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<1>
Accession Number
2013260590
Authors
Maimer A. Remppis A. Sack F.-U. Ringes-Lichtenberg S. Greten T.
Brazkiewicz F. Schroder S. Goncalves M. Efferth T. Greten H.J.
Institution
(Maimer) Department of Endocrinology and Metabolism, University of
Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
(Maimer, Ringes-Lichtenberg, Greten, Brazkiewicz, Schroder, Goncalves,
Greten) Heidelberg School of Chinese Medicine, Karlsruher Strase 12, 69126
Heidelberg, Germany
(Maimer, Greten, Brazkiewicz, Schroder, Goncalves, Greten) ICBAS,
University of Porto, Rua de Jorge Viterbo Ferreira No. 228, 4050-313
Porto, Portugal
(Remppis) Department of Cardiology, University of Heidelberg, Im
Neuenheimer Feld 410, 69120 Heidelberg, Germany
(Sack) Department of Heart Surgery, University of Heidelberg, Im
Neuenheimer Feld 400, 69120 Heidelberg, Germany
(Schroder) HanseMerkur Center for Traditional Chinese Medicine, University
Medical Center Hamburg-Eppendorf, Martinistrase 52, 20246 Hamburg, Germany
(Efferth) Department of Pharmaceutical Biology, Institute of Pharmacy and
Biochemistry, Johannes Gutenberg University of Mainz, Staudinger Weg 5,
55099 Mainz, Germany
Title
Objectifying acupuncture effects by lung function and numeric rating scale
in patients undergoing heart surgery.
Source
Evidence-based Complementary and Alternative Medicine. 2013 , 2013.
Article Number: 219817. Date of Publication: 2013.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Rationale. Poststernotomy pain and impaired breathing are common clinical
problems in early postoperative care following heart surgery.
Insufficiently treated pain increases the risk of pulmonary complications.
High-dose opioids are used for pain management, but they may cause side
effects such as respiratory depression. Study Design. We performed a
prospective, randomized, controlled, observer-blinded, three-armed
clinical trial with 100 patients. Group 1 (n = 33) and Group 2 (n = 34)
received one 20 min session of standardized acupuncture treatment with two
different sets of acupoints. Group 3 (n = 33) served as standard analgesia
control without additional intervention. Results. Primary endpoint
analysis revealed a statistically significant analgesic effect for both
acupuncture treatments. Group 1 showed a mean percentile pain reduction
(PPR) of 18% (SD 19, P < 0.001). Group 2 yielded a mean PPR of 71% (SD 13,
P < 0.001). In Group 1, acupuncture resulted in a mean forced vital
capacity (FVC) increase of 30 cm³ (SD 73) without statistical
significance (P = 0.303). In Group 2, posttreatment FVC showed a
significant increase of 306 cm³ (SD 215, P < 0.001).
Conclusion. Acupuncture revealed specific analgesic effects after
sternotomy. Objective measurement of poststernotomy pain via lung function
test was possible. 2013 Anna Maimer et al.

<2>
Accession Number
2013261650
Authors
Dahl J.S. Videbaek L. Poulsen M.K. Pellikka P.A. Veien K. Andersen L.I.
Haghfelt T. Moller J.E.
Institution
(Dahl, Videbaek, Poulsen, Veien, Haghfelt) Department of Cardiology,
Odense University Hospital, Sdr. Boulevard, 5000 Odense C, Denmark
(Pellikka) Division of Cardiovascular Diseases, Mayo Clinic Rochester,
United States
(Andersen) Department of Thoracic Surgery, Odense University Hospital,
Denmark
(Moller) Department of Cardiology, Heart Center, Copenhagen University
Hospital Rigshospitalet, Denmark
Title
Prevention of atrial fibrillation in patients with aortic valve stenosis
with candesartan treatment after aortic valve replacement.
