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<1>
Accession Number
2013314382
Authors
Kurien T. Pearson R.G. Scammell B.E.
Institution
(Kurien, Pearson, Scammell) Queen's Medical Centre, University of
Nottingham, Nottingham, United Kingdom
(Scammell) Division of Orthopaedic and Accident Surgery, Queen's Medical
Centre, University of Nottingham, Nottingham NG7 2UH, United Kingdom
Title
Bone graft substitutes currently available in orthopaedic practice: The
evidence for their use.
Source
Bone and Joint Journal. 95 B (5) (pp 583-597), 2013. Date of Publication:
May 2013.
Publisher
Journal of Bone and Joint Surgery Inc. (20 Pickering Street, Needham MA
02492, United States)
Abstract
We reviewed 59 bone graft substitutes marketed by 17 companies currently
available for implantation in the United Kingdom, with the aim of
assessing the peer-reviewed literature to facilitate informed
decision-making regarding their use in clinical practice. After critical
analysis of the literature, only 22 products (37%) had any clinical data.
Norian SRS (Synthes), Vitoss (Orthovita), Cortoss (Orthovita) and
Alpha-BSM (Etex) had Level I evidence. We question the need for so many
different products, especially with limited published clinical evidence
for their efficacy, and conclude that there is a considerable need for
further prospective randomised trials to facilitate informed
decision-making with regard to the use of current and future bone graft
substitutes in clinical practice. 2013 The British Editorial Society of
Bone & Joint Surgery.

<2>
Accession Number
2013310114
Authors
Prieto M.A. Guash S. Mendez J.C. Munoz C. Planas A. Reyes G.
Institution
(Prieto, Mendez, Planas) Department of Anesthesiology, Hospital
Universitario la Princesa, Madrid, Spain
(Guash, Munoz) Department of Immunology, Hospital Universitario la
Princesa, Madrid, Spain
(Reyes) Department of Cardiac Surgery, Hospital Universitario la Princesa,
c/Diego de Leon 62, 28006 Madrid, Spain
Title
Does use of cell saver decrease the inflammatory response in cardiac
surgery?.
Source
Asian Cardiovascular and Thoracic Annals. 21 (1) (pp 37-42), 2013. Date of
Publication: February 2013.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Background: The role of a cell-saver device in the inflammatory response
to cardiac surgery has not been well documented. We hypothesized that the
use of a cell saver may reduce proinflammatory cytokine concentrations in
patients undergoing cardiac surgery. Methods: 57 patients presenting for
first-time nonemergency cardiac surgery were prospectively randomized to
control or cell salvage groups. Blood samples for inflammatory marker
assays were collected from the arterial line on induction of anesthesia,
at the end of cardiopulmonary bypass, 1 h after surgery, and 24 h after
surgery. Plasma proinflammatory cytokines were analyzed using a sandwich
solid-phase enzyme-linked immunosorbent assay. Results: The highest
cytokine levels were observed 1 h after surgery. When comparing serum
interleukin levels in both patient groups during the different
perioperative periods, we found a higher interleukin-8 concentration 24 h
after the procedure, and higher concentrations of the p40 subunit of
interleukin-12 at 1 h and 24 h postoperatively. The concentrations of
interleukin-6 and p40 were greater in blood stored by the cardiotomy
suction system than in blood processed by the cell saver (p = 0.01 in both
cases). The interleukin-8 concentration was higher in the blood processed
by the cell saver (p = 0.03). No significant differences were observed in
interleukin-1 and interferon gamma levels in blood from both systems.
Clinical outcomes were similar in both groups. Conclusions: Our results
suggest that cell salvage in low-risk patients undergoing their first
elective cardiac procedure does not decrease the inflammatory response
after surgery. The Author(s) 2012.

<3>
Accession Number
2013310436
Authors
Cerfolio R.J. Bryant A.S. Skylizard L. Minnich D.J.
Institution
(Cerfolio) Section of Thoracic Surgery, Division of Cardiothoracic
Surgery, University of Alabama at Birmingham, Birmingham, AL, United
States
(Cerfolio) Section of Lung Cancer Research, University of Alabama at
Birmingham, Birmingham, AL, United States
(Bryant, Minnich) Division of Cardiothoracic Surgery, University of
Alabama at Birmingham, 703 19th St S, ZRB 739, Birmingham, AL 35294,
United States
(Skylizard) Division of Robotic Thoracic Surgery, University of Alabama at
Birmingham, Birmingham, AL, United States
Title
Optimal technique for the removal of chest tubes after pulmonary
resection.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (6) (pp 1535-1539),
2013. Date of Publication: June 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The objective is to determine the optimal manner to remove a
chest tube after pulmonary resection. Method: This was a prospective,
randomized single-institution study. Patients who underwent elective
thoracotomy for pulmonary resection by 1 or 2 general thoracic surgeons
were randomized to have their chest tube removed on either full
inspiration or full expiration. Both patient groups performed a Valsalva
maneuver during tube removal. Outcomes included the incidence of
clinically nonsignificant pneumothorax (defined as a new or increased
pneumothorax on the post-chest tube removal chest roentgenogram in
asymptomatic patients), symptoms, delayed discharge, and the need for a
new chest tube. Results: Between November 2008 and June 2011, 1189
patients underwent pulmonary resection, and of these 342 met the criteria
for the study. Of the 179 patients randomized to have their chest tube
removed on full inspiration, 58 (32%) had a larger or new pneumothorax
after chest tube removal and 5 (3%) required intervention or delayed
discharge. Of the 163 patients randomized to have their chest tube removed
on full expiration, 32 (19%; P = .007) had a larger or new pneumothorax
after chest tube removal, and only 2 (1%) required intervention or delayed
discharge (P = .78). Conclusions: Removal of chest tubes at the end of
expiration leads to a lower incidence of non-clinically significant
pneumothorax than at the end of inspiration. Because of these findings,
this study was closed early and was thus underpowered for finding a
statistically significant difference in the rare (1%-3%) clinically
significant pneumothoraces. 2013 by The American Association for Thoracic
Surgery.

