EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2013285031
Authors
Tefikow S. Barth J. Maichrowitz S. Beelmann A. Strauss B. Rosendahl J.
Institution
(Tefikow, Strauss, Rosendahl) Jena University Hospital, Friedrich Schiller
University Jena, Institute of Psychosocial Medicine and Psychotherapy,
Jena, Germany
(Barth) University of Bern, Institute of Social and Preventive Medicine,
Bern, Switzerland
(Maichrowitz, Beelmann) Friedrich Schiller University Jena, Institute of
Psychology, Department of Research Synthesis, Intervention and Evaluation,
Jena, Germany
Title
Efficacy of hypnosis in adults undergoing surgery or medical procedures: A
meta-analysis of randomized controlled trials.
Source
Clinical Psychology Review. 33 (5) (pp 623-636), 2013. Date of
Publication: July 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
This meta-analysis investigates the efficacy of hypnosis in adults
undergoing surgical or medical procedures compared to standard care alone
or an attention control. Through a comprehensive literature search N=. 34
eligible randomized controlled trials (RCTs) were included, comprising a
total of 2597 patients. Random effects meta-analyses revealed positive
treatment effects on emotional distress (g=. 0.53, CI 95% [0.37; 0.69]),
pain (g=. 0.44, CI 95% [0.26; 0.61]), medication consumption (g=. 0.38, CI
95% [0.20; 0.56]), physiological parameters (g=. 0.10, CI 95% [0.02;
0.18]), recovery (g=. 0.25, CI 95% [0.04; 0.46]), and surgical procedure
time (g=. 0.25, CI 95% [0.12; 0.38]). In conclusion, benefits of hypnosis
on various surgically relevant outcomes were demonstrated. However, the
internal validity of RCTs seems limited and further high methodological
quality RCTs are needed to strengthen the promising evidence of hypnosis
for adults undergoing surgery or medical procedures. 2013 Elsevier Ltd.

<2>
Accession Number
2013265274
Authors
Gijsen V.M.G.J. Hesselink D.A. Croes K. Koren G. De Wildt S.N.
Institution
(Gijsen, Croes, De Wildt) Clinical Pharmacologist, Erasmus MC - Sophia
Childrens Hospital, Department of Pediatric Surgery and Intensive Care, Dr
Molewaterplein 60, 3015 GJ Rotterdam, Netherlands
(Gijsen, Koren) Division of Clinical Pharmacology and Toxicology, Hospital
for Sick Children, Toronto, ON, Canada
(Hesselink) Division of Nephrology and Renal Transplantation, Department
of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
(Koren) Department of Medicine, University of Western Ontario, London, ON,
Canada
Title
Prevalence of renal dysfunction in tacrolimus-treated pediatric transplant
recipients: A systematic review.
Source
Pediatric Transplantation. 17 (3) (pp 205-215), 2013. Date of Publication:
May 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Renal dysfunction after non-renal transplantation in adult
tacrolimus-treated transplant patients is well documented. Little is known
about its prevalence in children. Age-related changes in both disposition
and effect of tacrolimus as well as renal function may preclude
extrapolation of adult data to children. To systematically review the
literature on renal dysfunction in non-renal pediatric transplant
recipients treated with tacrolimus. PubMed/Medline, Embase, and Google
were searched from their inception until April 19, 2012, with the search
terms "tacrolimus," "renal function," "transplantation," and "children."
Eighteen of 385 retrieved papers were considered relevant. Twelve dealt
with liver, four with heart transplant, one with heart and lung
transplant, and one with intestinal recipients. Reported prevalences of
mild and severe chronic kidney disease ranged from 0% to 39% and 0% to
71.4%, respectively, for liver, and from 22.7% to 40% and 6.8% to 46%,
respectively, for heart and/or lung transplant recipients. Ranges remained
wide after adjusting for follow-up time and disease severity. Possible
explanations are inclusion bias and definitions used for renal
dysfunction. A considerable proportion of pediatric non-renal transplant
patients who receive tacrolimus-based immunosuppression, appear to suffer
from chronic kidney disease. This conclusion warrants further research
into the real risk, its risk factors, and individualization of
immunosuppressant therapy. 2013 John Wiley & Sons A/S.

<3>
Accession Number
2013274682
Authors
Potter B.J. Deverenne B. Doucette S. Fergusson D. Magder S.
Institution
(Potter, Deverenne, Magder) McGill University Health Center, Montreal QC,
Canada
(Doucette, Fergusson) Ottawa Hospital Research Institute, Ottawa, ON,
Canada
Title
Cardiac output responses in a flow-driven protocol of resuscitation
following cardiac surgery.
Source
Journal of Critical Care. 28 (3) (pp 265-269), 2013. Date of Publication:
June 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: Determine the role of cardiac output and central venous
pressure (CVP) measurements in the clinical decisions that were based on
the algorithm used in a randomized trial that compared a colloid to a
crystalloid solution in the management of patients early after cardiac
surgery (FACS trial, NCT00337805, Crit Care Med 2010; 38:2117). Methods:
We analyzed the changes in CVP and cardiac index (CI) in 729 fluid
challenges from the FACS trial in which 119 patients were randomized to
colloid and 118 to crystalloid boluses in a flow-based protocol. A fluid
challenge was defined as being positive if CI increased by <0.3
L/min^-1m^-2 and negative if CI increased by <0.3
L/min^-1m^-2 but CVP increased by <2 mmHg. Results: As
defined in the protocol, 26% of boluses were given for a low CI (<2.2
L/min^-1m^-2). CI did not increase in 20% of boluses
despite an adequate increase in CVP; in the protocol this meant that
further volume boluses were not given. In another 34% of boluses in which
CI did not increase, CVP increased by < 2 mmHg, which meant that volume
responsiveness could not be ruled out and another bolus was indicated. 43%
of the boluses were given for hypotension, but surprisingly in 90% of
these instances, CI was in the acceptable range indicating that the low
arterial pressure was due to decreased systemic vascular resistance.
Conclusion: Measurement of cardiac output and CVP significantly influenced
clinical decisions in the FACS algorithm. 2013 Elsevier Inc.

<4>
Accession Number
22958313
Authors
Tewarie L.S. Menon A.K. Hatam N. Amerini A. Moza A.K. Autschbach R.
Goetzenich A.
Institution
(Tewarie) Department of Cardiothoracic and Vascular Surgery, University
Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
Title
Prevention of sternal dehiscence with the sternum external fixation
(Stern-E-Fix) corset--randomized trial in 750 patients.
Source
Journal of cardiothoracic surgery. 7 (pp 85), 2012. Date of Publication:
2012.
Abstract
The main objective of this study will be to determine the effects of a new
advanced sternum external fixation (Stern-E-Fix) corset on prevention of
sternal instability and mediastinitis in high-risk patients. This
prospective, randomized study (January 2009 - June 2011) comprised 750
male patients undergoing standard median sternotomy for cardiac procedures
(78% CABG). Patients were divided in two randomized groups (A, n = 380:
received a Stern-E-Fix corset postoperatively for 6 weeks and B, n = 370:
control group received a standard elastic thorax bandage). In both groups,
risk factors for sternal dehiscence and preoperative preparations were
similar. Wound infections occurred in n = 13 (3.42%) pts. in group A vs. n
= 35 (9.46%) in group B. In group A, only 1 patient presented with sternal
dehiscence vs. 22 pts. in group B. In all 22 patients, sternal rewiring
followed by antibiotic therapy was needed. Mediastinitis related mortality
was none in A versus two in B. Treatment failure in group B was more than
five times higher than in A (p = 0.01); the mean length of stay in
hospital was 12.5 +/- 7.4 days (A) versus 18 +/- 15.1 days (B) (p=0.002).
Re-operation for sternal infection was 4 times higher in group B. Mean
ventilation time was relatively longer in B (2.5 vs. 1.28 days) (p =
0.01). The mean follow-up period was 8 weeks (range 6 - 12 weeks). We
demonstrated that using an external supportive sternal corset
(Stern-E-Fix) yields a significantly better and effective prevention
against development of sternal dehiscence and secondary sternal infection
in high-risk poststernotomy patients.

<5>
Accession Number
2013278473
Authors
Wu Y.-C. Zhang J.-F. Shen W.-F. Zhao Q.
Institution
(Wu, Zhang, Zhao) Department of Cardiac Surgery, Rui Jin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
(Shen) Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai 200025, China
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement for severe aortic stenosis: A meta analysis.
Source
Chinese Medical Journal. 126 (6) (pp 1171-1177), 2013. Date of
Publication: 20 Mar 2013.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Transcatheter aortic valve implantation (TAVI) has emerged as
the treatment choice for non-operable patients with severe symptomatic
aortic stenosis (AS) and may be a good alternative to surgery for those at
very high or prohibitive surgical risk. We performed a meta-analysis to
evaluate the comparative benefits of TAVI versus surgical aortic valve
replacement (SAVR) in patients with severe AS. Methods A comprehensive
literature search of PubMed, Embase, ScienceDirect and Cochrane Central
Register of Controlled trials was performed, and randomized trials as well
as cohort studies with propensity score analysis were included. Results
One randomized trial (n=699) and six retrospective cohort studies (n=781)
were selected for meta-analysis. Mortality at 30-day and 1-year follow-up
was comparable between TAVI and SAVR. Despite similar incidences of
stroke, myocardial infarction, re-operation for bleeding, and renal
failure requiring dialysis, TAVI was associated with a lower occurrence
rate of new-onset atrial fibrillation (OR 0.51, 95% CI 0.33-0.78) and
shorter procedural time (mean difference -67.50 minutes, 95% CI -87.20 to
-47.81 minutes). Post-operative aortic regurgitation and permanent
pacemaker implantation were more common in patients after TAVI than in
those with SAVR (OR 5.53, 95% CI 3.41-8.97; OR 1.71, 95% CI 1.02-2.84,
respectively). Conclusion In patients with severe symptomatic AS, TAVI and
SAVR did not differ with respect to short- and mid-term survival, but the
incidence of permanent pacemaker implantation and post-procedural aortic
regurgitation remain relatively high after TAVI.