Source
International Journal of Cardiology. 165 (2) (pp 242-246), 2013. Date of
Publication: 10 May 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Accumulating data has suggested that treatment with
Angiotensin-II receptor antagonists can prevent the new onset of atrial
fibrillation (AF). The aim of this study was to evaluate whether treatment
with candesartan on top of conventional treatment could prevent new onset
AF in patients with aortic valve stenosis (AS) after aortic valve
replacement. Methods and results: The study was a single centre,
consecutive; investigator initiated study using a prospective randomised
blinded endpoint design. 91 patients with severe AS without known AF
scheduled for aortic valve replacement (AVR) were randomised to
candesartan 32 mg once daily on top of conventional treatment or
conventional therapy immediately after AVR. Patients were examined with
ECG 3, 6, 9 and 12 months after surgery, and Holter-ECG analysis after 3
and 12 months. Primary endpoint was episode of AF with a duration
exceeding 30 s, on the ECG or Holter-ECG and/or patients hospitalised due
to AF. 14 patients developed new onset AF during follow up. AF-free
survival was significantly higher (94% vs 74%, p = 0.02) in patients
treated with candesartan. Conclusion: In patients with symptomatic severe
AS undergoing AVR, treatment with candesartan may prevent the new onset of
atrial fibrillation. 2012 Elsevier Ireland Ltd.

<3>
Accession Number
2013083295
Authors
Carrio M.L. Ventura J.L. Javierre C. Rodriguez-Castro D. Farrero E.
Torrado H. Badia M.B. Granados J.
Institution
(Carrio, Ventura, Rodriguez-Castro, Farrero, Torrado) Department of
Critical Care, Hospital Universitari de Bellvitge. Idibell, Barcelona,
Spain
(Javierre) Department of Physiological Sciences II, University of
Barcelona. Idibell, Barcelona, Spain
(Badia) Department of Pharmacy, Hospital Universitari de Bellvitge.
Idibell, Barcelona, Spain
(Granados) Department of Cardiac Surgery, Hospital Universitari de
Bellvitge. Idibell, L'Hospitalet de Llobregat, Barcelona, Spain
Title
Does post-cardiac surgery magnesium supplementation improve outcome?.
Source
Magnesium Research. 25 (4) (pp 159-167), 2012. Date of Publication:
December 2012.
Publisher
John Libbey Eurotext (127, avenue de la Republique, Montrouge 92120,
France)
Abstract
Hypomagnesemia has been linked with increased morbidity and mortality in
critically ill patients. Since the condition is common after
cardiopulmonary bypass surgery, the objective of this study was to
determine whether magnesium supplementation in the immediate postoperative
period may improve outcomes of patients undergoing cardiac surgery with
cardiopulmonary bypass. This prospective, randomized, double-blind,
placebo-controlled study was conducted in a third-level, cardiac surgery
intensive care unit (ICU) at a university hospital. Two hundred and
sixteen patients undergoing elective cardiac surgery with cardiopulmonary
bypass were randomized to receive either an intravenous bolus of 1.5 g of
magnesium sulphate followed by an infusion of 12 g of the same salt in 24
h (105 patients), or placebo (111 patients) administered according to the
same schedule as the treatment group. No significant differences were
found either in the primary end point (hours of intubation) or in the
secondary end points (length of inotropic support, new atrial
fibrillation, ventricular tachycardia or ventricular fibrillation, length
of intensive care unit stay, or ICU or hospital mortality). Hypomagnesemia
was present in 12% of patients on admission to the intensive care unit.
The magnesium group had a greater need for pacemaker stimulation. In
conclusion, under the conditions of the present study, magnesium
supplementation after cardiac surgery with cardiopulmonary bypass does not
favourably affect clinical outcomes.

<4>
Accession Number
2013261854
Authors
Chocron S. Vandel P. Durst C. Laluc F. Kaili D. Chocron M. Etievent J.-P.
Institution
(Chocron, Durst, Laluc, Kaili, Etievent) Department of Thoracic and
Cardiovascular Surgery, EA3920, University Hospital Jean Minjoz, Boulevard
Fleming, 25000 Besancon, France
(Vandel) Department of Psychiatry, EA3920, University Hospital Jean
Minjoz, Besancon, France
(Chocron) Unit of Transversal Research in Psychogenesis and
Psychopathology, University of Paris 13, Villetaneuse, France
Title
Antidepressant therapy in patients undergoing coronary artery bypass
grafting: The MOTIV-CABG trial.
