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<1>
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), 2012. 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.

<2>
[Use Link to view the full text]
Accession Number
2013250606
Authors
Watanabe G. Matsumoto I. Kiuchi R.
Institution
(Watanabe, Matsumoto, Kiuchi) Department of General and Cardiothoracic
Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa,
13-1, Takara-machi, Kanazawa 920-8640, Japan
Title
Novel sternum lifting technique for robotic internal thoracic artery graft
harvesting.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 8 (1) (pp 76-79), 2013. Date of Publication: January-February
2013.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Internal thoracic artery (ITA) harvesting using the robotic system usually
requires artificially induced capnothorax to provide visualization and
working space, but this procedure has the disadvantage of deteriorating
the hemodynamics. We developed an electrical sternum lifting system (ESLS)
for robotic ITA harvesting, which is robust and can be finely adjusted,
capable of lifting the sternum for a maximum of 5 to 10 cm. Using a
mechanical sternum lifting device significantly (P < 0.01) shortened the
time of ITA harvesting from a mean +/- SD of 55.5 +/- 24.1 minutes to 33.0
+/- 15.7 minutes. No patient using the ESLS required induced capnothorax.
Our novel ESLS provides a good operative field of view and allows ITA
harvesting without inducing capnothorax. Copyright 2013 by the
International Society for Minimally Invasive Cardiothoracic Surgery.

<3>
Accession Number
2013234855
Authors
Mascherbauer J. Fuchs C. Pernicka E. Wollenek G. Rosenhek R. Bonderman D.
Maurer G. Baumgartner H.
Institution
(Mascherbauer, Fuchs, Rosenhek, Bonderman, Maurer, Baumgartner) Department
of Cardiology, Medical University of Vienna, University Hospital,
Waehringer Guertel 18-20, A-1090 Vienna, Austria
(Pernicka) Department of Medical Statistics, Medical University of Vienna,
Vienna, Austria
(Wollenek) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Baumgartner) Adult Congenital and Valvular Heart Disease Center,
University Hospital Munster, Germany
Title
Predictors of outcome of non-ischemic mitral valve surgery.
Source
International Journal of Cardiology. 165 (1) (pp 87-92), 2013. Date of
Publication: 30 Apr 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Data on the risk stratification of patients undergoing mitral
valve (MV) surgery for non-ischemic mitral disease are sparse. The present
study seeks to define them in a contemporary cohort. Methods: 193
consecutive patients referred to non-ischemic MV surgery were
prospectively studied. Baseline characteristics and the type of surgery
were analyzed with regard to operative and late mortality as well as
functional outcome. Results: 129 patients underwent MV replacement and 64
MV repair. MV replacement patients presented with more symptoms (p =
0.010), higher EuroSCORE (6.1 versus 5.6; p = 0.009), more frequently
underwent additional valve surgery (7.8 versus 0%; p = 0.003) and were
more frequently female (p = 0.048). Operative mortality was 3.1%, two
thirds of operative deaths had additional surgery of the tricuspid valve
(p = 0.019). Patients were followed for 5.2 +/- 2.7 years. 1-, 3-, 5- and
7-year survival rates were 93-, 91-, 82-, and 79% in MV replacement
patients versus 100-, 98-, 96-, and 89% in patients with MV repair (p =
0.015). However, by multivariate logistic regression, overall mortality
was determined by additional surgery of the tricuspid valve (p = 0.0103),
multivessel coronary disease (p = 0.026), and age (p < 0.0001), but not by
the type of surgery (p = 0.066). Furthermore, the type of surgery did not
influence functional outcome (p = 0.515). Conclusions: Apart from age and
coronary artery disease the need for additional tricuspid valve surgery
significantly determines the outcome of non-ischemic MV surgery. The type
of operation appears less important when the need for additional valve
surgery and co-morbidities like coronary artery disease are taken into
consideration. 2011 Elsevier Ireland Ltd.

<4>
Accession Number
2013245347
Authors
Taravati S.H. Sattari H. Khosravi M. Shabani M.
Institution
(Taravati, Sattari) Afzalipour School of Medicine, Kerman University of
Medical Sciences, Kerman, Iran, Islamic Republic of
(Khosravi) Resident of Anesthesiology, Afzalipour School of Medicine,
Kerman University of Medical Sciences, Kerman, Iran, Islamic Republic of
(Shabani) Assistant Professor of Physiology, Kerman Neuroscience Research
Center, Kerman University of Medical Sciences, Kerman, Iran, Islamic
Republic of
Title
Comparison of the effects of methadone and morphine on postoperative pain
scale following thoracic surgery in opium addict patients.
Source
Journal of Kerman University of Medical Sciences. 20 (2) (pp 138-145),
2013. Date of Publication: March,April 2013.
Publisher
Kerman University of Medical Sciences (Jahad Boulevard, Kerman 76175-584,
Iran, Islamic Republic of)
Abstract
Background & Aims: Post operative pain is cause of suffering in most
patients and can cause a lot of problems. Analgesic effects of many
narcotics have been widely studied. In this study, the effects of
methadone and morphine on postoperative pain scale following thoracic
surgery in opium addict patients were assessed. Methods: In this clinical
trial and double blind study, sixty opium addict patients (ASA I, II),
aged 20-65 yr, were randomly allocated into two groups. Thirty minutes
before induction of general anesthesia the first group received 0.1 mg/kg
methadone and the second group received 0.1 mg/kg morphine. The two groups
were assessed and compared in regard to the intensity of pain and
meperidine requirement in the first post operative 24 hr. Results:
Intensity of post operative pain and meperidine requirement in the
methadone group were significantly lower than those in the morphine group
(P<0.01). Conclusion: Administration of 0.1mg/kg methadone as
premedication for opium addict patients reduces the post operative pain
more than morphine. Therefore, premedication with methadone for opium
addict patients undergoing thoracic surgery is recommended.