<6>
Accession Number
2013272421
Authors
Abdel-Meguid M.E.
Institution
(Abdel-Meguid) Department of Anesthesia, Faculty of Medicine, Ain Shams
University, Egypt
(Abdel-Meguid) King Fahad Specialist Hospital, Saudi Arabia
Title
Dexmedetomidine as anesthetic adjunct for fast tracking and pain control
in off-pump coronary artery bypass.
Source
Saudi Journal of Anaesthesia. 7 (1) (pp 6-8), 2013. Date of Publication:
January-March 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: This study was designed to determine the efficacy of
dexmedetomidine (a highly selective alpha-2 agonist) in achieving fast
tracking and improved postoperative pain control in off-pump coronary
artery bypass (OPCAB) patients. Methods: Thirty patients scheduled for
elective OPCAB were prospectively randomized into two groups: Group I (15
patients) started dexmedetomidine at 0.5 ug/kg/hour after the induction of
anesthesia; this was reduced to 0.3 ug/kg/hour on admission in the cardiac
intensive care unit and continued for 12 hours post extubation. Group II
(15 patients) received a similar volume and infusion rate of normal
saline. Visual analog scale (VAS) of 10-100 was explained thoroughly to
the patients during the preoperative visit. Postoperative pain was managed
with morphine. The total dose of morphine was recorded. Extubation time
and VAS was recorded every two hours for 12 hours post extubation.
Results: Extubation time in group I was 72+/-8 minutes and 186+/-22
minutes in group II. Mean total use of narcotics in group II was
23.5+/-20.7 mg compared to 11.4+/-6.3 mg in group I. VAS median figures
were lower at all data points in group I than in group II. Conclusion:
Dexmedetomidine showed an effective and safe profile as an anesthetic
adjunct in OPCAB, achieving fast tracking of patients and higher quality
of pain control with a lower consumption of narcotics.

<7>
[Use Link to view the full text]
Accession Number
23400891
Authors
Li X. Qi Y. Li Y. Zhang S. Guo S. Chu S. Gao P. Zhu D. Wu Z. Lu L. Shen W.
Jia N. Niu W.
Institution
(Li) State Key Laboratory of Medical Genomics, Ruijin Hospital, School of
Medicine, Shanghai Jiao Tong University, Shanghai, China.
Title
Impact of mineralocorticoid receptor antagonists on changes in cardiac
structure and function of left ventricular dysfunction: a meta-analysis of
randomized controlled trials.
Source
Circulation. Heart failure. 6 (2) (pp 156-165), 2013. Date of Publication:
Mar 2013.
Abstract
A comprehensive evaluation of the benefits of mineralocorticoid receptor
antagonists on cardiac remodeling is lacking. We aimed to evaluate the
impact of mineralocorticoid receptor antagonists on changes in cardiac
structure and function of left ventricular dysfunction. Articles were
identified by online searches in PubMed, EMBASE, Cochrane, and
ClinicalTrials.gov databases before June 2012, by hand searches of reviews
and relevant journals, and by contact with the authors. Qualified articles
were restricted to randomized controlled trials. There were, respectively,
12, 4, and 3 qualified trials that randomized 572, 647, and 407 patients
to spironolactone, canrenoate, and eplerenone, and 531, 655, and 395
patients to placebo or active treatment, respectively. Overall, under
mineralocorticoid receptor antagonist treatment there was improvement in
left ventricular ejection fraction (weighted mean difference, 2.97; 95%
confidence interval [95% CI], 2.26-3.67; P<0.0005), left ventricular
end-systolic and end-diastolic volume index (weighted mean difference,
-5.64; 95% CI, -7.94 to -3.34; P<0.0005 and weighted mean difference,
-7.46; 95% CI, -11.63 to -3.3; P<0.0005), serum amino-terminal peptide of
procollagen type-III (weighted mean difference, -1.12; 95% CI, -1.49 to
-0.74; P<0.0005), B-type natriuretic peptide (weighted mean difference,
-67.06; 95% CI, -91.24 to -42.88; P<0.0005), peak velocities of early
mitral inflow (E; weighted mean difference, -9.57; 95% CI, -12.98 to
-6.17; P<0.0005), and E wave deceleration time (weighted mean difference,
7.08; 95% CI, 4.07-10.09; P<0.0005). There was low probability of
heterogeneity and publication bias. Our findings demonstrate that
mineralocorticoid receptor antagonist treatment may exert beneficial
effects on the reversal of cardiac remodeling and improvement of left
ventricular function.

<8>
[Use Link to view the full text]
Accession Number
23258574
Authors
Maurer M.S. Teruya S. Chakraborty B. Helmke S. Mancini D.
Institution
(Maurer) Columbia University Medical Center, New York, NY, USA.
Title
Treating anemia in older adults with heart failure with a preserved
ejection fraction with epoetin alfa: single-blind randomized clinical
trial of safety and efficacy.
Source
Circulation. Heart failure. 6 (2) (pp 254-263), 2013. Date of Publication:
Mar 2013.
Abstract
Anemia is a common comorbidity in older adults with heart failure and a
preserved ejection fraction and is associated with worse outcomes. We
hypothesized that treating anemia with subcutaneous epoetin alfa would be
associated with reverse ventricular remodeling and improved exercise
capacity and health status compared with placebo. Prospective, randomized,
single-blind, 24-week study with blinded end point assessment among anemic
(average hemoglobin of 10.4+/-1 g/dL) older adult patients (n=56; 77+/-11
years; 68% women) with heart failure and a preserved ejection fraction
(ejection fraction=63+/-15%; B-type natriuretic peptide=431+/-366 pg/mL)
was conducted. Treatment with epoetin alfa resulted in significant
increases in hemoglobin (P<0.0001). Changes in end-diastolic volume
(-6+/-14 versus -4+/-16 mL; P=0.67) at 6 months did not differ between
epoetin alfa and placebo, but declines in stroke volume (-5+/-8 versus
2+/-10 mL; P=0.09) without significant changes in left ventricular mass
were observed. Changes in 6-minute walk distance (16+/-11 versus 5+/-12 m;
P=0.52) did not differ. Although quality of life improved by the Kansas
City Cardiomyopathy Questionnaire and the Minnesota Living with Heart
Failure Questionnaire in both cohorts, there were no significant
differences between groups. Administration of epoetin alfa to older adult
patients with heart failure and a preserved ejection fraction compared
with placebo did not change left ventricular end-diastolic volume and left
ventricular mass nor did it improve submaximal exercise capacity or
quality of life. URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER:
NCT00286182.