<4>
Accession Number
2013315314
Authors
Oxman D.A. Issa N.C. Marty F.M. Patel A. Panizales C.Z. Johnson N.N.
Licona J.H. McKenna S.S. Frendl G. Mentzer S.J. Jaklitsch M.T. Bueno R.
Colson Y. Swanson S.J. Sugarbaker D.J. Baden L.R.
Institution
(Oxman, Issa, Marty, Licona, Baden) Division of Infectious Diseases,
Brigham and Women's Hospital, 75 Francis St, PBB A-4, Boston, MA 02115,
United States
(Panizales, Johnson, Mentzer, Jaklitsch, Bueno, Colson, Swanson,
Sugarbaker) Division of Thoracic Surgery, Brigham and Women's Hospital,
Boston, MA, United States
(Patel) Department of Pharmacy, Brigham and Women's Hospital, Boston, MA,
United States
(McKenna, Frendl) Department of Anesthesiology, Brigham and Women's
Hospital, Boston, MA, United States
(Oxman) Division of Pulmonary and Critical Care, Thomas Jefferson
University Hospital, Philadelphia, PA, United States
Title
Postoperative antibacterial prophylaxis for the prevention of infectious
complications associated with tube thoracostomy in patients undergoing
elective general thoracic surgery: A double-blind, placebo-controlled,
randomized trial.
Source
JAMA Surgery. 148 (5) (pp 440-446), 2013. Date of Publication: May 2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Objective: To determine whether extended postoperative antibacterial
prophylaxis for patients undergoing elective thoracic surgery with tube
thoracostomy reduces the risk of infectious complications compared with
preoperative prophylaxis only. Design: Prospective, randomized,
double-blind, placebo-controlled trial. Setting: Brigham and Women's
Hospital, an 800-bed tertiary care teaching hospital in Boston,
Massachusetts. Participants: A total of 251 adult patients undergoing
elective thoracic surgery requiring tube thoracostomy between April 2008
and April 2011. Interventions: Patients received preoperative
antibacterial prophylaxis with cefazolin sodium (or other drug if the
patient was allergic to cefazolin). Postoperatively, patients were
randomly assigned (at a 1:1 ratio) using a computer-generated
randomization sequence to receive extended antibacterial prophylaxis
(n=125) or placebo (n=126) for 48 hours or until all thoracostomy tubes
were removed, whichever came first. Main Outcome Measures: The combined
occurrence of surgical site infection, empyema, pneumonia, and Clostridium
difficile colitis by postoperative day 28. Results: Atotal of 245 patients
were included in the modified intention-to-treat analysis (121 in the
intervention group and 124 in the placebo group). Thirteen patients
(10.7%) in the intervention group and 8 patients (6.5%) in the placebo
group had a primary end point (risk difference, -4.3% [95% CI, -11.3% to
2.7%]; P =.26). Six patients (5.0%) in the intervention group and 5
patients (4.0%) in the placebo group developed surgical site infections
(risk difference, -0.93% [95% CI, -6.1% to 4.3%]; P =.77). Seven patients
(5.8%) in the intervention group and 3 patients (2.4%) in the placebo
group developed pneumonia (risk difference, -3.4% [95% CI, -8.3% to 1.6%];
P =.21). One patient in the intervention group developed empyema. No
patients experienced C difficile colitis. Conclusions: Extended
postoperative antibacterial prophylaxis for patients undergoing elective
thoracic surgery requiring tube thoracostomy did not reduce the number of
infectious complications compared with preoperative prophylaxis only.
Trial Registration: clinicaltrials.gov Identifier: NCT00818766 2013
American Medical Association. All rights reserved.