Source
Annals of Thoracic Surgery. 95 (5) (pp 1609-1618), 2013. Date of
Publication: May 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: The efficacy of antidepressant therapy in patients undergoing
coronary artery bypass grafting (CABG) is not clearly established.
Methods: This double-blind trial was conducted at University Hospital,
Besancon, France. Adult CABG patients were randomized (1:1) to receive
escitalopram (10 mg daily) or placebo from 2 to 3 weeks before to 6 months
after surgery, including 12 months post-surgery follow-up. The primary
composite endpoint was the occurrence of mortality or predefined morbidity
events. Secondary endpoints included measures of depression, mental and
physical health using Beck Depression Inventory Short Form (BDI), and
quality of life 36-Item Short Form (SF-36) self assessments. Results: The
treated cohort contained 361 patients with mean age 67 years. At 12
months, the proportions of patients with the composite morbidity and
mortality endpoint were not different between escitalopram and placebo
(110 of 182 [60.4%] vs 108 of 179 [60.3%], p = 0.984). However, over the 6
months postoperative period, the BDI and SF-36 Mental Component Summary
scores were better overall in the escitalopram group than in the placebo
group for all patients (p = 0.015 and p = 0.014, respectively) and
preoperatively depressed (BDI > 3) patients (p = 0.002 and p = 0.005,
respectively). Moreover, the SF-36 Pain score was better overall in the
escitalopram group than in the placebo group in the
preoperatively-depressed subset (p = 0.026). Conclusions: Antidepressant
therapy had no effect on morbidity and mortality events up to 1 year after
CABG. However, antidepressant therapy may provide faster improvements to
mental health aspects of quality of life and reduce postoperative pain in
patients with preoperative depression. Subject to contra-indications, we
recommend antidepressant therapy in coronary revascularization patients
who are preoperatively depressed. 2013 by The Society of Thoracic
Surgeons.

<5>
Accession Number
2013270786
Authors
Romeo F. Acconcia M.C. Sergi D. Romeo A. Muscoli S. Valente S. Gensini
G.F. Chiarotti F. Caretta Q.
Institution
(Romeo, Sergi) Department of Cardiovascular Disease, University of
Rome-Tor Vergata, Rome, Italy
(Acconcia, Romeo, Muscoli) Department of Cardiovascular Disease,
University of Rome-La Sapienza, Rome, Italy
(Valente, Gensini, Caretta) Department of Medical and Surgical Critical
Care, University of Florence, Largo Brambilla, 3-50134 Florence, Italy
(Chiarotti) Department of Cell Biology and Neuroscience, Italian National
Institute of Health, Rome, Italy
Title
The outcome of intra-aortic balloon pump support in acute myocardial
infarction complicated by cardiogenic shock according to the type of
revascularization: A comprehensive meta-analysis.
Source
American Heart Journal. 165 (5) (pp 679-692), 2013. Date of Publication:
May 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Aims Despite the recommendations of the current guidelines, scientific
evidence continue to challenge the effectiveness of intra-aortic balloon
pump (IABP) in acute myocardial infarction (AMI) complicated by
cardiogenic shock. Moreover, 2 recent meta-analyses showed contrasting
results. The aim of this study is to test the effect of IABP according to
the type of therapeutic treatment of AMI: percutaneous coronary
intervention (PCI), thrombolytic therapy (TT), or medical therapy without
reperfusion. Articles published from January 1, 1986, to December 31,
2012, were collected and analyzed by meta-analysis. Methods and results We
evaluated the IABP impact on inhospital mortality, on safety end points
(stroke, severe bleeding) and long-term survival, using risk ratio (RR)
and risk difference (RD) estimates. We found that the risk of death was
(i) not significantly different between the IABP and control groups (RR
0.95, P =.52; RD -0.04, P =.28), (ii) significantly reduced in the TT
subgroup (RR 0.77, P <.0001; RD -0.16, P <.0001), and (iii) significantly
increased in the PCI subgroup (RR 1.18, P =.01; RD 0.07, P =.01). There
were no significant differences in secondary end points (P, not
significant). In addition, we compared the meta-analyses collected over
the same search period. Conclusion The results show that IABP support is
significantly effective in TT reperfusion but is associated with a
significant increase of the inhospital mortality with primary PCI. The
comparison of the meta-analyses demonstrates the key role of analysing
primary clinical treatments to avoid systematic errors. 2013, Mosby, Inc.