<9>
Accession Number
2013271803
Authors
Sun Y. Ji B. Zhu X. Zheng Z.
Institution
(Sun, Ji, Zhu) Department of Cardiopulmonary Bypass, State Key Laboratory
of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Zheng) Department of Cardiovascular Surgery, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
Title
Efficacy of Carbon Dioxide Insufflation for Cerebral and Cardiac
Protection During Open Heart Surgery: A Systematic Review and
Meta-Analysis.
Source
Artificial Organs. 37 (5) (pp 439-446), 2013. Date of Publication: May
2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
In spite of widespread application around the world, there has been
controversy on the cerebral and cardiac protection efficacy of carbon
dioxide insufflation (CDI) during open heart surgery. To make a
comprehensive evaluation, we screened all relevant published randomized
controlled trials to perform the first systematic review and meta-analysis
for CDI during open heart surgery. We searched PubMed, EMBASE, the
Cochrane Controlled Clinical Trial register, WANFAN, CQVIP, and CNKI
database for published articles. Randomized controlled trials were
included when the research provided data of neurological complications
postoperatively, creatinine kinase, MB isoenzyme (CK-MB) on the first
postoperative day, or all-cause mortality. We chose a fixed-effects model
when the trials showed low heterogeneity, otherwise a random effects model
was used. The quality of studies was assessed by modified Jadad scale.
Four studies were included in this meta-analysis. The overall pooled
relative risk (RR) for neurological complications was 1.59, 95% confidence
interval (CI)=[0.57, 4.46], and the z-score for overall effect was 0.89
(P=0.37). The standardized mean difference of the CK-MB between groups was
1.15, 95% CI=[-1.27, 3.56], and the z-score for overall effect was 0.93
(P=0.35). The overall pooled RR for all-cause mortality was 0.5, 95%
CI=[0.16, 1.64], and the z-score for overall effect was 1.14 (P=0.25).
There was no significant difference between groups. Because of the
insufficiency of powerful evidences, the cerebral and cardiac protection
efficacy of CDI during open heart surgery needs to be further verified by
more high-quality trials. 2013, International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<10>
Accession Number
2013276735
Authors
Taylor S. Margolick J. Abughosh Z. Goldenberg S.L. Lange D. Bowie W.R.
Bell R. Roscoe D. MacHan L. Black P.
Institution
(Taylor, Margolick, Abughosh, Goldenberg, Lange, Bell, Black) Department
of Urologic Sciences, University of British Columbia, Gordon and Leslie
Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC V5Z 1M9,
Canada
(Bowie) Department of Medicine, University of British Columbia, Vancouver,
Canada
(Roscoe) Department of Pathology and Laboratory Medicine, University of
British Columbia, Vancouver, Canada
(MacHan) Department of Radiology, University of British Columbia,
Vancouver, Canada
Title
Ciprofloxacin resistance in the faecal carriage of patients undergoing
transrectal ultrasound guided prostate biopsy.
Source
BJU International. 111 (6) (pp 946-953), 2013. Date of Publication: May
2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
What's known on the subject? and What does the study add? * Transrectal
ultrasound guided prostate biopsies (TRUSBx) are associated with a
spectrum of complications, including most significantly infection, which
affects up to 5% of patients. In the most severe cases, infection leads to
sepsis, a life-threatening complication. Escherichia coli is the primary
responsible pathogen. Although antibiotic prophylaxis with
fluoroquinolones is routinely used, there is evidence that the infection
rate after TRUSBx is increasing, and this appears to be due to an
increasing prevalence of ciprofloxacin-resistant rectal flora. * This is
the largest prospective clinical trial to date analysing the rectal flora
of men undergoing prostate biopsies. We determined the microbial and
antibiotic sensitivity profiles from 849 patients. Ciprofloxacin-resistant
Gram-negative organisms were identified in the rectal flora of 19.0% of
men. Furthermore, fluoroquinolone use within 6 months preceding a TRUSBx
and the presence of a prosthetic heart valve were significant predictors
of ciprofloxacin resistance on rectal swab. Determining the prevalence of
rectal fluoroquinolone resistance has important implications in evaluation
of the suitability of prophylactic regimens. Antimicrobial profiles
derived from rectal swabs pre-biopsy may prove useful in guiding targeted
antibiotic prophylaxis. Objectives To establish the prevalence of
ciprofloxacin-resistant bacteria in patients undergoing transrectal
ultrasound guided prostate biopsies (TRUSBx) and to determine whether this
predicts subsequent infectious complications. To identify risk factors for
harbouring ciprofloxacin-resistant flora. Patients and Methods Any patient
undergoing a TRUSBx from 2009 to 2011 was eligible for enrolment in this
prospective study. Pre-biopsy rectal and urine cultures and post-biopsy
urine cultures were obtained and antimicrobial susceptibility was
determined. Univariate and multivariate analyses were performed to
identify independent patient risk factors associated with
ciprofloxacin-resistant rectal flora. Results A total of 865 patients
underwent TRUSBx, of whom 19.0% were found to have ciprofloxacin-resistant
Gram-negative coliforms. Escherichia coli was the most prevalent
Gram-negative rectal isolate (80.9%) and accounted for 90.6% of
ciprofloxacin resistance. Patient characteristics that conferred an
increased risk of harbouring ciprofloxacin-resistant organisms included a
history of a heart valve replacement (P < 0.05) and ciprofloxacin use in
the past 3 months (P < 0.05). Infectious complications were observed in
3.6% (n = 31) of the patient population and 48% of these patients grew
ciprofloxacin-resistant organisms on the pre-biopsy rectal swab (P <
0.001). Conclusions Antimicrobial resistance to ciprofloxacin in the
rectal flora was common, particularly in patients with recent
ciprofloxacin use and a heart valve replacement. Despite a significant
correlation between those patients who developed infections and the
detection of ciprofloxacin-resistant organisms, only 9.0% (n = 15) of the
total group with ciprofloxacin resistance developed an infectious
complication. Future studies will need to evaluate the cost effectiveness
and clinical utility of a pre-biopsy rectal culture in targeting
antibiotic prophylaxis. 2013 BJU International.

<11>
Accession Number
2013276783
Authors
Eisen H.J. Kobashigawa J. Starling R.C. Pauly D.F. Kfoury A. Ross H. Wang
S.-S. Cantin B. Van Bakel A. Ewald G. Hirt S. Lehmkuhl H. Keogh A. Rinaldi
M. Potena L. Zuckermann A. Dong G. Cornu-Artis C. Lopez P.
Institution
(Eisen) Division of Cardiology, Drexel University College of Medicine,
Hahnemann University Hospital, Philadelphia, PA, United States
(Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Starling) Kaufman Center for Heart Failure, Heart and Vascular Institute,
Cleveland Clinic Foundation, Cleveland, OH, United States
(Pauly) Division of Cardiovascular Medicine, University of Florida,
College of Medicine, Gainesville, FL, United States
(Kfoury) Intermountain Medical Center, Salt Lake City, UT, United States
(Ross) Department of Cardiology/Heart Transplant, University Health
Network, Toronto General Hospital, Toronto, ON, Canada
(Wang) Division of Cardiovascular Surgery, National Taiwan University,
Taipei, Taiwan (Republic of China)
(Cantin) Quebec Heart Institute, Quebec, QC, Canada
(Van Bakel) Medical University of South Carolina, Charleston, SC, United
States
(Ewald) Washington University, School of Medicine, St. Louis, MO, United
States
(Hirt) University Hospital Regensburg, Regensburg, Germany
(Lehmkuhl) German Heart Center Berlin, Berlin, Germany
(Keogh) Heart and Lung Transplant Unit, St. Vincents Hospital,
Darlinghurst, Sydney, Australia
(Rinaldi) Az.Ospedaliero-Universitaria, S.Giovanni Battista di Torino,
Torino, Italy
(Potena) School of Medicine, University of Bologna, Bologna, Italy
(Zuckermann) Department of Cardiothoracic Surgery, University of Vienna,
Vienna, Austria
(Dong) Novartis Pharmaceuticals, East Hanover, NJ, United States
(Cornu-Artis, Lopez) Novartis Pharma AG, Basel, Switzerland
Title
Everolimus versus mycophenolate mofetil in heart transplantation: A
randomized, multicenter trial.
Source
American Journal of Transplantation. 13 (5) (pp 1203-1216), 2013. Date of
Publication: May 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
In an open-label, 24-month trial, 721 de novo heart transplant recipients
were randomized to everolimus 1.5 mg or 3.0 mg with reduced-dose
cyclosporine, or mycophenolate mofetil (MMF) 3 g/day with standard-dose
cyclosporine (plus corticosteroids +/- induction). Primary efficacy
endpoint was the 12-month composite incidence of biopsy-proven acute
rejection, acute rejection associated with hemodynamic compromise, graft
loss/retransplant, death or loss to follow-up. Everolimus 1.5 mg was
noninferior to MMF for this endpoint at month 12 (35.1% vs. 33.6%;
difference 1.5% [97.5% CI: -7.5%, 10.6%]) and month 24. Mortality to month
3 was higher with everolimus 1.5 mg versus MMF in patients receiving
rabbit antithymocyte globulin (rATG) induction, mainly due to infection,
but 24-month mortality was similar (everolimus 1.5 mg 10.6% [30/282], MMF
9.2% [25/271]). Everolimus 3.0 mg was terminated prematurely due to higher
mortality. The mean (SD) 12-month increase in maximal intimal thickness
was 0.03 (0.05) mm with everolimus 1.5 mg versus 0.07 (0.11) mm with MMF
(p < 0.001). Everolimus 1.5 mg was inferior to MMF for renal function but
comparable in patients achieving predefined reduced cyclosporine trough
concentrations. Nonfatal serious adverse events were more frequent with
everolimus 1.5 mg versus MMF. Everolimus 1.5 mg with reduced-dose
cyclosporine offers similar efficacy to MMF with standard-dose
cyclosporine and reduces intimal proliferation at 12 months in de novo
heart transplant recipients. In this study comparing cardiac transplant
recipients receiving one of two doses of everolimus with reduced dose
cyclosporine to patients receiving mycophenolate mofetil with standard
dose cyclosporine, the authors find no effect on acute cellular rejection,
modestly reduced renal function, and a reduction in the incidence and
severity of lesions defined by intravascular ultrasound. See editorial by
Mehra on page 1119. 2013 The American Society of Transplantation and the
American Society of Transplant Surgeons.