<5>
Accession Number
2013308286
Authors
Kosiborod M. Arnold S.V. Spertus J.A. McGuire D.K. Li Y. Yue P. Ben-Yehuda
O. Katz A. Jones P.G. Olmsted A. Belardinelli L. Chaitman B.R.
Institution
(Kosiborod, Arnold, Spertus, Li, Jones) Department of Cardiovascular
Research, Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Kosiborod, Arnold, Spertus) Department of Medicine, University of
Missouri-Kansas City, Kansas City, MO, United States
(McGuire) Department of Internal Medicine, University of Texas
Southwestern Medical Center, Dallas, TX, United States
(Yue, Ben-Yehuda, Olmsted, Belardinelli) Gilead Sciences, Foster City, CA,
United States
(Katz) Department of Cardiology, Ashkelon and Faculty of Health Sciences,
Ben Gurion University, Ashkelon, Israel
(Chaitman) Department of Internal Medicine, Division of Cardiology, St.
Louis University, St. Louis, MO, United States
Title
Evaluation of ranolazine in patients with type 2 diabetes mellitus and
chronic stable angina: Results from the TERISA randomized clinical trial
(Type 2 Diabetes Evaluation of Ranolazine in Subjects with Chronic Stable
Angina).
Source
Journal of the American College of Cardiology. 61 (20) (pp 2038-2045),
2013. Date of Publication: 21 May 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to examine the efficacy of ranolazine versus
placebo on weekly angina frequency and sublingual nitroglycerin use in
subjects with type 2 diabetes mellitus, coronary artery disease (CAD), and
chronic stable angina who remain symptomatic despite treatment with up to
2 antianginal agents. Background: Patients with diabetes have more
extensive CAD than those without diabetes, and a high burden of angina.
Ranolazine is not only effective in treating angina but also may improve
glycemic control, thus providing several potential benefits in this
high-risk group. We conducted a randomized trial to test the antianginal
benefit of ranolazine in patients with diabetes and stable angina.
Methods: TERISA (Type 2 Diabetes Evaluation of Ranolazine in Subjects With
Chronic Stable Angina) was an international, randomized, double-blind
trial of ranolazine versus placebo in patients with diabetes, CAD, and
stable angina treated with 1 to 2 antianginals. After a single-blind,
4-week placebo run-in, patients were randomized to 8 weeks of double-blind
ranolazine (target dose 1000 mg bid) or placebo. Anginal episodes and
nitroglycerin use were recorded with daily entry into a novel electronic
diary. Primary outcome was the average weekly number of anginal episodes
over the last 6 weeks of the study. Results: A total of 949 patients were
randomized across 104 centers in 14 countries. Mean age was 64 years, 61%
were men, mean diabetes duration was 7.5 years, and mean baseline HbA1c
was 7.3%. Electronic diary data capture was 98% in both groups. Weekly
angina frequency was significantly lower with ranolazine versus placebo
(3.8 [95% confidence interval (CI): 3.6 to 4.1] episodes vs. 4.3 [95% CI:
4.0 to 4.5] episodes, p = 0.008), as was the weekly sublingual
nitroglycerin use (1.7 [95% CI: 1.6 to 1.9] doses vs. 2.1 [95% CI: 1.9 to
2.3] doses, p = 0.003). There was no difference in the incidence of
serious adverse events between groups. Conclusions: Among patients with
diabetes and chronic angina despite treatment with up to 2 agents,
ranolazine reduced angina and sublingual nitroglycerin use and was well
tolerated. (Type 2 Diabetes Evaluation of Ranolazine in Subjects With
Chronic Stable Angina [TERISA]; NCT01425359) 2013 American College of
Cardiology Foundation.

<6>
Accession Number
2013308092
Authors
Sharma V. Chamos C. Valencia O. Meineri M. Fletcher S.N.
Institution
(Sharma, Chamos, Valencia, Fletcher) St George's Hospital, London, United
Kingdom
(Meineri) Department of Anesthesia and Pain Medicine, Toronto General
Hospital, Toronto, ON, Canada
Title
The impact of internet and simulation-based training on transoesophageal
echocardiography learning in anaesthetic trainees: A prospective
randomised study.
Source
Anaesthesia. 68 (6) (pp 621-627), 2013. Date of Publication: June 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
With the increasing role of transoesophageal echocardiography in clinical
fields other than cardiac surgery, we decided to assess the efficacy of
multi-modular echocardiography learning in echo-naive anaesthetic
trainees. Twenty-eight trainees undertook a pre-test to ascertain basic
echocardiography knowledge, following which the study subjects were
randomly assigned to two groups: learning via traditional methods such as
review of guidelines and other literature (non-internet group); and
learning via an internet-based echocardiography resource (internet group).
After this, subjects in both groups underwent simulation-based
echocardiography training. More tests were then conducted after a review
of the respective educational resources and simulation sessions. Mean (SD)
scores of subjects in the non-internet group were 28 (10)%, 44 (10)% and
63 (5)% in the pre-test, post-intervention test and post-simulation test,
respectively, whereas those in the internet group scored 29 (8)%, 59
(10)%, (p = 0.001) and 72 (8)%, p = 0.005, respectively. The use of
internet- and simulation-based learning methods led to a significant
improvement in knowledge of transoesophageal echocardiography by
anaesthetic trainees. The impact of simulation-based training was greater
in the group who did not use the internet-based resource. We conclude that
internet- and simulation-based learning methods both improve
transoesophageal echocardiography knowledge in echo-naive anaesthetic
trainees. 2013 The Association of Anaesthetists of Great Britain and
Ireland.

<7>
Accession Number
2013310164
Authors
Ghaemian A. Nouraei S.M. Abdollahian F. Naghshvar F. Giussani D.A. Nouraei
S.A.R.
Institution
(Ghaemian, Nouraei, Abdollahian, Naghshvar) Mazandaran Heart Institute,
Mazandaran University of Medical Sciences, Department of Cardiovascular
Science, Mazandaran, Sari, Iran, Islamic Republic of
(Giussani, Nouraei) Department of Physiology, Neuroscience and
Development, University of Cambridge, Cambridge, United Kingdom
(Nouraei) Department of ENT Surgery, Charing Cross Hospital, London,
United Kingdom
Title
Remote ischemic preconditioning in percutaneous coronary
revascularization: A double-blind randomized controlled clinical trial.
Source
Asian Cardiovascular and Thoracic Annals. 20 (5) (pp 548-554), 2012. Date
of Publication: October 2012.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Objective: To assess the impact of pre-procedural remote ischemic
preconditioning on the incidence of myocardial complications following
percutaneous coronary intervention. Background: Ischemic preconditioning
of a remote vascular territory improves the subsequent ischemic tolerance
of distant organs. Method: The Myocardial Event Reduction with Ischemic
Preconditioning Therapy (MERIT) trial recruited 80 consecutive patients
undergoing elective angioplasty with drug-eluting stents to receive two
5-min lower limb tourniquet occlusions or an un-inflated tourniquet
(controls) 1 h before the procedure. The primary outcome was troponin T
level at 24 h. Secondary outcomes were intra-procedural chest pain and
ST-segment deviation. Results: 6 patients in the control group and 2 in
the ischemic preconditioning group had pre-procedural raised troponin T (p
= 0.23). This increased to 16 (40%) in the control group and 5 (12.5%) in
the study group at 24 h (p = 0.01). Fewer patients in the study group
experienced intra-procedural chest pain (1 vs. 7, p = 0.056). Mean
ST-segment deviation time was 13+/-35 s in the study group and 58+/-118 s
in the control group (p = 0.02). At a mean follow-up of 11 months, the
major adverse cardiac event rate did not differ significantly between the
groups. Conclusion: These data suggest that ischemic preconditioning
reduces the absolute risk of post-procedure cardiomyocyte necrosis by
27.5%, and reduces intra-procedural chest pain and ST-segment deviation in
patients undergoing percutaneous coronary interventions. We suggest its
routine use in percutaneous coronary intervention, although the long-term
prognostic impact in this patient group warrants further investigation.
The Author(s) 2012.