All rights reserved.

<6>
Accession Number
2013263419
Authors
Pieper D. Mathes T. Neugebauer E. Eikermann M.
Institution
(Pieper, Mathes, Neugebauer, Eikermann) Institute for Research in
Operative Medicine, School of Medicine, Witten/Herdecke University,
Ostmerheimer Str 200, D-51109 Cologne, Germany
Title
State of evidence on the relationship between high-volume hospitals and
outcomes in surgery: A systematic review of systematic reviews.
Source
Journal of the American College of Surgeons. 216 (5) (pp 1015-1025.e18),
2013. Date of Publication: May 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)

<7>
Accession Number
2013270777
Authors
Seo J.-B. Kang S.-H. Hur S.-H. Park K.W. Youn T.-J. Park J.-S. Yang H.-M.
Lee H.-Y. Kang H.-J. Koo B.-K. Bae J.-H. Kim S.-W. Moon K.-W. Choi J.-W.
Lee S.-G. Chung W.-Y. Kim S.-J. Kim D.-I. Kim B.-O. Hyon M.-S. Park K.-S.
Cha T.-J. Yoo C.-W. Jeon H.-K. Kim H.-S.
Institution
(Seo, Chung) Seoul National University Boramae Medical Center, Seoul,
South Korea
(Kang, Park, Yang, Lee, Kang, Koo, Kim) Seoul National University
Hospital, Seoul, South Korea
(Hur) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Youn) Seoul National University, Bundang Hospital, Seongnam, South Korea
(Park) Yeungnam University Medical Center, Daegu, South Korea
(Bae) Konyang University Hospital, Daejeon, South Korea
(Kim) Chung-Ang University Medical Center, Seoul, South Korea
(Moon) St Vincent's Hospital, Suwon, South Korea
(Choi) Eulji General Hospital, Seoul, South Korea
(Lee) Ulsan University Hospital, Ulsan, South Korea
(Kim) Kyunghee University Medical Center, Seoul, South Korea
(Kim) Inje University Pusan Paik Hospital, Busan, South Korea
(Kim) Inje University Sang-gye Paik Hospital, Seoul, South Korea
(Hyon) Soon Chun Hyang University Hospital, Seoul, South Korea
(Park) Inha University Hospital, Incheon, South Korea
(Cha) Kosin University Gospel Hospital, Busan, South Korea
(Yoo) Sejong General Hospital, Bucheon, South Korea
(Jeon) Uijeongbu St Mary's Hospital, Uijeongbu, South Korea
(Jeon) Department of Internal Medicine, Cardiovascular Center, Uijeongbu
St Mary's Hospital, 65-1, Geumo-dong, Uijeongbu, Gyeonggi-do 480-717,
South Korea
Title
Randomized trial comparing the efficacy between different types of
paclitaxel-eluting stents: The comparison of Efficacy between COroflex
PLEASe and Taxus stent (ECO-PLEASANT) randomized controlled trial.
Source
American Heart Journal. 165 (5) (pp 733-743), 2013. Date of Publication:
May 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Aims Paclitaxel-eluting stents (PESs) have been shown to inhibit
neointimal hyperplasia after percutaneous coronary intervention. Coroflex
Please (B Braun, Melsungen, Germany) is a newly developed PES. We compared
the clinical and angiographic efficacy of Coroflex Please with Taxus
Liberte (Boston Scientific, Natick, MA) in a real-world practice. Methods
and Results We performed a prospective, open-label, randomized, controlled
study that enrolled 945 patients undergoing percutaneous coronary
interventions in 18 centers in Korea. The primary end point was clinically
driven target vessel revascularization at 9 months. The baseline
characteristics were mostly similar and comparable between 2 groups. At 9
months, the incidence of clinically driven target vessel revascularization
was 14.6% for Coroflex and 6.4% for Taxus, which was significantly
different (hazard ratio 2.43, 95% CI 1.50-3.94, noninferiority P value =
1.000). This is well corroborated by the difference of in-stent late loss
between 2 stents (0.71 +/- 0.64 mm vs 0.52 +/- 0.50 mm, P <.001) by
9-month follow-up angiography (n = 415 vs 215). Among secondary clinical
end points, stent thrombosis (definite and probable) for 1 year was 2.2%
in Coroflex and 1.3% in Taxus (P =.317). Also, myocardial infarction for 9
months was higher in Coroflex group than that in Taxus (4.9% vs 1.6%, P
=.012), which was partly contributed by the higher incidence of
periprocedural myocardial infarction in Coroflex arm (2.2% vs 0.3%, P
=.028). Conclusions Coroflex Please was inferior to Taxus Liberte with
regard to clinical and angiographic efficacy. 2013, Mosby, Inc. All
rights reserved.