<5>
Accession Number
2013233912
Authors
Bangalore S. Kumar S. Volodarskiy A. Messerli F.H.
Institution
(Bangalore, Volodarskiy) Cardiovascular Clinical Research Center, New York
University, Leon H. Charney Division of Cardiology, New York, NY 10016,
United States
(Kumar) Division of Cardiology, University of Nebraska, Medical Centre,
Omaha, NE, United States
(Messerli) Division of Cardiology, St. Luke' s Roosevelt Hospital,
Columbia University, New York, NY, United States
Title
Blood pressure targets in patients with coronary artery disease:
Observations from traditional and Bayesian random effects meta-analysis of
Randomised trials.
Source
Heart. 99 (9) (pp 601-613), 2013. Date of Publication: May 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Context Most guidelines for treatment of hypertension including the Joint
National Committee-7 recommend a blood pressure (BP) goal of <140/90 mm Hg
for hypertensive patients and a more aggressive goal of <130/80 mm Hg for
patients with coronary artery disease (CAD), based largely on expert
consensus. Objective To evaluate the BP targets in patients with CAD Data
Sources PUBMED, EMBASE and CENTRAL Study Selection: Randomised clinical
trials (RCTs) of antihypertensive therapy in patients with CAD, enrolling
at least 100 patients, with achieved systolic pressure of <=135 mm Hg in
the 'intensive BP' group and <=140 mm Hg in the 'standard BP' group with
follow-up for at least 1 year and evaluating cardiovascular outcomes. Data
Extraction The following efficacy outcomes were extracted-all-cause
mortality, cardiovascular mortality, myocardial infarction, stroke, angina
pectoris, heart failure and revascularisation. Results We identified 15
RCTs enrolling 66 504 participants with 276 328 patient-years of
follow-up. Intensive BP group (<=135 mm Hg) was associated with a 15%
decrease in heart failure rate and 10% decrease in stroke rate, driven
largely by trials with a more intensive BP group (<=130 mm Hg), with
similar outcomes for death and cardiovascular death and was associated
with a 105% increase in the risk of hypotension. More intensive BP group
(=130 mm Hg) was also associated with a reduction in myocardial infarction
and angina pectoris. The results were similar in a Bayesian random effects
model. In addition, lower seemed to be better (based on regression
analysis) for the outcomes of myocardial infarction, stroke, heart failure
and perhaps angina. Conclusions The present body of evidence suggests that
in patients with CAD, intensive systolic BP control to <=135 mm Hg and
possibly to <=130 mm Hg is associated with a modest reduction in stroke
and heart failure but at the expense of hypotension. Lower was better,
although not consistently so for myocardial infarction, stroke, heart
failure and perhaps angina. Further trials are needed to prove these
findings.

<6>
Accession Number
2013239047
Authors
Vegh T. Juhasz M. Szatmari S. Enyedi A. Sessler D.I. Szegedi L.L. Fulesdi
B.
Institution
(Vegh, Juhasz, Szatmari, Fulesdi) Department of Anesthesiology and
Intensive Care, University of Debrecen, Nagyerdei krt. 98, Debrecen-4032,
Hungary
(Enyedi) Institute of Surgery, Division of Thoracic Surgery, University of
Debrecen, Debrecen, Hungary
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Sessler) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
(Szegedi) Department of Anesthesiology, Free University of Brussels, UZ
Brussel, Belgium
(Vegh, Sessler, Fulesdi) Outcomes Research Cosortium, Cleveland, OH,
United States
Title
Effects of different tidal volumes for one-lung ventilation on oxygenation
with open chest condition and surgical manipulation: A randomised
cross-over trial.
Source
Minerva Anestesiologica. 79 (1) (pp 24-32), 2013. Date of Publication:
January 2013.
Publisher
Edizioni Minerva Medica (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Background. The ideal tidal volume (TV) during one-lung ventilation (OLV)
remains controversial. High TVs may increase the incidence of
postoperative lung injury after thoracic surgery. There is nonetheless
little evidence that the use of low TV during OLV will fail to provide
adequate arterial oxygenation. We evaluated the influence of low (5
mL/kg^-1) and high (10 mL/kg ^-1) TV on arterial
oxygenation during one-lung ventilation in clinical conditions. Methods. A
hundred patients scheduled for lung surgery were studied. Patients were
randomly assigned to either 30 minutes of one-lung ventilation with a TV
of 10 mL/kg^-1 at a rate of 10 breaths/minute (Group 10, N.=50)
or a TV of 5 mL/kg^-1 with 5 cmH₂O PEEP at a rate of
20 breaths/minute (Group 5, N.=50). According to the rules of crossover
design during the subsequent 30 minutes, each patient received the
alternative management. Arterial blood partial pressures, hemodynamic
responses, and ventilatory parameters were recorded. Results are presented
as means +/- SDs; P<0.05 was considered statistically significant.
Results. PaO₂ was unaffected by TV (10 mL/kg^-1:
218+/-106 versus 5 mL/kg^-1: 211+/-119 mmHg, P=0.29). Calculated
intrapulmonary shunt fraction was also similar with each TV during OLV (5
mL/kg^-1: 25+/-9% versus 10 mL/kg^-1: 24+/-8%,
p=0.14). In contrast, low TV significantly increased PaCO₂ (10
mL/kg^-1: 39+/-6 versus 5 mL/kg^-1: 44+/-8 mmHg,
P<0.001). There were significant differences both in peak (10 mL/kg
^-1: 27+/-6 versus 5 mL/kg^-1: 21+/-5 cmH
₂O, P<0.001) and plateau airway pressure values (10 mL/kg
^-1: 22+/-6 versus 5 mL/kg^-1: 18+/-5 cmH
₂O, P<0.001) during OLV. Conclusion. Low TV (5
mL/kg^-1) accompanied by 5 cmH₂O PEEP provides
comparable arterial oxygenation and intrapulmonary shunt fraction during
one-lung ventilation as higher TV (10 mL/kg^-1) without PEEP.