<8>
Accession Number
2013307254
Authors
Ma G. Chen J. Meng X. Deng L. Gao Y. Meng J.
Institution
(Ma, Chen, Deng, Gao, Meng) General Hospital of Ningxia Medical
University, Department of Anesthesiology, No. 804, Shenli nan street,
Yinchuan 750004, China
(Meng) Department of Gastroenterology, General Hospital of Ningxia Medical
University, Yinchuan, China
Title
High-dose propofol reduces S-100beta protein and neuron-specific enolase
levels in patients undergoing cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (3) (pp 510-515),
2013. Date of Publication: June 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: In a variety of experimental models, propofol has been shown
to protect the brain. It was hypothesized that a clinically achievable
high dose of propofol would induce cerebral protective effects in patients
undergoing cardiac surgery with cardiopulmonary bypass (CPB). The authors
investigated the effects of different target plasma concentrations of
propofol on cerebral injury by measuring serum S-100beta protein and
neuron-specific enolase (NSE) levels in patients undergoing single-valve
replacement with CPB. Design: A prospective, randomized study. Setting: A
university hospital. Participants: Forty-two patients undergoing
single-valve replacement with CPB. Interventions: Patients were randomly
divided into 3 groups (n = 14 each). Each group received a
target-controlled infusion of propofol with plasma concentrations of 1.8
mug/mL (low dose, Group-L), 2.4 mug/mL (medium dose, Group-M), or 3.2
mug/mL (high dose, Group-H). The propofol target concentrations were
unchanged throughout the surgery. Measurements and Main Results: In all 3
groups of patients, at all time points after CPB, the plasma S-100beta
protein and NSE levels, which served as biochemical markers of brain
damage, were significantly higher than the preoperative levels (p<0.05).
Group-H showed significant decreases in S-100beta protein and NSE compared
with Group-L (p< 0.05). Conclusion: In the range of commonly used clinical
concentrations, administration of a high dose of propofol during CPB
attenuated the biochemical markers of brain damage as compared with
low-dose propofol anesthesia. 2013 Elsevier Inc.

<9>
Accession Number
2013307251
Authors
Xu C.-E. Zou C.-W. Zhang M.-Y. Guo L.
Institution
(Xu, Zou) Department of Cardiac Surgery, Provincial Hospital Affiliated to
Shandong University, Jinan, China
(Zhang) Department of Anesthesiology, Provincial Hospital Affiliated to
Shandong University, 324# Jingwu-Weiqi Road, Jinan, 250021, Shandong
Province, China
(Guo) Department of Cardiology, Provincial Hospital Affiliated to Shandong
University, Jinan, China
Title
Effects of high-dose ulinastatin on inflammatory response and pulmonary
function in patients with type-A aortic dissection after cardiopulmonary
bypass under deep hypothermic circulatory arrest.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (3) (pp 479-484),
2013. Date of Publication: June 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To investigate effects of high-dose ulinastatin on the release
of proinflammatory cytokines and lung injury in patients with aortic
dissection after cardiopulmonary bypass (CPB) under deep hypothermic
circulatory arrest (DHCA). Design: A prospective, randomized and
double-blinded study. Setting: A teaching hospital. Participants:
Thirty-six patients with acute type-A aortic dissection undergoing cardiac
surgery using CPB under DHCA. Interventions: These patients randomly were
selected to received total doses of 20,000 units/kg of ulinastatin (n =
18) or 0.9% saline (control, n = 18) at 3 time points (after anesthetic
induction, before aortic cross-clamp, and after aortic cross-clamp
release). Measurements and Main Results: Tumor necrosis factor-alpha,
interleukin 6, interleukin 8 and polymorphonuclear neutrophil elastase
(PMNE) were measured after anesthetic induction (T0), 30 minutes (T1)
after aortic cross-clamp, 3 (T2), 6 (T3) and 9 (T4) hours after weaning
from CPB. Except for T1, pulmonary data, such as alveolar-arterial oxygen
pressure difference, physiologic deadspace, peak inspiratory pressure,
plateau pressure, static compliance and dynamic compliance, were obtained
at the same time points. Concentrations of cytokines and PMNE were
significantly lower in the ulinastatin group than the control group from
T1 to T4, and peaked at T2 between the 2 groups. Compared with the
pulmonary data of the control group at T2~T4, postoperative
alveolar-arterial oxygen pressure difference, physiologic deadspace, peak
inspiratory pressure, and plateau pressure significantly were lower, and
static compliance and dynamic compliance higher in the ulinastatin group.
Significantly shorter intubation time and intensive care unit stay were
found in the ulinastatin group. Conclusions: High-dose ulinastatin
attenuates the elevation of cytokines and PMNE, reduces the pulmonary
injury and improves the pulmonary function after CPB under DHCA.
Consequently, it shortens the time of intubation and intensive care unit
stay. 2013 Elsevier Inc.