<8>
[Use Link to view the full text]
Accession Number
2013262746
Authors
Zheng F. Sheinberg R. Yee M.-S. Ono M. Zheng Y. Hogue C.W.
Institution
(Zheng, Sheinberg, Yee, Hogue) Department of Anesthesiology and Critical
Care Medicine, Johns Hopkins University, School of Medicine, 1800 Orleans
St., Zayed 6208B, Baltimore, MD 21287, United States
(Ono) Division of Cardiac Surgery, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Zheng) Department of Anesthesiology, School of Medicine, Zhejiang
University, Hangzhou, China
Title
Cerebral near-infrared spectroscopy monitoring and neurologic outcomes in
adult cardiac surgery patients: A systematic review.
Source
Anesthesia and Analgesia. 116 (3) (pp 663-676), 2013. Date of Publication:
May 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND: Near-infrared spectroscopy is used during cardiac surgery to
monitor the adequacy of cerebral perfusion. In this systematic review, we
evaluated available data for adult patients to determine (1) whether
decrements in cerebral oximetry during cardiac surgery are associated with
stroke, postoperative cognitive dysfunction (POCD), or delirium; and (2)
whether interventions aimed at correcting cerebral oximetry decrements
improve neurologic outcomes. METHODS: We searched PubMed, Cochrane, and
Embase databases from inception until January 31, 2012, without
restriction on languages. Each article was examined for additional
references. A publication was excluded if it did not include original data
(e.g., review, commentary) or if it was not published as a full-length
article in a peer-reviewed journal (e.g., abstract only). The identified
abstracts were screened first, and full texts of eligible articles were
reviewed independently by 2 investigators. For eligible publications, we
recorded the number of subjects, type of surgery, and criteria for
diagnosis of neurologic end points. RESULTS: We identified 13 case
reports, 27 observational studies, and 2 prospectively randomized
intervention trials that met our inclusion criteria. Case reports and 2
observational studies contained anecdotal evidence suggesting that
regional cerebral O₂ saturation (rSco₂) monitoring
could be used to identify cardiopulmonary bypass cannula malposition. Six
of 9 observational studies reported an association between acute
rSco₂ desaturation and POCD based on the Mini-Mental State
Examination (n = 3 studies) or more detailed cognitive testing (n = 6
studies). Two retrospective studies reported a relationship between
rSco₂ desaturation and stroke or type I and II neurologic
injury after surgery. The observational studies had many limitations,
including small sample size, assessments only during the immediate
postoperative period, and failure to perform risk adjustments. Two
randomized studies evaluated the efficacy of interventions for treating
rSco₂ desaturation during surgery, but adherence to the
protocol was poor in one. In the other study, interventions for
rSco₂ desaturation were associated with less major organ injury
and shorter intensive care unit hospitalization compared with
nonintervention. CONCLUSIONS: Reductions in rSco₂ during
cardiac surgery may identify cardiopulmonary bypass cannula malposition,
particularly during aortic surgery. Only low-level evidence links low rSco
₂ during cardiac surgery to postoperative neurologic
complications, and data are insufficient to conclude that inter ventions
to improve rSco ₂ desaturation prevent stroke or POCD.
Copyright 2013 International Anesthesia Research Society.

<9>
Accession Number
2013256374
Authors
Al Masri H.A.