<7>
[Use Link to view the full text]
Accession Number
2013249608
Authors
Ravven S. Bader C. Azar A. Rudolph J.L.
Institution
(Ravven) Harvard Medical School, United States
(Ravven) Department of Psychiatry, Cambridge Health Alliance, United
States
(Bader) Albert Einstein College of Medicine, United States
(Azar) Providence VA Medical Center, Geriatrics and Extended Care,
Providence, RI, United States
(Rudolph) Geriatric Research, Education, Clinical Center, VA Boston
Healthcare System, 150 S. Huntington Ave, Boston MA, United States
(Rudolph) Division of Aging, Brigham and Women's Hospital, Boston, MA,
United States
Title
Depressive symptoms after CABG surgery: A meta-analysis.
Source
Harvard Review of Psychiatry. 21 (2) (pp 59-69), 2013. Date of
Publication: March-April 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Learning Objectives: After participating in this educational activity, the
reader should be better able to measure the risk of depression before and
after coronary artery bypass graft (CABG) surgery; examine the course of
depression after CABG; and apply the results of the study to the treatment
of patients. Objective: Depression is highly comorbid with coronary artery
disease. Clinicians face the question of whether patients' depressive
symptoms will improve after coronary artery bypass graft surgery (CABG).
The objective of this meta-analysis is to determine the course of
depressive symptoms after CABG. Methods: EMBASE, PubMed, and PsycINFO were
searched for studies assessing depression before and after CABG.
Meta-analyses were performed for depression at early (1-2 weeks), recovery
(>2 weeks to 2 months), mid (>2 months to 6 months), and late (>6 months)
postoperative time points. Heterogeneity and publication bias were
analyzed. Results: Thirty-nine studies were included in the meta-analysis.
Twelve reported dichotomous outcomes; 18 reported continuous outcomes; and
9 reported both. Risk of depression was increased early (relative risk
[RR] = 1.27; 95% confidence interval [CI], 1.01-1.61). There was a
significantly decreased risk of depression at recovery (RR = 0.78; 95% CI,
0.67-0.90), mid (RR = 0.64; 95% CI, 0.58-0.70), and late (RR = 0.68; 95%
CI, 0.58-0.79) time points without heterogeneity. All studies reporting
continuous depression scales had significant heterogeneity. Conclusions:
The risk of depression decreased post-CABG when depression was measured
dichotomously. While depression improves overall and remits for some
patients after CABG, the majority of patients will not experience
remission of depression. Preoperative and postoperative depression
monitoring is important. 2013 President and Fellows of Harvard College.

<8>
Accession Number
2013240769
Authors
Cundy T.P. Shetty K. Clark J. Chang T.P. Sriskandarajah K. Gattas N.E.
Najmaldin A. Yang G.-Z. Darzi A.
Institution
(Cundy, Shetty, Clark, Chang, Sriskandarajah, Yang, Darzi) Hamlyn Centre,
Imperial College London, St Mary's Hospital, London W2 1PF, United Kingdom
(Cundy, Shetty, Clark, Chang, Sriskandarajah, Darzi) Department of Surgery
and Cancer, St Mary's Hospital, Imperial College London, United Kingdom
(Gattas, Najmaldin) Department of Paediatric Surgery, Leeds General
Infirmary, Leeds, United Kingdom
Title
The first decade of robotic surgery in children.
Source
Journal of Pediatric Surgery. 48 (4) (pp 858-865), 2013. Date of
Publication: April 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Background Robotic surgery offers technological solutions to current
challenges of minimal access surgery, particularly for delicate and
dexterous procedures within spatially constrained operative workspaces in
children. The first robotic surgical procedure in a child was reported in
April 2001. This review aims to examine the literature for global case
volumes, trends, and quality of evidence for the first decade of robotic
surgery in children. Methods A systematic literature search was performed
for all reported cases of robotic surgery in children during the period of
April 2001 to March 2012. Results Following identification of 220 relevant
articles, 137 articles were included, reporting 2393 procedures in 1840
patients. The most prevalent gastrointestinal, genitourinary, and thoracic
procedures were fundoplication, pyeloplasty, and lobectomy, respectively.
There was a progressive trend of increasing number of publications and
case volumes over time. The net overall reported conversion rate was 2.5%.
The rate of reported robot malfunctions or failures was 0.5%. Conclusions
Robotic surgery is an expanding and diffusing innovation in pediatric
surgery. Future evolution and evaluation should occur simultaneously, such
that wider clinical uptake may be led by higher quality and level of
evidence literature. 2013 Elsevier Inc. All rights reserved.