<12>
Accession Number
2013273380
Authors
Aghadavoudi O. Ameli Zamani K. Farajzadegan Z.
Institution
(Aghadavoudi) Department of Anesthesiology, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Ameli Zamani) School of Medicine AND Student Research Committee, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Farajzadegan) Department of Community Medicine, School of Medicine,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Title
Comparing the effects of hydroxy ethyl starch 6% and gelatin as
replacement for prime during coronary artery bypass graft surgery.
Source
Journal of Isfahan Medical School. 31 (223) , 2013. Date of Publication:
April 2013.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
Background: Several fluids have been used in priming the cardiopulmonary
pump in coronary artery bypass graft surgery (CABG). Hydroxy-ethyl starch
6% (HES 6%) is a new colloid fluid which is widely used as a substitute
for intraoperative fluid. Gelatin is also a commonly used colloid fluid
for priming. However, it has some adverse effects, especially on the
coagulation system. Methods: In this clinical trial, patients were
randomized into two groups of HES 6% and gelatin. Prothrombin time (PT),
partial thromboplastin time (PTT), and international normalized ratio
(INR) were measured before surgery and immediately and 24 hours after the
operation. Chest drainage (CD) was measured 24 hours after the operation.
Urine output (UO) was measured during the first 24 postoperative hours.
Blood urea nitrogen (BUN) and creatinine were measured before and 24 hours
after surgery. Data was analyzed with SPSS. Findings: Totally 100 patients
were recruited for this study. CD was not significantly different between
HES 6% and gelatin groups. In the HES and gelatin groups the UO was also
not significantly different. PT and INR did not show any significant
difference betwean the two groups before, at the end and 24 hours after
surgery, however PTT was significantly higher(p-value=0.05) in gelatin
group only at the end of surgery(30.6+/- 5.7,44 +/- 27,37 +/- 19 for HES
vs 30.5 +/- 5.7,56 +/- 35,37 +/- 23 for gelatin respectively). BUN was
only significantly higher in HES group 24 hours after surgery (19.9 +/-9.8
vs 16.4 +/- 7.6, Pvalue = 0.05). Cr did not differ. Conclusion: HES and
gelatine are both options for prime in cardiopulmonary pomp,with adverse
effect on renal function and coagulation respectively.more studies with
larger sample sizes are recommended.

<13>
Accession Number
2013274154
Authors
Head S.J. Osnabrugge R.L.J. Howell N.J. Freemantle N. Bridgewater B.
Pagano D. Pieter Kappetein A.
Institution
(Head, Osnabrugge, Pieter Kappetein) Department of Cardiothoracic Surgery,
Erasmus University Medical Center, Rotterdam, Netherlands
(Howell, Pagano) Department of Cardiothoracic Surgery and Quality and
Outcomes Research Unit, University Hospital Birmingham, Birmingham, United
Kingdom
(Howell) School of Clinical and Experimental Medicine, University of
Birmingham, Birmingham, United Kingdom
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Bridgewater) Department of Cardiothoracic Surgery, Manchester Academic
Health Science Centre University of Manchester, University Hospital of
South Manchester, Manchester, United Kingdom
Title
A systematic review of risk prediction in adult cardiac surgery:
Considerations for future model development.
Source
European Journal of Cardio-thoracic Surgery. 43 (5) (pp e121-e129), 2013.
Article Number: ezt044. Date of Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: Risk prediction in adult patients undergoing cardiac surgery
remains inaccurate and should be further improved. Therefore, we aimed to
identify risk factors that are predictive of mortality, stroke, renal
failure and/or length of stay after adult cardiac surgery in contemporary
practice. Methods: We searched the Medline database for English-language
original contributions from January 2000 to December 2011 to identify
preoperative independent risk factors of one of the following outcomes
after adult cardiac surgery: death, stroke, renal failure and/or length of
stay. Two investigators independently screened the studies. Inclusion
criteria were (i) the study described an adult cardiac patient population;
(ii) the study was an original contribution; (iii) multivariable analyses
were performed to identify independent predictors; (iv) >=1 of the
predefined outcomes was analysed; (v) at least one variable was an
independent predictor, or a variable was included in a risk model that was
developed. Results: The search yielded 5768 studies. After the initial
title screening, a second screening of the full texts of 1234 studies was
performed. Ultimately, 844 studies were included in the systematic review.
In these studies, we identified a large number of independent predictors
of mortality, stroke, renal failure and length of stay, which could be
categorized into variables related to: disease pathology, planned surgical
procedure, patient demographics, patient history, patient comorbidities,
patient status, blood values, urine values, medication use and gene
mutations. Many of these variables are frequently not considered as
predictive of outcomes. Conclusions: Risk estimates of mortality, stroke,
renal failure and length of stay may be improved by the inclusion of
additional (non-traditional) innovative risk factors. Current and future
databases should consider collecting these variables. The Author 2013.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<14>
Accession Number
2013274116
Authors
Brunelli A. Salati M. Pompili C. Refai M. Sabbatini A.
Institution
(Brunelli, Salati, Pompili, Refai, Sabbatini) Division of Thoracic
Surgery, Ospedali Riuniti Ancona, Ancona, Italy
(Brunelli) Section of Minimally Invasive Thoracic Surgery, Division of
Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
Title
Regulated tailored suction vs regulated seal: A prospective randomized
trial on air leak duration.
Source
European Journal of Cardio-thoracic Surgery. 43 (5) (pp 899-904), 2013.
Article Number: ezs518. Date of Publication: May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objective: The objective of this study was to compare the air leak
duration of two regulated chest tube modes following pulmonary lobectomy.
Methods: This is a prospective randomized trial on 100 consecutive
pulmonary lobectomies (2010-11) performed for lung cancer. A single
24-French chest tube was connected to an electronic system capable of
maintaining the pleural pressure within preset values (regulated suction
mode) or within a physiological range (regulated seal mode). Patients were
randomized to two groups: Group 1, regulated individualized suction
(range: -11 to -20 cmH₂O, according to lobectomy type); Group
2, regulated seal (-2 cmH₂O). The main endpoint was the
duration of air leak (h) calculated from the end of the operation to a
value consistently below 20 ml/min. Patients with prolonged air leak (>168
h) were connected to a portable device before discharge. Their air leak
duration was considered as 192 h. The sample size was calculated to detect
1-day difference in air leak duration with a statistical power of 80%.
Results: The two groups were well matched for several baseline and
surgical characteristics. No crossovers occurred between groups. The
average air leak duration (Group 1: 28 vs Group 2: 22.2, P = 0.6), and the
number of patients with prolonged air leak (Group 1: 5 vs Group 2: 4, P =
0.7) and with other complications (Group 1: 6 patients vs Group 2: 7
patients, P = 0.9) were similar between the groups. Sixteen patients of
Group 1 and 21 of Group 2 had an air leak present immediately after
extubation. Among them, patients of Group 2 (regulated seal) had an air
leak lasting 34.5 h less than those of Group 1 (regulated suction) (52.9
vs 87.4, P = 0.07). Conclusions: Regulated seal is as effective and safe
as regulated suction in managing chest tubes following lobectomy. This
information demonstrates with objective data the non-superiority of
regulated suction vs regulated seal and may assist in future
investigations on regulated pleural pressure. The Author 2012. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<15>
Accession Number
2013255898
Authors
Prasad A. Gossl M. Hoyt J. Lennon R.J. Polk L. Simari R. Holmes Jr. D.R.
Rihal C.S. Lerman A.
Institution
(Prasad, Gossl, Hoyt, Polk, Simari, Holmes Jr., Rihal, Lerman) Division of
Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and
Mayo Foundation, 200 First Street SW, Rochester, MN 55905, United States
(Lennon) Division of Biomedical Statistics and Informatics, Mayo Clinic
and Mayo Foundation, Rochester MN, United States
Title
Remote ischemic preconditioning immediately before percutaneous coronary
intervention does not impact myocardial necrosis, inflammatory response,
and circulating endothelial progenitor cell counts: A single center
randomized sham controlled trial.
Source
Catheterization and Cardiovascular Interventions. 81 (6) (pp 930-936),
2013. Date of Publication: May 2013.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Aims: Percutaneous coronary intervention (PCI) is frequently accompanied
by myocardial injury. The present study was performed to determine whether
remote ischemic preconditioning (IP) induces cardioprotection during PCI.
Methods: We enrolled 95 patients requiring nonemergency PCI for stable
disease or unstable angina into this prospective clinical trial. Patients
were randomized to either remote IP (induced by three 3-min cycles of
blood pressure cuff inflations to 200 mm Hg around the upper arm, followed
by 3-min of reperfusion n = 47) or sham control (n = 48) immediately
preceding PCI. The primary outcome measure was the frequency of post-PCI
myonecrosis, defined as a peak postprocedural cTnT T >=0.03 ng/dL.
Secondary outcome measures were the change in plasma high-sensitivity
C-reactive protein (hsCRP) levels following PCI and in endothelial
progenitor cells (EPC) counts following IP. Results: There was no
difference in the primary endpoint of the frequency of PCI related
myonecrosis which occurred in 22 (47%) and 19 (40%) patients in the remote
IP and control groups, respectively, P = 0.42. There was significant
increase in hsCRP post-PCI in both groups (P < 0.001), but there was no
difference between the groups (median %change in hsCRP 46% vs. 54%, P =
0.73). There was no significant change in circulating early (CD34
-/CD133+/KDR+), intermediate (CD34+/CD133+/KDR+), or late
(CD34+/CD133-/KDR+) EPC in the two groups immediately following IP. The
composite rate of death, myocardial infarction, and target lesion
revascularization at 1 year was 14.1% versus 13.7% (P = 0.90).
Conclusions: Our study indicates that remote IP immediately before PCI
does not induce cardioprotection in low to moderate risk patients. 2012
Wiley Periodicals, Inc.