<10>
Accession Number
2013310408
Authors
Canaud L. Patterson B.O. Peach G. Hinchliffe R. Loftus I. Thompson M.M.
Institution
(Canaud, Patterson, Peach, Hinchliffe, Loftus, Thompson) Department of
Outcomes Research, St. George's Vascular Institute, London, United Kingdom
Title
Systematic review of outcomes of combined proximal stent grafting with
distal bare stenting for management of aortic dissection.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (6) (pp 1431-1438),
2013. Date of Publication: June 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Available data on outcomes of combined proximal stent grafting
with distal bare stenting for management of aortic dissection are limited.
This is a systematic review of outcomes of this approach. Methods: Studies
involving combined proximal stent grafting with distal bare stenting for
management of aortic dissection were systematically searched and reviewed.
Results: A total of 4 studies were included, with 108 patients treated for
acute (n = 54) and chronic (n = 54) aortic dissection. Technical success
rate was 95.3% (range, 84-100). The 30-day mortality was 2.7% (range,
0%-5%). Morbidity rate within 30 days was 51.8% (range, 0%-65%) and
included stroke (2.7%), paraplegia (2.7%), retrograde dissection (1.8%),
renal failure (14.8%), severe cardiopulmonary complications (5.5%), and
bowel ischemia (0.9%). Incidence of type I endoleak was 9.2% (10/108).
During follow-up, 5 patient deaths (4.6%) were related to aortic rupture
or aortic repair. Reintervention rate was from 12.9%. Two cases of delayed
retrograde type A dissection (1.9%) and 1 case of aortobronchial fistula
(0.9%) were reported. Most common delayed complication was thoracic
stent-graft migration (4.7%). Device failure rate was 9.2%. Favorable
aortic remodeling was observed: studies reporting midterm follow-up of the
true lumen demonstrated high rates of false-lumen regression and
true-lumen expansion. At 12 months, complete false-lumen thrombosis was
observed at the thoracic level in 70.4% and at the abdominal level in
13.5%. Conclusions: Combined proximal stent grafting with distal bare
stenting for management of aortic dissection appears to be a reasonable
approach for type B aortic dissection, clearly improved true-lumen
perfusion and diameter although failing to suppress false-lumen patency
completely. Contemporary information on this approach is mainly provided
by small series with a wide range of results. 2013 by The American
Association for Thoracic Surgery.

<11>
Accession Number
2013311319
Authors
Aydin U. Aydin N. Gorur A. Findik O. Duzyol C. Yilmaz M. Orhan A.L.
Kocogullari C.U.
Institution
(Aydin, Gorur, Findik, Duzyol, Kocogullari) Department of Cardiovascular
Surgery, Kocaeli Derince Education and Research Hospital, 41900 Kocaeli,
Turkey
(Aydin) Department of Nuclear Medicine, Kocaeli Derince Education and
Research Hospital, Kocaeli, Turkey
(Yilmaz) Department of Anesthesiology, Kocaeli Derince Education and
Research Hospital, Kocaeli, Turkey
(Orhan) Department of Cardiology, Kocaeli Derince Education and Research
Hospital, Kocaeli, Turkey
Title
Cineangiographic intraoperative evaluation of venous grafts during
coronary bypass surgery.
Source
Journal of Cardiac Surgery. 28 (3) (pp 258-261), 2013. Date of
Publication: May 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background and Objective: Evaluation of graft patency is an important
component of coronary bypass surgery. In the present study, intraoperative
cineangiography was performed in a cardiovascular hybrid operating room to
evaluate anastomosis quality and patency of coronary venous grafts.
Method: This prospective study evaluated coronary bypass grafts in 34
patients between January 2012 and June 2012. Radiopaque material was
administered into the grafts through a vessel cannula before the proximal
anastomosis. Then, cineangiographic images were obtained using a mobile
C-arm cineangiography system. The myocardial perfusion scintigraphy (MPS)
of the patients was compared between preoperative and first month
postoperative periods to assess graft function. Results: The localization
of the grafts in the target vessel, structural status of the grafts,
anastomosis line, and availability of the target vessel were easily
evaluated. Angiographic defects were detected in two grafts (3%, n = 60)
in two patients (6%, n = 34). Staining was observed in the distal
myocardial segments of the saphenous vein grafts following the
administration of radiopaque material. The procedure took eight minutes,
on average (range, 5-14 minutes), and a mean of 15 mL (range, 10-35 mL) of
opaque material was used. None of the patients developed intraoperative
myocardial infarction, postoperative complications, or contrast
material-induced renal failure. No mortality was observed. The distal
myocardial segments of saphenous vein grafts were detected to be perfused
92% normally, 5% reversibly defective, and 3% irreversibly defective with
postoperative MPS controls. Conclusion: Cineangiographic graft evaluation
in a hybrid operating room is a practical, safe, noninvasive, easily
available, and easily applicable method. 2013 Wiley Periodicals, Inc.