<9>
Accession Number
2013239452
Authors
Chen T.-T. Jiandong-Liu Wang G. Jiang S.-L. Li L.-B. Gao C.-Q.
Institution
(Chen, Wang, Jiang, Li, Gao) Department of Cardiovascular Surgery, Chinese
PLA General Hospital, Beijing Fuxing Road 28, Beijing, China
(Jiandong-Liu) 175th Hospital of PLA, Xiamen University, Department of
Anesthesiology, Zhangzhou, China
Title
Combined treatment of ulinastatin and tranexamic acid provides beneficial
effects by inhibiting inflammatory and fibrinolytic response in patients
undergoing heart valve replacement surgery.
Source
Heart Surgery Forum. 16 (1) (pp E38-E47), 2013. Date of Publication:
February 2013.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Objective: To investigate the effect of ulinastatin and tranexamic acid
administered alone or in combination on inflammatory cytokines and
fibrinolytic system in patients undergoing heart valve replacement surgery
during cardiopulmonary bypass (CPB). Background: CPB-induced fibrinolytic
hyperfunction and systemic inflammatory response syndrome (SIRS) are the
leading causes responsible for the occurrence of postsurgical
complications such as postsurgical cardiac insufficiency and lung injury,
which may lead to an increase in postsurgical bleeding, prolongation of
hospital stay, and increased costs. Methods: One hundred twenty patients
undergoing heart valve replacement surgery during CPB were randomly
assigned into 4 groups of 30 patients each: blank control group (Group C),
tranexamic acid group (Group T), ulinastatin group (Group U), and
tranexamic acid-ulinastatin combination group (Group D). Physiological
saline, tranexamic acid, ulinastatin, and a combination of tranexamic acid
and ulinastatin were given to each group, respectively. Arterial blood was
collected from the radial artery at 4 time points: after induction of
anesthesia (T1), unclamping the ascending aorta (T2), and at 1 hour (T3)
and 24 hours (T4) after CPB. The levels of plasma tumor necrosis factor
alpha (TNF-a), interleukin 6 (IL-6), neutrophil elastase (NE), and the
concentrations of tissue plasminogen activator (t-PA) and a2-antiplasmin
(a2-AP) were detected. The changes in the volume of pericardial
mediastinal drainage after surgery were observed and recorded. Results:
The plasma TNF-alpha, IL-6, and NE levels significantly increased in
patients from all 4 groups at time points of T2, T3, and T4 in comparison
to those before CPB (P < .05), and the plasma TNF-a and IL-6 levels in
groups U and D were significantly lower than those in the other 2 groups
(P < .05). The plasma t-PA, a2-AP, and D-dimer concentrations
significantly increased in patients from all 4 groups at T2 and T3
compared with those before CPB (P < .05), and the plasma t-PA and D-dimer
concentrations were significantly lower in groups T and D than those in
groups U and C (P < .05) at T2 and T3. The plasma a2-AP concentrations in
groups T and D were significantly higher than those in Group C at T3 (P <
.05). The volumes of pericardial mediastinal drainage per body surface
area were significantly lower in groups T and D than those in Group C 6
hours after the surgery (P < .05). Conclusions: Ulinastatin inhibits the
release of inflammatory medium and reduces the inflammatory response
during CPB. Tranexamic acid can effectively inhibit the fibrinolytic
hyperfunction caused by CPB and thus decreases postsurgical bleeding. In
addition, it exhibits a minor anti-inflammatory response. As a
consequence, a combined treatment of ulinastatin and tranexamic acid
reduces postsurgical bleeding and shortens postoperative hospital stay in
patients undergoing heart valve replacement surgery. 2013 Forum
Multimedia Publishing, LLC.

<10>
Accession Number
2013216313
Authors
Veljovic M. Mihajlovic I. Subota V. Antunovic M. Jevdjic J. Udovicic I.
Popadic A. Vulovic T.
Institution
(Veljovic, Udovicic, Popadic) Clinic of Anesthesiology and Intensive Care,
Military Medical Academy, Belgrade, Serbia
(Subota) Institute for Medical Biochemistry, Military Medical Academy,
Belgrade, Serbia
(Antunovic) Sector of Pharmacy, Military Medical Academy, Belgrade, Serbia
(Veljovic, Antunovic) Military Medical Academy, University of Defence,
Belgrade, Serbia
(Mihajlovic) Medicines and Medical Devices Agency of Serbia, Belgrade,
Serbia
(Jevdjic, Vulovic) Department of Anesthesiology, Clinical Center
'Kragujevac', Kragujevac, Serbia
Title
Effect of pretreatment with omega-3 polyunsaturated fatty acids (PUFAs) on
hematological parameters and platelets aggregation in patients during
elective coronary artery bypass grafting.
Source
Vojnosanitetski Pregled. 70 (4) (pp 396-402), 2013. Date of Publication:
April 2013.
Publisher
Vojnomedicinske akademija (Crnotravska 17, Belgrade 11040, Serbia)
Abstract
Bacground/Aim. Using omega-3 polyunsaturated fatty acids (PUFAs) in
coronary artery bypass graft surgery (CABG) could provide protection
against ischemic-reperfusion damage, prevention of postoperative
arrhythmia and attenuation of inflammatory response. However, omega-3
PUFAs inhibit cyclooxygenase (and thus decrease the synthesis of
thromboxane A2 from arachidonic acid in platelets), which leads to
decreased platelet aggregation. In cardiac surgery it is necessary to
achieve a balance between inhibition and full platelets function. It is as
well as important to closely follow hematological parameters, impaired by
CABG itself. Therefore, the aim of the study was to establish the effects
of pretreatment with omega-PUFAs on hematological parameters and
plateletes aggregation in patients with elective CABG. Methods. This
prospective, randomized, placebo-controlled, single-center trial was
performed on parallel groups. The patients (n = 40) undergoing elective
CABG were randomized receiving preoperative intravenous omega-3 PUFAs
(Omegaven 10%) infusion (the PUFAs group) or the same volume of 0.9%
saline solution infusion (the control group). Infusion was given a day
before surgery and repeated four hours before starting extracorporeal
circulation (CPB) via the peripheral vein at single doses of 100 mL (25
mL/h). Platelet function analysis was performed using multiple electrode
aggregometry (MEA, multiplate-analyzer) before starting CPB and 2 h
postoperatively for the patients of both groups. Results. There were no
clinically relevant differences in baseline characteristics between the
groups. He-matological parameters were not significantly different between
the groups pre-, intra- and postoperatively. During the first 24 h after
surgery, the loss of blood was similar in the PUFAs and the control group
(680 +/- 274 mL and 608 +/- 210 mL, respectively; p = 0.356).
Postopera-tively, platelet aggregation was not significantly different
between the PUFAs and the control group in adenosine diphosphate (ADP)
test (39 +/- 11 and 42 +/- 15, respectively; p = 0.701), arachidonic acid
(ASPI) test (64 +/- 24 and 70 +/- 27, respectively; p = 0.525) and trombin
receptor-activating peptide (TRAP) test (68 +/- 25 and 75 +/- 26,
respectively; p = 0.396), while their aggregation in collagen (COL) test
was statistically significantly lower in the PU-FAs related to the control
group (32 +/- 15 and 47 +/- 20, respectively; p = 0.009). Conclusion.
Acute pretreatment with omega-3 PUFAs insignificantly affected the
activity of platelets and did not influence postoperative blood loss.