<16>
[Use Link to view the full text]
Accession Number
23460569
Authors
Moerman A. Bove T. Francois K. Jacobs S. Deblaere I. Wouters P. De Hert S.
Institution
(Moerman) Department of Anesthesiology, Ghent University Hospital, De
Pintelaan 185, 9000 Gent, Belgium.
Title
Society of cardiovascular anesthesiologists: the effect of blood pressure
regulation during aortic coarctation repair on brain, kidney, and muscle
oxygen saturation measured by near-infrared spectroscopy: a randomized,
clinical trial.
Source
Anesthesia and analgesia. 116 (4) (pp 760-766), 2013. Date of Publication:
Apr 2013.
Abstract
In this study, we compared the effects of 3 frequently used arterial blood
pressure-regulating agents on brain (rScO2), renal (SrO2), and muscle
(SmO2) oxygen saturation, during aortic coarctation repair in children.
Based on the reported adverse effect of sodium nitroprusside (SNP) on
left-sided rScO2 during aortic coarctation repair, we tested the
hypothesis that the alterations in left rScO2 occurring with SNP would not
be present with sevoflurane and nitroglycerin (NTG). Additionally, we
explored the effects of blood pressure regulation with SNP, NTG, or
sevoflurane on right-sided rScO2, SrO2, and SmO2. Children with isolated
aortic coarctation undergoing surgical repair through a left thoracotomy
without the use of cardiopulmonary bypass were considered eligible for the
study. During aortic cross-clamping, control of mean arterial blood
pressure (MAP) was conducted according to randomization by the use of SNP,
NTG, or sevoflurane to obtain a mean target right brachial blood pressure
of 120% to 150% of the MAP value before cross-clamping. Bilateral rScO2,
SrO2, and SmO2 were recorded continuously with near-infrared spectroscopy.
As a primary end point, the maximal relative change in left-sided rScO2 in
response to aortic cross-clamping was compared among treatment groups. Ten
patients per group were included. No significant difference among
treatment groups was observed in maximal relative change in left-sided
rScO2 (SNP versus sevoflurane: mean difference -0.7%, 99% confidence
interval [CI] -31% to 29%, P = 1.0; SNP versus NTG: mean difference -1.8%,
99% CI -32% to 28%, P = 1.0; sevoflurane versus NTG: mean difference
-1.1%, 99% CI -31% to 29%, P = 1.0). Additional analyses also detected no
difference between groups in right rScO2 (P = 0.4). Compared with NTG,
treatment with SNP resulted in a significantly larger (-64% +/- 17% vs
-34% +/- 25%, P = 0.01) and faster (-9 +/- 4 %min(-1) vs -4 +/- 3
%min(-1), P = 0.004) decrease in SmO2. Right-sided rScO2 and MAP showed a
poor correlation for NTG (r = -0.2, P = 0.93), whereas borderline for
sevoflurane (r = 0.44, P = 0.09) and SNP (r = 0.56, P = 0.04). The mean
differences in left-sided rScO2 among the patients treated with SNP, NTG,
or sevoflurane for proximal hypertension during aortic cross-clamping were
no more than 32%. Additional analysis demonstrated a low MAP-rScO2
dependence with the use of NTG. Because NTG also resulted in a smaller and
slower decrease of oxygen saturation in peripheral tissues, our data
suggest that its use might be preferable for proximal blood pressure
control during surgical procedures involving aortic cross-clamping.

<17>
Accession Number
2013130259
Authors
Navarese E.P. Gurbel P.A. Andreotti F. Tantry U. Jeong Y.-H. Kozinski M.
Engstrom T. di Pasquale G. Kochman W. Ardissino D. Kedhi E. Stone G.W.
Kubica J.
Institution
(Navarese, Kozinski, Kubica) Department of Cardiology and Internal
Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus
University, Sklodowskiej-Curie Street No. 9, 85-094 Bydgoszcz, Poland
(Gurbel, Tantry, Jeong) Center for Thrombosis Research, Cardiac
Catheterization Laboratory, 2401 West Belvedere Avenue, Baltimore, MD
21215, United States
(Andreotti) Department of Cardiovascular Sciences, Catholic University,
Largo A. Gemelli 8, 00168 Rome, Italy
(Engstrom) Cardiac Catheterization Laboratory, Department of Cardiology,
The Heart Center, Rigshospitalet, Copenhagen 2100, Denmark
(di Pasquale) Unita Operativa di Cardiologia, Ospedale Maggiore, Largo
Bartolo Nigrisoli 2, 40133 Bologna, Italy
(Kochman) Faculty of Health Sciences, Medical University of Gdansk,
Swissmed Hospital, 44 Wilenska Street, 80-215 Gdansk, Poland
(Ardissino) Unita Operativa di Cardiologia, Azienda Ospedaliero
Universitaria di Parma, Via Gramsci 14, 43100 Parma, Italy
(Kedhi) Department of Cardiology, Maasstadziekenhuis, Maasstadweg, 3079DZ
Rotterdam, Netherlands
(Stone) Columbia University Medical Center, New York-Presbyterian
Hospital, The Cardiovascular Research Foundation, New York, NY 10022,
United States
Title
Optimal timing of coronary invasive strategy in non-ST-segment elevation
acute coronary syndromes: A systematic review and meta-analysis.
Source
Annals of Internal Medicine. 158 (4) (pp 261-270), 2013. Date of
Publication: 19 Feb 2013.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The optimal timing of coronary intervention in patients with
non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter
of debate. Conflicting results among published studies partly relate to
different risk profiles of the studied populations. Purpose: To do the
most comprehensive meta-analysis of current evidence on early versus
delayed invasive treatment in NSTE-ACS. Data Sources: MEDLINE, PubMed
Central, and Google Scholar databases; conference proceedings;
ClinicalTrials.gov registry; and Current Controlled Trials registry
through May 2012. Study Selection: Available randomized, controlled trials
(RCTs) and observational studies comparing early versus delayed
intervention in the NSTE-ACS population. Data Extraction: Data were
extracted for populations, interventions, outcomes, and risk of bias.
All-cause mortality was the prespecified primary end point. The longest
follow-up available in each study was chosen. The odds ratio with 95% CI
was the effect measure. Data Synthesis: Seven RCTs (5370 patients) and 4
observational studies (77 499 patients) were included. Early intervention
was less than 20 hours after hospitalization or randomization for RCTs and
24 hours or less for observational studies. Meta-analysis of the RCTs was
inconclusive for a survival benefit associated with the early invasive
strategy (odds ratio, 0.83 [95% CI, 0.64 to 1.09]; P = 0.180); a similar
result emerged from the observational studies. With early versus late
intervention, the odds ratios in the RCTs were 1.15 (CI, 0.65 to 2.01; P =
0.63) and 0.76 (CI, 0.56 to 1.04; P = 0.090) for myocardial infarction and
major bleeding during follow-up, respectively. Limitation: Current
evidence from RCTs is limited by the small overall sample size, low
numbers of events in some trials, and heterogeneity in the timing of
intervention and in patient risk profiles. Conclusion: At present, there
is insufficient evidence either in favor of or against an early invasive
approach in the NSTE-ACS population. A more definitive RCT is warranted to
guide clinical practice. Primary Funding Source: None. 2013 American
College of Physicians.

<18>
Accession Number
2013271639
Authors
Lomivorotov V.V. Efremov S.M. Shmirev V.A. Ponomarev D.N. Svyatchenko A.V.
Deryagin M.N. Lomivorotov V.N. Karaskov A.M.
Institution
(Lomivorotov, Efremov, Shmirev, Ponomarev, Svyatchenko, Deryagin,
Lomivorotov, Karaskov) Research Institute of Circulation Pathology,
Rechkunovskaya Street 15, Novosibirsk 630055, Russian Federation
Title
Does Glutamine Promote Benefits for Patients With Diabetes Mellitus
Scheduled for Cardiac Surgery?.
Source
Heart Lung and Circulation. 22 (5) (pp 360-365), 2013. Date of
Publication: May 2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: We hypothesised, that perioperative use of
N(2)-l-alanyl-l-glutamine confers cardioprotection and improves insulin
resistance in diabetic patients with coronary artery disease operated
under cardiopulmonary bypass. Methods: This double-blind,
placebo-controlled, randomised study included 64 patients with diabetes
mellitus type 2 who were scheduled for on-pump coronary artery bypass
graft surgery. The protocol group (32 patients) and the control group (32
patients) glutamine (0.4g/kg/day of 20% solution of
N(2)-l-alanyl-l-glutamine (" Dipeptiven" Fresenius Kabi,
Germany)) and placebo (0.9% NaCl), respectively. Perioperative
concentration of troponin I in plasma was considered as the primary
end-point. Whereas the secondary end-points were insulin resistance,
insulin sensitivity, beta-cell function, blood glucose, plasma
triglycerides and free fatty acids concentrations. Insulin resistance,
insulin sensitivity and beta-cell function were measured using HOMA
equation. Thermodilution method was used to measure haemodynamics in all
the patients. Results: No differences have been found in perioperative
dynamics of troponin I, insulin resistance, insulin sensitivity, beta-cell
function, blood glucose, plasma triglycerides free fatty acids
concentrations and haemodynamics. Conclusion: Our results have failed to
confirm the cardioprotective properties and modulatory effect on
perioperative insulin resistance that are thought to be attributable to
parenteral glutamine administration in dose 0.4. g/kg/day among cardiac
patients with DM operated on under CPB. 2012 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ).