Institution
(Al Masri) Prince Hashim Hospital, King Hussain Medical Center, Amman,
Jordan
Title
Midazolam and morphine for elective intubation in NICU.
Source
Rawal Medical Journal. 37 (1) (pp 42-45), 2012. Date of Publication: 2012.
Publisher
Pakistan Medical Association (Garden Road, Karachi - 3, Pakistan)
Abstract
Objective To assess the use of midazolam and morphine as premedication for
elective intubation in neonates, and to compare the intubation conditions
with these combination versus awake intubation. Methods A non blind
randomized prospective study was conducted at Prince Hashim Hospital
between November 2009 and December 2010. Forty premature neonates in
intensive care unit requiring nonemergency intubation were assigned to
receive 0.1 mg /kg IV morphine followed by 0.1 mg/kg IV midazolam two
minutes before intubation (study group) or awake intubation (control
group). Number of attempts, duration of procedure, heart rate and blood
pressure were monitored.Results Out of 40 intubations, 20 were enrolled in
each group; there were no significant demographic differences between the
groups. Successful intubation on first attempt was achieved in 16
premature (80 %) in study group versus 8 (40%) of controls. After10
minutes post intubation, median increase of mean blood pressure in study
group were - 5.9, versus 0.15 in control group. Mean time for intubation
in study group was significantly less; 38.05 versus 123.05 seconds in
control group. Incidence of bradycardiwas 50% in control group and 60% in
study group. 70% of study group had hypoxemia after one minute versus 55%
of control group; 45% of study group had severe hypoxia versus 30% of
control group. Conclusion Morphine and midazolam decreased time and number
of attempt needed for intubation, however, neonates should have
cardiorespiratory, oxygen saturation, and blood pressure monitoring during
intubation.

<10>
Accession Number
2013228738
Authors
Athappan G. Patvardhan E. Tuzcu E.M. Svensson L.G. Lemos P.A. Fraccaro C.
Tarantini G. Sinning J.-M. Nickenig G. Capodanno D. Tamburino C. Latib A.
Colombo A. Kapadia S.R.
Institution
(Athappan, Patvardhan, Tuzcu, Kapadia) Department of Cardiovascular
Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH,
United States
(Athappan) Case Western Reserve University, Cleveland, OH, United States
(Svensson) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Lemos) Sirio-Libanes Hospital, Sao Paulo, Brazil
(Fraccaro, Tarantini, Sinning) University of Padova, Padova, Italy
(Nickenig) Department of Medicine II Cardiology, University Hospital Bonn,
Bonn, Germany
(Capodanno, Tamburino) Ferrarotto Hospital, University of Catania,
Catania, Italy
(Latib, Colombo) San Raffaele Scientific Institute, Milan, Italy
Title
Incidence, predictors, and outcomes of aortic regurgitation after
transcatheter aortic valve replacement: Meta-analysis and systematic
review of literature.
Source
Journal of the American College of Cardiology. 61 (15) (pp 1585-1595),
2013. Date of Publication: 16 Apr 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study was designed to establish the incidence, impact,
and predictors of post-transcatheter aortic valve replacement (TAVR)
aortic regurgitation (AR). Background: AR is an important limitation of
TAVR with ill-defined predictors and unclear long-term impact on outcomes.
Methods: Studies published between 2002 and 2012 with regard to TAVR were
identified using an electronic search and reviewed using the
random-effects model of DerSimonian and Laird. From 3,871 initial
citations, 45 studies reporting on 12,926 patients (CoreValve [Medtronic
CV Luxembourg S.a.r.l., Tolochenaz, Switzerland] n = 5,261 and Edwards
valve [Edwards Lifesciences, Santa Ana, California] n = 7,279) were
included in the analysis of incidence and outcomes of post-TAVR AR.