<11>
Accession Number
2013251321
Authors
Shan L. Saxena A. McMahon R. Wilson A. Newcomb A.
Institution
(Shan, Newcomb) Department of Cardiothoracic Surgery, St Vincent's
Hospital Melbourne, Fitzroy, VIC, Australia
(Saxena, McMahon) Department of Medicine, South Eastern Sydney and
Illawarra Health Network, Cardiology Unit, Wollongong, NSW, Australia
(Wilson) Department of Cardiology, St Vincent's Hospital Melbourne,
Fitzroy, VIC, Australia
(Newcomb) University of Melbourne Department of Surgery, St Vincent's
Hospital Melbourne, Fitzroy, VIC, Australia
Title
A systematic review on the quality of life benefits after aortic valve
replacement in the elderly.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (5) (pp 1173-1189),
2013. Date of Publication: May 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Surgical aortic valve replacement is being increasingly
performed in elderly patients with good perioperative outcomes and
long-term survival. Evidence is limited on health-related quality of life
after aortic valve replacement, which is an important measure of operative
success in the elderly. Methods: A systematic review of clinical studies
after January 2000 was performed to identify health-related quality of
life in the elderly after aortic valve replacement. Strict inclusion and
exclusion criteria were applied. Quality appraisal of each study also was
performed using predefined criteria. Health-related quality of life
results were synthesized through a narrative review with full tabulation
of the results of all included studies. Results: Health-related quality of
life improvements were shown across most or all domains in different
health-related quality of life instruments. Elderly patients experienced
marked symptomatic improvement. Health-related quality of life was
equivalent or superior to both an age-matched population and younger
patients undergoing identical procedures. There were excellent functional
gains after surgery, but elderly patients remain susceptible to geriatric
issues and mood problems. Concomitant coronary artery bypass did not
affect health-related quality of life. There was a diverse range of study
designs, methods, and follow-up times that limited direct comparison
between studies. Conclusions: Aortic valve replacement results in
significant health-related quality of life benefits across a broad range
of health domains in elderly patients. Age alone should not be a
precluding factor for surgery. Data are heterogeneous and mostly
retrospective. We recommend future studies based on consistent guidelines
provided in this systematic review. Copyright 2013 by The American
Association for Thoracic Surgery.

<12>
Accession Number
2013251305
Authors
Ranucci M. Baryshnikova E. Crapelli G.B. Woodward M.K. Paez A. Pelissero
G.
Institution
(Ranucci, Baryshnikova, Crapelli) Department of Cardiothoracic and
Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato
Intensive Care, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
(Woodward, Paez) Instituto Grifols S.A., Barcelona, Spain
(Pelissero) Scientific Directorate, IRCCS Policlinico San Donato, Milan,
Italy
Title
Preoperative antithrombin supplementation in cardiac surgery: A randomized
controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (5) (pp 1393-1399),
2013. Date of Publication: May 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Purified antithrombin supplementation in cardiac surgery has
been suggested for the treatment of heparin resistance and the prevention
of thromboembolic complications. This study is a randomized controlled
trial of preoperative purified antithrombin supplementation, with the
primary end point of avoiding low (<58%) postoperative antithrombin
activity levels and secondary end points including avoidance of heparin
resistance, clinical outcome, and safety end points. Methods: Two hundred
patients were randomly allocated to the antithrombin group and the control
group. Patients in the antithrombin group received a dose of purified
antithrombin to reach an antithrombin activity value of 120%, whereas
patients in the control group did not receive antithrombin. Results: The
antithrombin activity values were significantly higher in the antithrombin
group at all postoperative determinations until discharge. Antithrombin
activity levels <58% at admission to the intensive care unit were found in
26.6% of patients in the control group versus none in the antithrombin
group (P = .001). Heparin resistance rate was significantly (P = .001)
higher in the control group (38.2%) versus the antithrombin group (17%).
Patients in the antithrombin group had a significant but clinically
irrelevant (8 mL/hour) higher postoperative bleeding, with no differences
in transfusion rates. No differences were found for clinical outcomes, and
no safety issues were identified. Conclusions: Preoperative antithrombin
supplementation prevents heparin resistance and avoids excessive
postoperative decrease of antithrombin activity. Copyright 2013 by The
American Association for Thoracic Surgery.