<19>
Accession Number
23488362
Authors
Cossette S. Frasure-Smith N. Robert M. Chouinard M.C. Juneau M. Guertin
M.C. Cournoyer A. Mailhot T. Kayser J.W.
Institution
(Cossette) Montreal Heart Institute Research Centre, R-2231, 5000,
Belanger est, Montreal, QC H1T 1C8.
Title
A pilot randomized trial of a smoking cessation nursing intervention in
cardiac patients after hospital discharge.
Source
Canadian journal of cardiovascular nursing = Journal canadien en soins
infirmiers cardio-vasculaires. 22 (4) (pp 16-26), 2012. Date of
Publication: 2012 Fall.
Abstract
One fifth of Canadians are smokers despite the availability of
community-based smoking cessation programs. It was hypothesized that
offering a post-discharge smoking cessation program to cardiac patients
would decrease smoking rates at six months. This pilot randomized study
explored the feasibility, acceptability and preliminary efficacy of a
smoking cessation intervention delivered by a smoking cessation nurse
specialist (SCNS) to cardiac patients after hospital discharge.
Participants (N=40) were randomized to either a postdischarge telephone
intervention delivered weekly for the first month and then monthly until
the third month (experimental group [EG]), or referral to usual community
care (control group [CG]). The researchers confirmed the feasibility of
recruitment and acceptability of the intervention, but dfficulty with
follow-up. The intention-to-treat analysis showed similar smoking
cessation rates in both groups at six months (25% EG versus 30% CG; p =
0.72). An intensifed follow-up protocol, or a more intensive,
comprehensive and multidisciplinary intervention might be required, given
the characteristics of the smokers.

<20>
Accession Number
23488361
Authors
Goldie C.L. Prodan-Bhalla N. Mackay M.
Institution
(Goldie) School of Nursing, University of British Columbia, 302-6190
Agronomy Road, Vancouver, BC V6T 1Z3.
Title
Nurse practitioners in postoperative cardiac surgery: are they effective?.
Source
Canadian journal of cardiovascular nursing = Journal canadien en soins
infirmiers cardio-vasculaires. 22 (4) (pp 8-15), 2012. Date of
Publication: 2012 Fall.
Abstract
High demand for acute care nurse practitioners (ACNPs) in Canadian
postoperative cardiac surgery settings has outpaced methodologically
rigorous research to support the role. To compare the effectiveness of
ACNP-led care to hospitalist-led care in a postoperative cardiac surgery
unit in a Canadian, university-affiliated, tertiary care hospital.
Patients scheduled for urgent or elective coronary artery bypass and/or
valvular surgery were randomly assigned to either ACNP-led (n=22) or
hospitalist-led (n=81) postoperative care. Both ACNPs and hospitalists
worked in collaboration with a cardiac surgeon. Outcome variables included
length of hospital stay, hospital readmission rate, postoperative
complications, adherence to follow-up appointments, attendance at cardiac
rehabilitation and both patient and health care team satisfaction.
Baseline demographic characteristics were similar between groups except
more patients in the ACNP-led group had had surgery on an urgent basis (p
< or = 0.01), and had undergone more complicated surgical procedures (p <
or =0.01). After discharge, more patients in the hospitalist-led group had
visited their family doctor within a week (p < or =0.02) and measures of
satisfaction relating to teaching, answering questions, listening and pain
management were higher in the ACNP-led group. Although challenges in
recruitment yielded a lower than anticipated sample size, this study
contributes to our knowledge of the ACNP role in postoperative cardiac
surgery. Our findings provide support for the ACNP role in this setting as
patients who received care from an ACNP had similar outcomes to
hospitalist-led care and reported greater satisfaction in some measures of
care.

<21>
Accession Number
71058023
Authors
Kobashigawa J. Kittleson M. Rafiei M. Osborne A. Chang D. Czer L. Patel J.
Institution
(Kobashigawa, Kittleson, Rafiei, Osborne, Chang, Czer, Patel) Cedars-Sinai
Heart Institute, Los Angeles, CA, United States
Title
Atg induction for sensitized patients who have undergone heart transplant:
Is it beneficial?.
Source
American Journal of Transplantation. Conference: 13th American Transplant
Congress, ATC 2013 Seattle, WA United States. Conference Start: 20130518
Conference End: 20130522. Conference Publication: (var.pagings). 13 (pp
457), 2013. Date of Publication: April 2013.
Publisher
Blackwell Publishing Ltd
Abstract
BACKGROUND: Heart transplant recipients who are sensitized pre-transplant
are at increased risk for the development of antibody mediated and
cellular rejection post transplantation. The use of induction therapy with
anti-thymocyte globulin (ATG) may reduce the incidence of antibody
mediated rejection (AMR), but this has not been formally studied in a
randomized controlled trial. The purpose of this study was to determine
the impact of ATG induction on the incidence of AMR in a large
single-center experience.METHODS: We identified 170 heart transplant (HTx)
patients transplanted between January 1994 and October 2011, with
pre-transplant panel reactive antibodies (PRA) >10%. Induction therapy was
given based on the treating physician's preference. One-year outcomes were
assessed, including the incidence of treated rejection and
pathology-defined AMR.RESULTS: Of the 170 HTx, 91 received ATG induction
and 79 did not. The mean pre-transplant PRA was significantly higher in
the ATG group (59 +/- 31% vs 43 +/- 32%, p=0.0015). In the ATG induction
group, there were fewer treated rejection episodes (14% vs 30%, p= 0.010)
and fewer pathology-defined AMR episodes (12% vs 26%, p=0.016). There was
no difference in the incidence of cellular rejection (12% in both groups).
CONCLUSION: ATG induction therapy for sensitized patients results in fewer
treated rejection episodes and a decreased incidence of pathology-defined
AMR. This suggests that ATG induction may be beneficial in sensitized
patients, but the results should be confirmed with a randomized trial.f.

<22>
Accession Number
71057353
Authors
Guo Z. Ju W. Wang P. He M. Deng S. He X.
Institution
(Guo, Ju, Wang, He, Deng, He) Organ Transplant Center, First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, China
Title
The effect of gender on transplant outcomes: A meta-analysis.
Source
American Journal of Transplantation. Conference: 13th American Transplant
Congress, ATC 2013 Seattle, WA United States. Conference Start: 20130518
Conference End: 20130522. Conference Publication: (var.pagings). 13 (pp
264-265), 2013. Date of Publication: April 2013.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Although the effects of donor-recipient gender matching on
transplant outcomes have been discussed for long, no widely-accepted
consensus has been reached. We conducted a meta-analysis to
comprehensively reevaluate how gender matching affects transplant outcomes
in major organ transplantations. 18Methods: PubMed/Medline, Embase, and
Cochrane library databases were searched for relevant studies. Twelve
studies (174177 patients) for kidney, 3 studies (28812 patients) for
liver, and 4 studies (19184 patients) for heart transplantation comparing
transplant outcomes between gender match and mismatch groups, or among the
four donor to recipient gender pairs were included. The primary outcome
were graft and patient survival.Results: We found it consistent in kidney,
heart, liver transplantation that compared with donor/recipient gender
match group, donor/recipient gender mismatch was associated with
significantly worse 1-, 3-, 5-year graft or patient survival. However,
gender mismatch had no deleterious effects on delayed graft function (DGF)
in kidney transplantation. The interaction between donor and recipient
gender is responsible for transplant outcomes. Male donor to male
recipient pairing is most advantageous for 5-year outcome, while female
donor to male recipient pairing have worst prognosis in both kidney and
liver transplantation.Conclusion: Gender matching greatly affects
transplant outcomes in major organ transplantation, which should be
considered when organs are allocated. (Table presented).

<23>
Accession Number
71053282
Authors
Corley A. Caruana L. Barnett A. Fraser J.
Institution
(Corley, Caruana, Barnett, Fraser) Prince Charles Hospital, Institute of
Health and Biomedical Innovation, Queensland University of Technology,
Brisbane, QLD, Australia
Title
Open and closed suctioning result in significant lung derecruitment: A
randomised controlled study using electrical impedance tomography.
Source
Anaesthesia and Intensive Care. Conference: Intensive Care Annual
Scientific Meeting of the Australian and New Zealand Intensive Care
Society, ANZICS and Australian College of Critical Care Nurses, ACCN 2010
Melbourne, VIC Australia. Conference Start: 20101014 Conference End:
20101016. Conference Publication: (var.pagings). 38 (6) (pp 1119-1120),
2010. Date of Publication: November 2010.
Publisher
Australian Society of Anaesthetists
Abstract
Airway suctioning is essential in airway management for mechanically
ventilated patients but is associated with lung de-recruitment. There is a
deficiency of high quality evidence investigating the effects of open
suction (OS) compared to closed suction (CS) in the area of lung volume
loss. Lung volumes can be safely and accurately determined by measuring
lung impedance using electrical impedance tomography (EIT). The aim of
this prospective observational randomised controlled study was to compare
lung volume changes during OS and CS, and end expiratory lung volume
(EELV) 30 minutes post each suction. Twenty post-cardiac surgical patients
were recruited. Both OS and CS were tested in randomised order for each
participant. Baseline end expiratory lung impedance (EELI) measures were
compared with EELI measures during each suction manoeuvre in addition to
30 minutes post-suction to determine lung volume loss. A mixed model using
a pair-wise estimate of means was used to determine the effect of OS and
CS on EELI. EELI reduced by -2405 impedance units (95% CI 2103, 2708; P
value <0.001) from baseline during OS and by -1645 (95% CI 1360, 1930; P
value <0.001) during CS. Thirty minutes after suctioning, EELI was 452
impedance units (95% CI 273, 633; P value <0.001) lower than baseline in
OS, and 726 units (95% CI 548, 904; P value <0.001) lower than baseline in
CS. Both OS and CS reduce expiratory lung volumes by a significant amount.
CS appears not to be protective against de-recruitment, even after 30
minutes. Consideration should be given to restoring EELV after suctioning
via a recruitment manoeuvre.