Results: The pooled estimate for moderate or severe AR post-TAVR was 11.7%
(95% confidence interval [CI]: 9.6 to 14.1). Moderate or severe AR was
more common with use of the CoreValve (16.0% vs. 9.1%, p = 0.005). The
presence of moderate or severe AR post-TAVR increased mortality at 30 days
(odds ratio: 2.95; 95% CI: 1.73 to 5.02) and 1 year (hazard ratio: 2.27;
95% CI: -1.84 to 2.81). Mild AR was also associated with an increased
hazard ratio for mortality, 1.829 (95% CI: 1.005 to 3.329) that was
overturned by sensitivity analysis. Twenty-five studies reported on
predictors of post-TAVR AR. Implantation depth, valve undersizing, and
Agatston calcium score (r = 0.47, p = 0.001) were identified as important
predictors. Conclusions: Moderate or severe aortic regurgitation is common
after TAVR and an adverse prognostic indicator of short- and long-term
survival. Incidence of moderate or severe AR is higher with use of the
CoreValve. Mild AR may be associated with increased long-term mortality.
Therefore, every effort should be made to minimize AR by a comprehensive
pre-procedural planning and meticulous procedural execution. 2013
American College of Cardiology Foundation.

<11>
Accession Number
2013228735
Authors
Aldweib N. Negishi K. Hachamovitch R. Jaber W.A. Seicean S. Marwick T.H.
Institution
(Aldweib, Negishi, Hachamovitch, Jaber, Seicean) Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Marwick) Menzies Research Institute Tasmania, University of Tasmania, 17
Liverpool Street, Hobart, TAS 7000, Australia
Title
Impact of repeat myocardial revascularization on outcome in patients with
silent ischemia after previous revascularization.
Source
Journal of the American College of Cardiology. 61 (15) (pp 1616-1623),
2013. Date of Publication: 16 Apr 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to compare the survival of asymptomatic
patients with previous revascularization and ischemia, who subsequently
underwent repeat revascularization or medical therapy (MT). Background:
Coronary artery disease is progressive and recurring; thus, stress
myocardial perfusion scintigraphy (MPS) is widely used to identify
ischemia in patients with previous revascularization. Methods: Of 6,750
patients with previous revascularization undergoing MPS between January 1,
2005, and December 31, 2007, we identified 769 patients (age 67.7 +/- 9.5
years; 85% men) who had ischemia and were asymptomatic. A propensity score
was developed to express the associations of revascularization. Patients
were followed up over a median of 5.7 years (interquartile range: 4.7 to
6.4 years) for all-cause death. A Cox proportional hazards model was used
to identify the association of revascularization with all-cause death,
with and without adjustment for the propensity score. The model was
repeated in propensity-matched groups undergoing MT versus
revascularization. Results: Among 769 patients, 115 (15%) underwent
revascularization a median of 13 days (interquartile range: 6 to 31 days)
after MPS. There were 142 deaths; mortality with MT and revascularization
were 18.3% and 19.1% (p = 0.84). In a Cox proportional hazards model
(chi-square test = 89.4) adjusting for baseline characteristics, type of
previous revascularization, MPS data, and propensity scores, only age and
hypercholesterolemia but not revascularization were associated with
mortality. This result was confirmed in a propensity-matched group.
Conclusions: Asymptomatic patients with previous revascularization and
inducible ischemia on MPS realize no survival benefit from repeat
revascularization. In this group of post-revascularization patients, an
ischemia-based treatment strategy did not alter mortality. 2013 American
College of Cardiology Foundation.

<12>
Accession Number
2013261020
Authors
O'Doherty A.F. West M. Jack S. Grocott M.P.W.
Institution
(O'Doherty) Portex Unit, UCL Institute of Child Health, London, United
Kingdom
(West, Jack) Aintree University Hospital NHS Foundation Trust, Liverpool,
United Kingdom
(West, Jack) Department of Musculoskeletal Biology, Institute of Ageing
and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
(Grocott) Critical Care Research Area, Southampton NIHR Respiratory
Biomedical Research Unit, Southampton, United Kingdom
(Grocott) Integrative Physiology and Critical Illness Group, Faculty of
Medicine, University of Southampton, Southampton, United Kingdom
(Grocott) Anaesthesia and Critical Care Research Unit, University Hospital
Southampton NHS Foundation Trust, Southampton, United Kingdom
Title
Preoperative aerobic exercise training in elective intra-cavity surgery: A
systematic review.