<12>
Accession Number
2013311321
Authors
Onan B. Onan I.S. Kilickan L. Sanisoglu I.
Institution
(Onan, Onan, Sanisoglu) Department of Cardiovascular Surgery, Istanbul
Florence Nightingale Hospital, Istanbul, Turkey
(Kilickan) Department of Anesthesiology, Istanbul Florence Istanbul
Nightingale Hospital, Istanbul, Turkey
(Kilickan) Department of Anesthesiology and Reanimation, JFK Hospital,
Istanbul, Turkey
(Onan) Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Education and Research Hospital, Kalp
Ve Damar Cerrahisi Klinigi, Kucukcekmece, Istanbul 34303, Turkey
Title
Effects of epidural anesthesia on acute and chronic pain after coronary
artery bypass grafting.
Source
Journal of Cardiac Surgery. 28 (3) (pp 248-253), 2013. Date of
Publication: May 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objective: To evaluate the effects of thoracic epidural anesthesia (TEA)
as an adjunct to general anesthesia (GA) on postoperative pain after
coronary artery bypass grafting (CABG). Methods: Between April 2009 and
March 2010, 40 patients with ischemic heart disease scheduled for elective
CABG were prospectively randomized to receive either GA (n = 20) or GA +
TEA (n = 20). Through epidural catheters, patients received an infusion of
(10-20 mg/h) 0.25%-bupivacaine intraoperatively and during the first 24
hours after surgery. Study endpoints included assessment of postoperative
pain at rest and with coughing, rescue analgesic need, and postoperative
course. Results: The differences in pain scores were decreased at rest
during 6 (0.1 +/- 0.3 vs. 2.4 +/- 1.8; p < 0.05) and 12 hours (0.1 +/- 0.3
vs. 3.9 +/- 2.3; p < 0.05) and with coughing at 6 (0.1 +/- 0.3 vs. 5.6 +/-
2.2; p < 0.05), 12 (0.1 +/- 0.3 vs. 5.9 +/- 2.3; p < 0.05), and 24 hours
(0.05 +/- 0.2 vs. 4.6 +/- 2.9; p < 0.05) in the GA + TEA group. At
one-month follow-up, pain scores were decreased in GA + TEA group (0.3 +/-
0.7 vs. 1.6 +/- 1.3; p = 003). There was no significant difference at
three and six months. Mechanical ventilation time (4.7 +/- 1.2 vs. 2.9 +/-
1.1 hours; p < 0.05), intensive care unit stay (28.4 +/- 9.0 vs. 22.4 +/-
3.4 hours; p < 0.05), and hospital stay (7.2 +/- 1.1 vs. 6.1 +/- 0.3 days;
p = 0.001) were reduced in the GA + TEA group. Conclusions: TEA
significantly reduced the intensity of postoperative pain and analgesic
consumption in the early postoperative period following CABG. The delivery
of effective analgesia along with conventional medications may prevent
chronic pain after surgery. 2013 Wiley Periodicals, Inc.

<13>
Accession Number
2013311326
Authors
D'Errigo P. Biancari F. Maraschini A. Rosato S. Badoni G. Seccareccia F.
Institution
(D'Errigo, Maraschini, Rosato, Badoni, Seccareccia) National Centre for
Epidemiology, Surveillance and Health Promotion, Istituto Superiore di
Sanita, Rome, Italy
(Biancari) Department of Surgery, Oulu University Hospital, P.O. Box 21,
Oulu 90029, Finland
Title
Thirty-day mortality after coronary artery bypass surgery in patients aged
<50 years: Results of a multicenter study and meta-analysis of the
literature.
Source
Journal of Cardiac Surgery. 28 (3) (pp 207-211), 2013. Date of
Publication: May 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Young patients requiring myocardial revascularization are
considered at low operative risk, but data on their outcome are scarce.
This study was undertaken to evaluate the prevalence and 30-day mortality
of patients aged <50 years after isolated coronary artery bypass surgery
(CABG). Materials and methods: This is a multicenter study including 2207
patients aged <50 years undergoing isolated CABG at 68 Italian hospitals.
Results: The proportion of patients aged <50 years in this series was 5.3%
and varied significantly from 0% to 9.9% in different institutions (p <
0.0001). The 30-day mortality rate was 0.9%. One-to-one propensity score
matching of patients aged <50 years versus older patients resulted in 2013
pairs whose 30-day mortality was 0.9% and 2.2%, respectively (p = 0.001).
Logistic regression showed that left ventricular ejection fraction <30%
(OR 5.5, 95% CI 1.6-18.6), peripheral vascular disease (OR 3.6, 95% CI
1.1-12.0), pulmonary hypertension (OR 18.1, 95% CI 1.8-187.0), critical
preoperative state (OR 4.7, 95% CI 1.5-14.3), and emergency operation (OR
3.8, 95% CI 1.1-12.9) were independent predictors of 30-day mortality.
Meta-analysis of five studies reporting on patients aged <50 years who
underwent isolated CABG showed that operative mortality in these patients
was 0.9% (95% CI, 0.8-1.1%, I² 0%, 135/14,316 patients).
Conclusions: The proportion of patients aged <50 years undergoing CABG is
low and varies significantly among institutions. The results of this study
and a meta-analysis of the literature data showed that CABG can be carried
out in young patients with an extremely low risk of operative mortality.
2013 Wiley Periodicals, Inc.