<24>
Accession Number
71052652
Authors
Shorrock D. Michael T. Patel V. Rangan B. Abdullah S. Banerjee S. Brilakis
E.
Institution
(Shorrock, Rangan) Dallas Veterans Affairs Medical Center, United States
(Michael, Patel, Abdullah) University of Texas Southwestern Medical
Center, United States
(Banerjee, Brilakis) VA North Texas Healthcare System, University of Texas
Southwestern Medical Ce, United States
Title
Frequency and outcomes of aortocoronary dissection during percutaneous
coronary intervention of chronic total occlusions: A case series and
systematic review of the literature.
Source
Catheterization and Cardiovascular Interventions. Conference: 36th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI Orlando, FL United States. Conference Start: 20130508
Conference End: 20130511. Conference Publication: (var.pagings). 81 (pp
S48), 2013. Date of Publication: May 2013.
Publisher
Wiley-Liss Inc.
Abstract
Background: Aortocoronary dissection can complicate percutaneous coronary
intervention (PCI) of chronic total occlusions (CTOs). Methods: We
retrospectively examined the frequency and outcomes of aortocoronary
dissection among 336 consecutive CTO PCIs performed at our institution
between 2005 and 2012 and performed a systematic review of the published
literature. Results: Aortocoronary dissection occurred in 6 patients
(1.8%, 95% confidence intervals 0.7%, 3.8%). All aortocoronary dissections
occurred in the right coronary artery (CTO target vessel in 5 patients and
donor vessel in 1 patient. The baseline clinical characteristics of
patients with and without aortocoronary dissection were similar. Compared
to patients without, those with aortocoronary dissection were more likely
to undergo crossing attempts using the retrograde approach (25% vs. 67%, P
= 0.036) and experience a major complication (2.4% vs. 33.3%, p = 008).
Technical and procedural success rates were similar in both groups. Of the
6 patients with aortocoronary dissection one underwent emergency coronary
bypass graft surgery, 4 were treated with ostial stenting and one was
treated conservatively without subsequent adverse clinical outcomes.
Systematic literature review provided 107 published cases of aortocoronary
dissection during PCI, that occurred mainly in the right coronary artery
(74.8%) and were treated with stenting (49.5%), emergency coronary bypass
graft surgery (29%) or conservatively (21.5%). Conclusion: Aortocoronary
dissection is an infrequent complication of retrograde CTO PCI and
although it can be treated with stents in most patients it may
infrequently require emergency coronary artery bypass graft surgery.

<25>
Accession Number
71052638
Authors
Garg N. Uretsky B. Ahmed Z. Hakeem A.
Institution
(Garg, Uretsky, Ahmed, Hakeem) UAMS, United States
Title
Comparative effectiveness of PCI with drug eluting stents vs. CABG for
multi-vessel CAD in diabetic patients- meta analysis of randomized
controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 36th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI Orlando, FL United States. Conference Start: 20130508
Conference End: 20130511. Conference Publication: (var.pagings). 81 (pp
S39), 2013. Date of Publication: May 2013.
Publisher
Wiley-Liss Inc.
Abstract
Background: Coronary artery bypass grafting (CABG) has been compared to
percutaneous coronary intervention (PCI) for multi-vessel disease (MVD)
using drug eluting stents (DES) in diabetic patients in recent randomized
clinical trials (RCTs). We performed meta-analysis of these RCTs. Methods:
RCTs comparing PCI with DES vs. CABG in diabetic patients with MVD were
included. The primary endpoint was a composite of death, MI and stroke as
reported in the primary trials. Effects of both revascularization
strategies were analyzed by calculating pooled estimates for death from
any cause, MI, repeat revascularization, and stroke. Separate analyses
were performed for each outcome by using risk ratio (RR) by fixed and
random effects models. Heterogeneity among studies was assessed by
calculating I² measure of inconsistency. Results: Three studies
with a total of 2862 patients met inclusion criteria (1440 PCI vs. 1422 in
CABG arm). Incidence of the primary outcome was 18.8% in PCI arm and 14%
in CABG arm, (RR-1.33, 95%CI 1.12-1.57, P = 0.0008), at a mean follow up
of three years. Similar results were obtained for death (10.6% vs. 7.5%,
RR 1.39, 95% CI 1.10-1.75, P = 0.006), and MI (9.4% vs. 5%, RR 2.71; 95%
CI 1.41-2.46, P < 0.0001). Stroke risk was significantly higher in the
CABG group (1.8% vs. 3.6%, RR 0.52; 95% CI 0.33-0.84, P < 0.007). PCI was
associated with several fold higher risk of subsequent revascularization
compared to CABG (14% vs. 5.1%, OR 3.0 (95% CI 2.27-3.98; p < 0.00001).
There was no heterogeneity amongst the trials for any of these endpoints
(I² = 0% for all comparisons). Conclusion: These data strongly
suggest thatCABG in diabetic patients with MVD is superior to MVD PCI with
DES. CABG decreased overall death, non-fatal myocardial infarction, and
repeat revasculariza-tion at the expense of increase in stroke risk.

<26>
Accession Number
71052629
Authors
Khan M. Wendel C. Thai H. Movahed M.
Institution
(Khan, Wendel, Thai, Movahed) Southern Arizona VA Health Care System,
United States
Title
Failed percutaneous recanalization of chronic total occlusion is
associated with higher in-hospital mortality: A systematic review and
meta-analysis of the literature.
Source
Catheterization and Cardiovascular Interventions. Conference: 36th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions', SCAI Orlando, FL United States. Conference Start: 20130508
Conference End: 20130511. Conference Publication: (var.pagings). 81 (pp
S33-S34), 2013. Date of Publication: May 2013.
Publisher
Wiley-Liss Inc.
Abstract
Background: Chronic total occlusions (CTOs) are the most complex and
challenging coronary lesions for percutaneous coronary intervention (PCI).
As compared to non-CTO interventions, PCI for CTO is a higher risk
procedure. Additionally, unsuccessful CTO-PCI may result in significant
mechanical trauma to coronaries due to multiple attempts to pass the
guide-wire along with higher radiation and contrast exposures. All of
these measures might result in higher rates of peri-procedural
complications and in-hospital cardiac events. The goal of this analysis is
to compare the rates of complications between the patients with successful
and failed PCI for CTOs. Methods: Using major electronic data bases, we
searched for studies comparing peri-procedural complications and
in-hospital events [death, major adverse cardiovascular events (MACE) and
urgent CABG (coronary artery bypass grafting)] between the patients who
underwent successful PCI recanalization of CTOs versus those who had
failed PCI attempts for CTOs. Results: We identified 18 observational
studies (10,566 patients) reporting in-hospital deaths for successful and
failed PCI-CTO groups. Of those studies, in-hospital MACE was reported in
10 studies and urgent CABG was reported in 13 studies. Compared to failed
intervention, successful PCI recanalization of a CTO was associated with
lower in-hospital mortality (RR of 0.355, 95% CI (0.221-0.569) with a
p-value < 0.001) (figure 1), lower overall risk of in-hospital MACE (RR of
0.458, 95% CI (0.324-0.647) p-value < 0.001) and a reduced need for urgent
CABG (RR of 0.144, 95% CI (0.097-0.215) p-value < 0.001). The analysis of
the pooled data showed higher rates of coronary perforations (81/1328
[6.1%] versus 24/2758 [0.90%]) and cardiac tamponade (10/678 [1.5%] versus
0/1589 [0%]) in patients with unsuccessful CTO PCI. Conclusion: As
compared to successful interventions, failed PCI attempts for CTOs appear
to be associated with higher rates of peri-procedural complications and
in-hospital events. (Table Presented) (Graph Presented).