<13>
Accession Number
2013251302
Authors
Haase-Fielitz A. Plass M. Kuppe H. Hetzer R. Ostland V. Westphal S.
Hoffmann J. Prowle J. Mertens P.R. Westerman M. Bellomo R. Haase M.
Institution
(Haase-Fielitz, Mertens, Haase) Department of Nephrology and Hypertension,
Diabetes and Endocrinology, Otto-von-Guericke-University Magdeburg,
Leipziger St. 44, 39120 Magdeburg, Germany
(Westphal, Hoffmann) Institute of Clinical Chemistry and
Pathobiochemistry, Otto-von-Guericke-University Magdeburg, Germany
(Plas, Kuppe) Institute of Anesthesiology, German Heart Center, Berlin,
Germany
(Hetzer) Department of Cardiothoracic Surgery, German Heart Center,
Berlin, Germany
(Ostland, Westerman) Intrinsic LifeSciences, San Diego, CA, United States
(Prowle, Bellomo) Department of Intensive Care, Austin Health, Melbourne,
Australia
Title
Low preoperative hepcidin concentration as a risk factor for mortality
after cardiac surgery: A pilot study.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (5) (pp 1380-1386),
2013. Date of Publication: May 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Hepcidin regulates iron absorption and recycling and is central
to host defense, protection from reactive iron species, and a biomarker of
iron-related pathophysiology. We assessed the value of hepcidin measured
preoperatively for the prediction of in-hospital mortality and renal
outcomes. Methods: We studied 100 adult patients undergoing cardiac
surgery in the control arm of a randomized, controlled trial. Plasma and
urine were sampled before induction of anesthesia, and hepcidin-25 was
quantified by competitive enzyme-linked immunoassay. Renal outcomes were
acute kidney injury defined by risk, injury, failure, loss of function,
end-stage renal disease (RIFLE) classification and need for renal
replacement therapy. Variables with the potential to influence hepcidin
expression were investigated. Results: Low preoperative hepcidin
concentration in urine (median, 15.3 ng/mL; 25-75 percentiles, 0-129.1)
and plasma (median, 49.2 ng/mL; 25th-75th percentile, 0-52.2) predicted
mortality (area under the curve-receiver operating characteristic
[AUC-ROC] for urine hepcidin, 0.89; 95% confidence interval, 0.73-0.99;
cutoff, 130 ng/mL; sensitivity, 73%; specificity, 100%; and AUC-ROC for
plasma hepcidin, 0.90; 95% confidence interval, 0.80-0.99; cutoff, 55
ng/mL; sensitivity, 83%; specificity, 100%). Survivors had median
preoperative hepcidin concentrations of 325.3 ng/mL (25th-75th percentile,
120-770.1 ng/mL) in urine and 113.1 ng/mL (25th-75th percentile,
77.7-203.1 ng/mL) in plasma. Preoperative serum creatinine did not predict
mortality (AUC-ROC, 0.50; 95% confidence interval, 0.10-0.94).
Furthermore, preoperative urine, plasma hepcidin, and serum creatinine did
not distinguish patients requiring postoperative renal replacement therapy
from those without (urine: AUC-ROC, 0.62; 95% confidence interval,
0.38-0.86; plasma: AUC-ROC, 0.63; 95% confidence interval, 0.34-0.91;
serum creatinine: AUC-ROC, 0.61; 95% confidence interval, 0.22-0.99).
Preoperative renal function and hemoglobin did not correlate with hepcidin
indices whereas plasma markers of inflammation did. Conclusions: Low
preoperative hepcidin concentration might be a risk factor for in-hospital
mortality. Findings should be validated in larger patient cohorts with a
greater number of events. Copyright 2013 by The American Association for
Thoracic Surgery.

<14>
Accession Number
2013226269
Authors
Sorensson P. Ryden L. Saleh N. Tornvall P. Arheden H. Pernow J.
Institution
(Sorensson, Ryden, Saleh, Tornvall, Pernow) Karolinska Institutet,
Department of Medicine, Unit of Cardiology, Karolinska University
Hospital, Stockholm, Sweden
(Arheden) Lund University, Department of Clinical Physiology, Skane
University Hospital, Lund, Sweden
(Sorensson) Department of Cardiology, Karolinska University Hospital,
Stockholm 171 76, Sweden
Title
Long-term impact of postconditioning on infarct size and left ventricular
ejection fraction in patients with ST-elevation myocardial infarction.
Source
BMC Cardiovascular Disorders. 13 , 2013. Article Number: 22. Date of
Publication: 25 Mar 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Ischemic postconditioning (PostC), reperfusion in brief
cycles, is known to induce short-term reduction in infarct size in
patients with ST elevation myocardial infarction (STEMI), especially among
those with large myocardium at risk (MaR). The aim of the present study
was to investigate the long-term effect of PostC on infarct size and left
ventricular ejection fraction (LVEF). Methods: Sixty-eight patients with a
first STEMI were randomised to primary percutaneous coronary intervention
(PCI) (n = 35) or PCI followed by PostC (n = 33). MaR was determined as
abnormally contracting segments on left ventricular angiogram. Cardiac
magnetic resonance was performed at 3 and 12 months for the determination
of infarct size and LVEF. Results: Overall there was no difference in
infarct size expressed in percentage of MaR between patients randomised to
the control (31%; 23, 41) and PostC (31%; 23, 43) groups at 12 months.
Likewise there was no difference in LVEF between control (49%; 41, 55) and
PostC (52%; 45, 55). In contrast, patients in the PostC group with MaR in
the upper quartile had a significantly smaller infarct size (29%; 18, 38)
than those in the control group (40%; 34, 48; p < 0.05) at 12 months. In
these patients LVEF was higher in the PostC (47%; 43, 50) compared to the
control group (38%; 34, 42; p < 0.01). Conclusions: In this long-term
follow-up study PostC did not reduce infarct size in relation to MaR or
improved LVEF in the overall study population. However, the present data
suggest that PostC exerts long-term beneficial effects in patients with
large MaR thereby extending previously published short-term observations.
Trial registration: Karolinska Clinical Trial Registration
(http://www.kctr.se). Unique identifier: CT20080014. 2013 Sorensson et
al.; licensee BioMed Central Ltd.

