective
off-pump CABG, AF, and early complications in patients with severe left
ventricle dysfunction (Ejection Fraction (EF)<30%). Methods: This study
was conducted on 104 patients with severe left ventriclar dysfunction (EF
< 30%), undergoing elective off-pump CABG surgery during April to
September 2011 at the Afshar Cardiovascular Center in Yazd, Iran. Patients
undergoing emergency surgery and those with unstable angina, creatinine
higher than 2.0 mg/dl, malignancy, or immunosuppressive disease were
excluded from the study. The subjects were divided into two groups: Group
I with preoperative increased hsCRP (>3 mg/dl) (n=51) and group N with
preoperative normal hsCRP (<3 mg/dl) (n=53). We evaluated post-CABG
variables including incidence, duration, and frequency of AF, early
morbidity (bleeding, infection, vomiting, renal and respiratory
dysfunctions), ICU or hospital stay and early mortality. Data were then
analyzed by Analysis of Variance (ANOVA), Chi-square and Fisher exact test
for quantitative and qualitative variables. Results: The average age of
the patients was 62.5 years, 75 cases (72.1%) were male, and 39 (37.5%)
were female. Postoperative AF occurred in 19 cases (18.2%); 17 cases
(33.3%) had hsCRP>=3 mg/dl and 2 cases (3.8%) had hsCRP<=3 mg/dl (P=0.03).
Postoperative midsternotomy infection, respiratory dysfunction, and
hospital stay were significantly higher in group I compared with group N
(P<0.05). No statistical significant differences were identified between
the two groups concerning other postoperative complications (bleeding,
vomiting, renal dysfunction and ICU stay) (P>0.05). Conclusion:
Preoperative hsCRP >=3 mg/dl can predict incidence of postoperative atrial
fibrillation and early complications such as midsternotomy infection,
respiratory dysfunction, and hospital stay following elective off-pump
CABG.