<27>
Accession Number
71051493
Authors
Imazio M. Brucato A. Cemin R. Belli R. Spodick D.H. Adler Y.
Institution
(Imazio, Belli) Cardiology, Maria Vittoria Hospital, Torino, Italy
(Brucato) Medicine, Ospedali Riuniti, Bergamo, Italy
(Cemin) Cardiology, San Maurizio Regional Hospital, Bolzano, Italy
(Spodick) Medicine, St. Vincent Hospital, University of Massachusetts,
Worcester, United States
(Adler) Cardiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
Title
Prevention of the post-pericardiotomy syndrome. A meta-analysis of
published randomized trials.
Source
Circulation. Conference: World Congress of Cardiology Scientific Sessions
2012, WCC 2012 Dubai United Arab Emirates. Conference Start: 20120418
Conference End: 20120421. Conference Publication: (var.pagings). 125 (19)
(pp e770-e771), 2012. Date of Publication: 15 May 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The natural history of the post-pericardiotomy syndrome
(PPS), a relatively common complication of cardiac surgery, is variable
ranging from mild, self-limited episodes to cases with protracted courses,
recurrences and readmissions. Preventive strategies may be valuable to
reduce morbidity and management costs. Objectives: Systematic review on
available data for the pharmacologic prevention of the PPS. Methods:
Controlled clinical studies were searched in several databases and were
included provided they focused on the pharmacologic primary prevention of
the PPS. Random-effect odds ratios (ORs) were computed for the occurrence
of the PPS. Results: From the initial sample of 343 citations, 4
controlled clinical trials for the primary prevention of the PPS were
finally included (894 patients); 3 studies were double-blind randomised
controlled trials (RCT). Treatment comparisons were as follows: colchicine
vs. placebo (2 RCTs enrolling a total of 471 patients), methylprednisolone
vs. placebo (a single RCT on 246 pediatric patients), and aspirin vs.
historical controls (a single non-randomised study on 177 pediatric
patients). Meta-analytic pooling showed that colchicine was associated
with a reduced risk of PPS (OR= 0.38 [0.22- 0.65]). Data either on
methylpredisolone (OR= 1.13 [0.57-2.25]), or aspirin (OR= 1.00
[0.16-6.11]) were negative but inconclusive because based on a single
study and/or a non-randomised design. Conclusion: Clinical evidence for
the primary prevention of the PPS is still limited to few studies of
variable quality. Nevertheless, available data suggest a beneficial
profile for colchicine, at present the only efficacious agent for PPS
primary prevention.

<28>
Accession Number
71053062
Authors
Chen Q. Sheikh A. Sheppard S. Gibbs R. Smith D. Haw M.
Institution
(Chen, Sheikh) Univ College of London Hosps, London, United Kingdom
(Sheppard, Smith, Haw) Southampton General Hosp, Southampton, United
Kingdom
(Gibbs) Univ of Portsmouth, Portsmouth, United Kingdom
Title
Combination of blood cardioplegic and strategic reperfusion period
leucodepletion during cardiopulmonary bypass preserves the cardiac and
pulmonary function: A prospective randomized controlled study.
Source
Circulation Research. Conference: Basic Cardiovascular Sciences 2012
Scientific Sessions New Orleans, LA United States. Conference Start:
20120723 Conference End: 20120726. Conference Publication: (var.pagings).
111 (4 MeetingAbstract) , 2012. Date of Publication: 03 Aug 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Leucocytes activation during cardiopulmonary bypass (CPB)
contributes to postoperative organ dysfunction. We compared the outcomes
of various leucodepletion strategies in patients undergoing coronary
artery bypass grafting (CABG). Methods: One hundred-twenty low-risk
patients undergoing first time CABG were prospectively randomized to six
groups: 1 non-leucodepletion arterial filtration; 2 continuous arterial
leucodepletion; 3 reperfusion period leucodepletion; 4 leucodepletion of
blood cardioplegia; 5 combination of continuous arterial and blood
cardioplegic leucodepletion; 6 combination of blood cardioplegic and
reperfusion period leucodepletion. Blood samples were taken 5 min before
CPB, 5 and 30 min on CPB, 5, 60 min after aortic X-clamp removal and 6 h
post-CPB. Activated leucocytes were identified with Nitroblue Tetrazolium
staining. Exhaled nitro oxide (NO) was measured pre- and post-CPB using
real-time chemiluminescense analyzer. Respiratory index (alveolar-arterial
oxygenation index, AaOI) was calculated 5 min before CPB and 5 min on CPB,
1, 2, 4, 8 and 18 h post-CPB. Results: Activated white cell counts were
similar before CPB in all groups, but reduced significantly 5, 60 min
following aortic X-clamp removal, and 6 h post-CPB in groups 2, 3, 5 and
6, compared with group 1 (ANOVA p=0.02). Post-CPB, NO increased in all
groups (p<0.05) except in Group 6 (3.17+/-0.64 vs. 3.63+/-0.79 ppb/s,
p=0.22). Group 6 exhibited a lower AaOI than group 1 over all time points
post-CPB (ANOVA, p=0.02). Postoperatively, there was a significant
reduction in inotropic requirement, ventilation time and atrial
fibrillation in group 6 (p=0.045, 0.04 and 0.043, respectively). There was
no difference in chest drain output, length of ICU and hospital stay among
all groups. Conclusions: Combination of blood cardioplegic and reperfusion
period leucodepletion appeared to be most effective in attenuating
activated leucocytes during CPB, which was associated with better
preservation of cardiac and pulmonary function compared with other
leucodepletion strategies.

<29>
Accession Number
71048979
Authors
Vierling W.
Institution
(Vierling) Institute of Pharmacology, Technical University Munich, Munich,
Germany
Title
Is magnesium important for the prevention and therapy of cardiac
arrhythmias?.
Source
Trace Elements and Electrolytes. Conference: 32nd Symposium of the Society
for Magnesium Research Herne Germany. Conference Start: 20120906
Conference End: 20120908. Conference Publication: (var.pagings). 30 (2)
(pp 85), 2013. Date of Publication: 2013.
Publisher
Dustri-Verlag Dr. Karl Feistle
Abstract
Based on the physiological and pharmacodynamic effects of magnesium, it
can be concluded that magnesium deficiency favors cardiac arrhythmias
while magnesium supply can prevent or abolish arrhythmias. The efficiency
of parenteral administration of magnesium for the treatment of certain
cardiac arrhythmias is acknowledged by cardiological societies and is
incorporated in guidelines to treat arrhythmias. Besides therapeutics the
preventive effect of magnesium is very important. In the Framingham study,
it was already detected that the appearance of dangerous arrhythmias was
inversely related to the serum concentrations of magnesium and potassium.
In a recent study, it was shown that sudden cardiac death, which in most
cases is related to arrhythmias, is more frequent if magnesium intake and
serum concentrations are low. An important question is whether magnesium
is suited for the prevention of atrial fibrillation in patients who
undergo cardiac surgery. The heart and thorax surgeons stated that
parenteral administration of magnesium can reduce the incidence of atrial
fibrillations after such an intervention. However, in a recent
meta-analysis, it was demonstrated that a beneficial effect of magnesium
only resulted if low quality studies were included, but was absent if only
studies with higher quality were selected. In contrast, in another study
where also only studies with higher quality were considered, it was
concluded that magnesium has indeed a preventive effect. Although there is
no final clarity, it can be stated that in each case, magnesium deficiency
has to be corrected to avoid cardiac arrhythmias and finally sudden
cardiac death. This is particularly important if predisposing factors like
intake of certain drugs, but also cardiac surgery, play a role.

<30>
Accession Number
71050858
Authors
Samat M. Hong Z.
Institution
(Samat, Hong) Department of Anesthesiology, First Affiliated Hospital of
Xinjiang Medical University, Urumqi, Xinjiang, China
Title
Tight heart rate control is needed for perioperative cardioprotection.
Source
British Journal of Anaesthesia. Conference: Joint Meeting of the
Anaesthetic Research Society and the Chinese Society of Anesthesiology
2011 Ji'nan, Shandong China. Conference Start: 20110910 Conference End:
20110910. Conference Publication: (var.pagings). 108 (3) (pp 546p), 2012.
Date of Publication: March 2012.
Publisher
Oxford University Press
Abstract
Recent meta-analyses assessing the efficacy of perioperative b-blockade
trials have failed to show a reduction in postoperative morbidity and
mortality. Tight control of heart rate (HR) has been suggested to improve
these outcomes. Meta-analyses have not considered the influence of tight
HR control on the efficacy of perioperative b-blockade. We identified all
randomized trials evaluating perioperative beta-blockers after non-cardiac
surgery and yielded 13 trials with 11 590 patients. We used the data from
these studies to correlate measures of HR control with major postoperative
outcomes, primarily in-hospital myocardial infarction. Odds ratios (ORs),
95% confidence limits (CLs), and heterogeneity were calculated. The
combined results of all studies show cardioprotective effect of
beta-blockers (OR=0.64, 95% CL=0.50-0.80, P<0.0001), but there was
considerable heterogeneity among the studies (57%). However, grouping the
trials on the basis of maximal HR showed that trials where the estimated
maximal HR was ,100 beats min^-1 were associated with
cardioprotection (OR=0.37, 95% CL=0.26-0.52, P<0.00001) and no
heterogeneity (Fig. 9), whereas those trials where the estimated maximal
HR was <100 beats min^-1 did not show cardioprotection. The
large heterogeneity in HR response to b-blockade was found to be related,
in part, to the type of b-blocker, specifically, metoprolol, and the
concomitant use of calcium channel blockers. Calcium channel blocker use
and beta-blockers other than metoprolol resulted in more effective control
of HR. The results suggest that effective control of HR is important for
achieving cardioprotection and demonstrates that administration of
beta-blockers does not reliably increase HR in all patients. Combination
therapy with other drugs and adequate control of anaesthesia may be
necessary for effective postoperative control of HR.