<15>
Accession Number
2013145840
Authors
Meybohm P. Herrmann E. Nierhoff J. Zacharowski K.
Institution
(Meybohm, Zacharowski) Clinic of Anesthesiology, Intensive Care Medicine
and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main,
Germany
(Herrmann, Nierhoff) Institute of Biostatistics and Mathematical
Modelling, University Hospital Frankfurt, Frankfurt am Main, Germany
Title
Aprotinin May Increase Mortality in Low and Intermediate Risk but Not in
High Risk Cardiac Surgical Patients Compared to Tranexamic Acid and
-Aminocaproic Acid - A Meta-Analysis of Randomised and Observational
Trials of over 30.000 Patients.
Source
PLoS ONE. 8 (3) , 2013. Article Number: e58009. Date of Publication: 06
Mar 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: To compare the effect of aprotinin with the effect of lysine
analogues (tranexamic acid and -aminocaproic acid) on early mortality in
three subgroups of patients: low, intermediate and high risk of cardiac
surgery. Methods and Findings: We performed a meta-analysis of randomised
controlled trials and observational with the following data sources:
Medline, Cochrane Library, and reference lists of identified articles. The
primary outcome measure was early (in-hospital/30-day) mortality. The
secondary outcome measures were any transfusion of packed red blood cells
within 24 hours after surgery, any re-operation for bleeding or massive
bleeding, and acute renal dysfunction or failure within the selected cited
publications, respectively. Out of 328 search results, 31 studies (15
trials and 16 observational studies) included 33,501 patients. Early
mortality was significantly increased after aprotinin vs. lysine analogues
with a pooled risk ratio (95% CI) of 1.58 (1.13-2.21), p<0.001 in the low
(n = 14,297) and in the intermediate risk subgroup (1.42 (1.09-1.84),
p<0.001; n = 14,427), respectively. Contrarily, in the subgroup of high
risk patients (n = 4,777), the risk for mortality did not differ
significantly between aprotinin and lysine analogues (1.03 (0.67-1.58), p
= 0.90). Conclusion: Aprotinin may be associated with an increased risk of
mortality in low and intermediate risk cardiac surgery, but presumably may
has no effect on early mortality in a subgroup of high risk cardiac
surgery compared to lysine analogues. Thus, decisions to re-license
aprotinin in lower risk patients should critically be debated. In
contrast, aprotinin might probably be beneficial in high risk cardiac
surgery as it reduces risk of transfusion and bleeding complications.
2013 Meybohm et al.

<16>
[Use Link to view the full text]
Accession Number
2013243940
Authors
Ji F. Li Z. Nguyen H. Young N. Shi P. Fleming N. Liu H.
Institution
(Ji) Department of Anesthesiology, First Affiliated Hospital of Soochow
University, Suzhou, Jiangsu, China
(Li) Department of Internal Medicine, University of California Davis
Health System, Sacramento, United States
(Young) Division of Cardiothoracic Surgery, University of California Davis
Health System, Sacramento, United States
(Ji, Shi, Fleming, Liu) Department of Anesthesiology and Pain Medicine,
University of California Davis Health System, 4150 V St, Sacramento, CA
95817, United States
(Nguyen) University of California Davis Health System, Sacramento, United
States
(Nguyen) Department of Anesthesiology and Critical Care, University of
California San Francisco Health System, San Francisco, United States
(Shi) Department of Anesthesiology, Shandong Provincial Qianfoshan
Hospital, Shandong University, Jinan, China
Title
Perioperative dexmedetomidine improves outcomes of cardiac surgery.
Source
Circulation. 127 (15) (pp 1576-1584), 2013. Date of Publication: 16 Apr
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Cardiac surgery is associated with a high risk of
cardiovascular and other complications that translate into increased
mortality and healthcare costs. This retrospective study was designed to
determine whether the perioperative use of dexmedetomidine could reduce
the incidence of complications and mortality after cardiac surgery.
Methods and Results-A total of 1134 patients who underwent coronary artery
bypass surgery and coronary artery bypass surgery plus valvular or other
procedures were included. Of them, 568 received intravenous
dexmedetomidine infusion and 566 did not. Data were adjusted with
propensity scores, and multivariate logistic regression was used. The
primary outcomes measured included mortality and postoperative major
adverse cardiocerebral events (stroke, coma, perioperative myocardial
infarction, heart block, or cardiac arrest). Secondary outcomes included
renal failure, sepsis, delirium, postoperative ventilation hours, length
of hospital stay, and 30-day readmission. Dexmedetomidine use
significantly reduced postoperative in-hospital (1.23% versus 4.59%;
adjusted odds ratio, 0.34; 95% confidence interval, 0.192-0.614;
P>0.0001), 30-day (1.76% versus 5.12%; adjusted odds ratio, 0.39; 95%
confidence interval, 0.226-0.655; P>0.0001), and 1-year (3.17% versus
7.95%; adjusted odds ratio, 0.47; 95% confidence interval, 0.312-0.701;
P=0.0002) mortality. Perioperative dexmedetomidine therapy also reduced
the risk of overall complications (47.18% versus 54.06%; adjusted odds
ratio, 0.80; 95% confidence interval, 0.68-0.96; P=0.0136) and delirium
(5.46% versus 7.42%; adjusted odds ratio, 0.53; 95% confidence interval,
0.37-0.75; P=0.0030). Conclusion-Perioperative dexmedetomidine use was
associated with a decrease in postoperative mortality up to 1 year and
decreased incidence of postoperative complications and delirium in
patients undergoing cardiac surgery. Copyright 2013 American Heart
Association, Inc.