<14>
Accession Number
2013307267
Authors
Richebe P. Picard W. Rivat C. Jelacic S. Branchard O. Leproust S. Cahana
A. Janvier G.
Institution
(Richebe, Rivat, Jelacic, Cahana) Department of Anesthesiology and Pain
Medicine, University of Washington Medical Center, Campus B. 356640, 1959
NE Pacific Street, Seattle, WA 98195-6540, United States
(Picard) Intensive Care Medicine, Centre Hospitalier Francois Mitterrand,
Pau, France
(Branchard, Janvier) Department of Anesthesiology and Intensive Care II,
Centre Hospitalier et Universitaire de Bordeaux, Pessac, France
(Leproust) University Hospital of Bordeaux, Clinical Epidemiology Unit,
Bordeaux, France
Title
Effects of nefopam on early postoperative hyperalgesia after cardiac
surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (3) (pp 427-435),
2013. Date of Publication: June 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The purpose of this randomized, double-blind placebo-controlled
study was to evaluate the effect of nefopam, a centrally acting
antinociceptive compound, on the development of hyperalgesia after
sternotomy. Preventive strategy giving nefopam from the early stage of
anesthesia was compared with a postoperative strategy only and placebo.
Design: This study was double-blinded and randomized. Setting: It was
conducted in a single university hospital. Participants: Ninety American
Society of Anesthesiologists II to III patients scheduled for elective
cardiac surgery. Interventions: Patients were assigned randomly to receive
a 0.3-mg/kg bolus of nefopam at the induction of anesthesia followed by a
continuous infusion of 0.065 mg/kg/h for 48 hours (G1), a 0.3-mg/kg bolus
of nefopam at the end of surgery followed by a continuous infusion of
0.065 mg/kg/h for 48 hours (G2), or a placebo (G3). Postoperative
analgesia was based on morphine patient-controlled analgesia and rescue
analgesia when necessary. Postoperative hyperalgesia, pain scores,
morphine consumption, and postoperative cognitive dysfunction were
assessed for the first 48 hours and thereafter on postoperative days 4 and
7. Measurements and Main Results: The postoperative extent of dynamic
hyperalgesia and the decrease of the nociceptive threshold evaluated by
von Frey filaments at the sternal midline were smaller in group 1 and
group 2 compared with the placebo group at the 24th hour. The primary
objective was the extent of hyperalgesia at the midline given as the mean
(standard deviation [SD]) (4.4 [2.5] cm for G1, 4.1 [2.7] for G2, and 6.1
[2.7] cm for G3. The punctuate is given as mean (SD) (64 [43] g for G1, 68
[40.8] g for G2, and 32 [27] g for G3; with p < 0.05 for the comparisons
of extent and punctuate hyperalgesia between G1 and G3 and G2 and G3). The
extent of hyperalgesia was not significantly different among the 3 groups
on days 2, 4, and 7 after surgery. There were no significant differences
in pain scores, morphine consumption, or postoperative cognitive
dysfunctions. Conclusions: Nefopam administered during the perioperative
period slightly reduced acute hyperalgesia after cardiac surgery, but this
was not associated with improved analgesic efficacy. 2013 Elsevier Inc.

<15>
Accession Number
2013300598
Authors
Daien C.I. Fesler P. Du Cailar G. Daien V. Mura T. Dupuy A.-M. Cristol
J.-P. Ribstein J. Combe B. Morel J.
Institution
(Daien, Combe, Morel) Department of Rheumatology, University Montpellier
I, Lapeyronie Hospital, Montpellier, France
(Daien, Combe, Morel) TNF Laboratory, CNRS, Montpellier, France
(Fesler, Du Cailar, Ribstein) Department of Internal Medicine and
Hypertension, Lapeyronie Hospital, Montpellier, France
(Daien) Department of Ophthalmology, Gui de Chauliac Hospital, INSERM,
Montpellier, France
(Mura) Department of Medical Information, Clinical Investigation Center,
Gui de Chauliac Hospital, Montpellier, France
(Mura, Dupuy) INSERM, CIC 1001, St Eloi Hospital, Montpellier, France
(Cristol) Department of Biochemistry, Lapeyronie Hospital, Montpellier,
France
Title
Etanercept normalises left ventricular mass in patients with rheumatoid
arthritis.
Source
Annals of the Rheumatic Diseases. 72 (6) (pp 881-887), 2013. Date of
Publication: June 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: Cardiovascular mortality is increased in patients with
rheumatoid arthritis (RA). RA is associated with an increased left
ventricular mass index (LVMI), a strong marker of cardiovascular
mortality, and vessel abnormalities. Experimental studies have suggested
that tumour necrosis factor alpha (TNFalpha) may induce LV hypertrophy.
Objective: To study the effect of medium-term (3- and 6-months) treatment
with the TNFalpha inhibitor etanercept (ETN) and synthetic
disease-modifying antirheumatic drugs (sDMARDs) on LV morphological
features and arterial stiffness in patients with RA. Methods: Consecutive
female patients with active RA requiring treatment with ETN (n=28) or
sDMARDs (n=20) were included. Clinical and biological monitoring,
echocardiography and pulse wave velocity (PWV) assessment were performed
at inclusion and at 3 and 6 months after the start of treatment. Paired t
tests and multivariate linear regression analysis were used. Results: Mean
LVMI tended to be higher at baseline in the ETN group than in the sDMARD
group (96.5+/-19.8 vs 84.3+/-26.8 g/m²; p=0.11 for the ETN and
sDMARD groups, respectively). In patients with ETN treatment, mean LVMI
was significantly decreased at 3 and 6 months (-6.3+/-7.6 and -14.2+/-9.3
g/m²; p<0.001), with no change from baseline for patients with
sDMARD treatment (-2.2+/-10.9 and -2.7+/-10.2 g/m²,
respectively). Blood pressure (BP) and aortic PWV were not changed by
either treatment. Conclusions: ETN induced a significant decrease in LVMI
with medium-term treatment with no change in BP or PWV. TNF alpha may be
an important factor of LV hypertrophy, which may explain the benefit of
TNF inhibitors on cardiovascular morbidity and mortality in RA. These
results need to be confirmed by larger studies and with other TNF
inhibitors.