Source
British Journal of Anaesthesia. 110 (5) (pp 679-689), 2013. Date of
Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
SummaryReduced physical fitness is associated with increased risk of
complications after intra-cavity surgery. Aerobic exercise training
interventions improve physical fitness in clinical populations. However,
it is unclear whether implementing a preoperative aerobic exercise
training intervention improves outcome after intra-cavity surgery. We
conducted a systematic review (Embase and PubMed, to April 2011) to
address the question: does preoperative aerobic exercise training in
intra-cavity surgery result in improved postoperative clinical outcomes?
Secondary objectives were to describe the effect of such an intervention
on physical fitness and health-related quality of life (HRQL) and report
feasibility, safety, and cost-effectiveness. Ten studies were identified
from 2443 candidate abstracts. Eight studies were small (<100 patients)
and all were single centre. Seven studies reported clinical outcomes. Two
studies were controlled trials and two used a sham intervention group. One
study in cardiac surgery demonstrated reduced postoperative hospital and
intensive care length of stay in the intervention group. Eight studies
showed improvement in >=1 measure of physical fitness after the
intervention. HRQL was reported in five studies; three showed improved
HRQL after the intervention. The frequency, duration, and intensities of
the exercise interventions varied across the studies. Adherence to
exercise interventions was good. Two exercise-related adverse events
(transient hypotension) were reported. Evidence for improved postoperative
clinical outcome after preoperative aerobic exercise training
interventions is limited. However, preoperative aerobic exercise training
seems to be generally effective in improving physical fitness in patients
awaiting intra-cavity surgery and appears to be feasible and safe. 2013
Author.

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Accession Number
71047610
Authors
Laferton J.A. Auer C.J. Mora M.S. Moosdorf R. Rief W.
Institution
(Laferton, Auer, Mora) Clinical Psychology and Psychotherapy, Hessen,
Germany
(Moosdorf) Cardiac and Thoracic Vessel Surgery, Hessen, Germany
(Rief) Clinical Psychology and Psychotherapy, Philipps University of
Marburg, Marburg, Hessen, Germany
Title
Optimizing preoperative expectations in heart surgery patients: A
randomized controlled trial.
Source
Psychosomatic Medicine. Conference: 71st Annual Scientific Meeting of the
American Psychosomatic Society Miami, FL United States. Conference Start:
20130313 Conference End: 20130316. Conference Publication: (var.pagings).
75 (3) (pp A-148), 2013. Date of Publication: April 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
In coronary heart disease and heart surgery there is sound evidence for
the relationship between patients' expectations and treatment outcome. In
addition, patients' expectations have been shown to be modifiable through
psychological interventions. Therefore targeting patients' expectations
might offer a promising opportunity to enhance heart surgery outcome.
However, few studies have tried to actively change patients' expectations
before surgery. The purpose of this clinical trial is to optimize
patients' outcome expectations before undergoing coronary artery bypass
graft surgery (CABG) through a brief psychoeducational program. Method: 75
patients waiting for elective CABG have been randomly assigned to one of
three groups: Expectation manipulation intervention (EMI), supportive
therapy (SP) or standard medical care. EMI and SP patients received two
individual sessions and two phone calls prior to surgery. Patients'
expectations were assessed before and after the psychological intervention
using the expectation scales of the Brief Illness Perception
Questionnaire. Additionally we assessed the acceptance of the
psychological interventions. Results: Of all patients being asked at
baseline assessment, 72.2 % would appreciate to talk about their
expectations and 47.2% would also appreciate to talk about their feelings
before surgery. Satisfaction with EMI (M = 32.50; SD = 3.94) and SP (M =
29.11; SD = 4.57), assessed after the interventions but before surgery, is
very high (7 Item scale ranging from 0 to 35). Expectations in the EMI
group improved significantly compared to both control groups. Only
Patients receiving EMI showed increased scores on the expectations
concerning disease duration (F=5.80; p =.01; h2=.24) and personal control
(F=6.49; p =.01; h2=.27). Long-term follow up investigations are currently
undertaken. Discussion: This brief psycho-educational intervention leads
to optimized preoperative expectations. Patients in the EMI group
developed a more realistic view about disease duration and improved
expectations in being able to control the course of their disease
themselves. Future analysis will show whether improved expectations lead
to better recovery from CABG.