<17>
Accession Number
2013201405
Authors
Lamas G.A. Goertz C. Boineau R. Mark D.B. Rozema T. Nahin R.L. Lindblad L.
Lewis E.F. Drisko J. Lee K.L.
Institution
(Lamas) Columbia University, Division of Cardiology, Mount Sinai Medical
Center, 4300 Alton Rd, Miami Beach, FL 33140, United States
(Goertz) Palmer Center for Chiropractic Research, Davenport, IA, United
States
(Boineau) National Heart, Lung, and Blood Institute, Bethesda, MD, United
States
(Nahin) National Center for Complementary and Alternative Medicine,
Bethesda, MD, United States
(Mark, Lindblad, Lee) Duke Clinical Research Institute, Durham, NC, United
States
(Rozema) Biogenesis Medical Center, Landrum, SC, United States
(Lewis) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Drisko) Integrative Medicine, University of Kansas Medical Center, Kansas
City, United States
Title
Effect of disodium EDTA chelation regimen on cardiovascular events in
patients with previous myocardial infarction: The TACT randomized trial.
Source
JAMA - Journal of the American Medical Association. 309 (12) (pp
1241-1250), 2013. Date of Publication: 27 Mar 2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Importance: Chelation therapy with disodium EDTA has been used for more
than 50 years to treat atherosclerosis without proof of efficacy.
Objective: To determine if an EDTA-based chelation regimen reduces
cardiovascular events. Design, Setting, and Participants: Double-blind,
placebo-controlled, 2 x 2 factorial randomized trial enrolling 1708
patients aged 50 years or older who had experienced a myocardial
infarction (MI) at least 6 weeks prior and had serum creatinine levels of
2.0 mg/dL or less. Participants were recruited at 134 US and Canadian
sites. Enrollment began in September 2003 and follow-up took place until
October 2011 (median, 55 months). Two hundred eighty-nine patients (17% of
total; n=115 in the EDTA group and n=174 in the placebo group) withdrew
consent during the trial. Interventions: Patients were randomized to
receive 40 infusions of a 500-mL chelation solution (3 g of disodium EDTA,
7 g of ascorbate, B vitamins, electrolytes, procaine, and heparin) (n=839)
vs placebo (n=869) and an oral vitamin-mineral regimen vs an oral placebo.
Infusions were administered weekly for 30 weeks, followed by 10 infusions
2 to 8 weeks apart. Fifteen percent discontinued infusions (n=38 [16%] in
the chelation group and n=41 [15%] in the placebo group) because of
adverse events. Main Outcome Measures: The prespecified primary end point
was a composite of total mortality, recurrent MI, stroke, coronary
revascularization, or hospitalization for angina. This report describes
the intention-to-treat comparison of EDTA chelation vs placebo. To account
for multiple interim analyses, the significance threshold required at the
final analysis was P=.036. Results: Qualifying previous MIs occurred a
median of 4.6 years before enrollment. Median age was 65 years, 18% were
female, 9% were nonwhite, and 31% were diabetic. The primary end point
occurred in 222 (26%) of the chelation group and 261 (30%) of the placebo
group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.99]; P=.035). There was no
effect on total mortality (chelation: 87 deaths [10%]; placebo, 93 deaths
[11%]; HR, 0.93 [95% CI, 0.70-1.25]; P=.64), but the study was not powered
for this comparison. The effect of EDTA chelation on the components of the
primary end point other than death was of similar magnitude as its overall
effect (MI: chelation, 6%; placebo, 8%; HR, 0.77 [95% CI, 0.54-1.11];
stroke: chelation, 1.2%; placebo, 1.5%; HR, 0.77 [95% CI, 0.34-1.76];
coronary revascularization: chelation, 15%; placebo, 18%; HR, 0.81 [95%
CI, 0.64-1.02]; hospitalization for angina: chelation, 1.6%; placebo,
2.1%; HR, 0.72 [95% CI, 0.35-1.47]). Sensitivity analyses examining the
effect of patient dropout and treatment adherence did not alter the
results. Conclusions and Relevance: Among stable patients with a history
of MI, use of an intravenous chelation regimen with disodium EDTA,
compared with placebo, modestly reduced the risk of adverse cardiovascular
outcomes, many of which were revascularization procedures. These results
provide evidence to guide further research but are not sufficient to
support the routine use of chelation therapy for treatment of patients who
have had an MI. Trial Registration: clinicaltrials.gov Identifier:
NCT00044213. 2013 American Medical Association. All rights reserved.

<18>
Accession Number
22641251
Authors
Wu Y.-T. Wu Y.-W. Hwang C.-L. Wang S.-S.
Institution
(Wu, Wu, Hwang, Wang) School and Graduate Institute of Physical Therapy,
College of Medicine, National Taiwan University, No. 17, Xuzhou Rd., 100
Taipei City, Taiwan (Republic of China)
(Wu) Department of Nuclear Medicine, National Taiwan University Hospital,
Taipei City, Taiwan (Republic of China)
(Wang) Department of Surgery, National Taiwan University Hospital, Taipei
City, Taiwan (Republic of China)
Title
Changes in diastolic function after exercise training in patients with and
without diabetes mellitus after coronary artery bypass surgery. A
randomized controlled trial.
Source
European Journal of Physical and Rehabilitation Medicine. 48 (3) (pp
351-360), 2012. Date of Publication: September 2012.
Publisher
Edizioni Minerva Medica (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Background: Left ventricular diastolic dysfunction and diabetes were
associated with prognosis after coronary artery bypass surgery (CABG).
Aim.This study investigated whether short-term exercise improves diastolic
function in patients with and without diabetes mellitus (DM) after CABG
and examined the relationship of these changes to exercise capacity.
Design. RCT Setting. Outpatient. Population. Patients with left
ventricular ejection fraction >=50% after CABG were included in this
study. Methods: Participants were randomly assigned to a control (N.=33)
or exercise (N.=28) group. The exercise group participated in three-month
treadmill exercise training. We evaluated all participants on diastolic
function, peak oxygen uptake (VO_2peak), and concomitant stroke
volume. Results: Exercise significantly enhanced VO _2peak to a
similar extent in all patients (P<0.05). Patients with DM improved in
arteriovenous oxygen difference ([av] O₂ diff) after training
(P=0.0l6), whereas those without DM improved in deceleration time of early
filling (P=0.031) with exercise training. The magnitude of improvement in
VO_2peak correlated with the change in (a-v) O₂ diff
in patients regardless of DM (r=0.442~0.542) and with baseline (a-v) O
₂ diff only in patients with DM (r=-0.480). Conclusion: After
CABG, all patients showed similar improvements in VO_2peak with
exercise training, mainly through increased (a-v) O₂ diff, but
those without DM showed greater improvements in deceleration time.
Clinical Rehabilitation Impact. Exercise training is beneficial for
improving exercise capacity associated with restorations of peripheral
oxygen utilization in both patients with and without DM.