<16>
Accession Number
2013312737
Authors
Hauer D. Kolassa I.-T. Laubender R.P. Mansmann U. Hagl C. Roozendaal B. de
Quervain D.J.-F. Schelling G.
Institution
(Hauer, Schelling) Department of Anaesthesiology, Ludwig-Maximilians
University, Munich 81377, Germany
(Kolassa) Institute of Psychology and Education, University of Ulm, Ulm
89069, Germany
(Laubender, Mansmann) Institute of Medical Informatics, Biometry and
Epidemiology, Ludwig-Maximilians University, Munich 81377, Germany
(Hagl) Department of Cardiac Surgery, Ludwig-Maximilians University,
Munich 81377, Germany
(Roozendaal) Department of Cognitive Neuroscience, Radboud University
Nijmegen Medical Centre and Donders Institute for Brain, Cognition and
Behaviour, Radboud University Nijmegen, Nijmegen, 6500 HB Nijmegen,
Netherlands
(de Quervain) Division of Cognitive Neuroscience, University of Basel,
Basel 4056, Switzerland
Title
A genotype-specific, randomized controlled behavioral intervention to
improve the neuroemotional outcome of cardiac surgery: Study protocol for
a randomized controlled trial.
Source
Trials. 14 (1) , 2013. Article Number: 89. Date of Publication: 01 Apr
2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Cardiac surgery is one of the most commonly performed surgical
procedures worldwide with >700,000 surgeries in 2006 in the US alone.
Cardiac surgery results in a considerable exposure to physical and
emotional stress; stress-related disorders such as depression or
post-traumatic stress disorder are the most common adverse outcomes of
cardiac surgery, seen in up to 20% of patients. Using information from a
genome-wide association study to characterize genetic effects on emotional
memory, we recently identified a single nucleotide polymorphism of the
glucocorticoid receptor gene (the Bcll single nucleotide polymorphism) as
a significant genetic risk factor for traumatic memories from cardiac
surgery and symptoms of post-traumaticstress disorder. The Bcll high-risk
genotype (Bcll GG) has a prevalence of 16.6% in patients undergoing
cardiac surgery and is associated with increased glucocorticoid receptor
signaling under stress. Concomitant animal experiments have confirmed an
essential role of glucocorticoid receptor activation for traumatic memory
formation during stressful experiences. Early cognitive behavioral
intervention has been shown to prevent stress-related disorders after
heart surgery.Methods/Design: The proposed study protocol is based on the
above mentioned earlier findings from animal experiments and preclinical
studies in volunteers. Patients (n = 872) will be genotyped for the Bcll
single nucleotide polymorphism before surgery, which should result in 120
homozygous high-risk carriers of the Bcll GG allele and 240 randomly
selected low-risk heterozygous or non-carriers of the single nucleotide
polymorphism. All patients will then undergo randomization to either
cognitive behavioral intervention or a control intervention consisting of
non-specific general information about the role of stress in heart
disease. The primary efficacy endpoint will be post-traumatic stress
levels at one year after surgery as determined by a standardized
questionnaire that has been specifically validated in patients after
critical illness.Discussion: The proposed randomized controlled trial
intends to demonstrate that a preoperatively administered minimal
cognitive behavioral intervention targeted to homozygous carriers of the
Bcll *G high-risk allele reduces traumatic memories and post-traumatic
stress disorder symptoms after heart surgery to a level seen in
non-carriers of the mutation, and thus improves the neuroemotional outcome
of cardiac surgery.Trial registration number: The trial will be registered
at http://www.clinicaltrials.gov/ before commencing with the study. 2013
Hauer et al.; licensee BioMed Central Ltd.

<17>
Accession Number
2013311334
Authors
Rousou J.A.
Institution
(Rousou) Division of Cardiac Surgery, Baystate Medical Center, North
Campus, 759 Chestnut Street, Springfield, MA 01107, United States
Title
Use of fibrin sealants in cardiovascular surgery: A systematic review.
Source
Journal of Cardiac Surgery. 28 (3) (pp 238-247), 2013. Date of
Publication: May 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Fibrin sealants are used for hemostasis and tissue adherence.
Aim of Study This systematic review summarizes published clinical data for
fibrin sealant use in cardiovascular surgery. Methods: A literature search
for the following terms was conducted using PubMed and EMBASE: (TISSEEL or
Tissucol or Beriplast P or Evicel or Quixil or Crosseal or Reliseal or
Fibringluraas or Bolheal or Tachosil or Vivostat or Vitagel or Artiss or
"fibrin glue" or "fibrin sealant" or "fibrin tissue adhesive") and
(cardiac or cardiovascular or vascular or heart or coronary or surgery).
Case reports and series were excluded; although reports of controlled
trials were preferred, uncontrolled trial data were also considered.
Results: Clinical trials and chart review analyses of fibrin sealants were
identified and summarized. Although clinical trial data were available for
other agents, the majority of published studies examined TISSEEL. Overall,
TISSEEL and other fibrin sealants showed improvements over standard of
care or control groups for a variety of predefined endpoints. Safety
findings are also summarized. Conclusions: Data from these studies showed
that fibrin sealants were well tolerated and provided effective hemostasis
in a range of cardiac and aortic surgeries. 2013 Wiley Periodicals, Inc.

<18>
Accession Number
2013308320
Authors
Pollack A. Nazif T. Mancini D. Weisz G.
Institution
(Pollack, Nazif, Mancini, Weisz) Department of Medicine, New
York-Presbyterian Hospital, Columbia University Medical Center, New York,
NY, United States
(Nazif, Weisz) Center for Interventional Vascular Therapy, New
York-Presbyterian Hospital, Columbia University Medical Center, 161 Fort
Washington Avenue, New York, NY 10032, United States
(Mancini) Center for Advanced Heart Failure and Cardiac Transplant, New
York-Presbyterian Hospital, Columbia University Medical Center, New York,
NY, United States
Title
Detection and imaging of cardiac allograft vasculopathy.
Source
JACC: Cardiovascular Imaging. 6 (5) (pp 613-623), 2013. Date of
Publication: May 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Cardiac allograft vasculopathy (CAV) is an important cause of morbidity
and mortality among cardiac transplant recipients. CAV occurs in
approximately 30% of patients by 5 years and 50% by 10 years, and is a
major cause of graft loss and death. Early detection of CAV is important
because it may allow alterations in medical therapy before progression to
the stage that revascularization is required. This has led to routine
screening for CAV in transplant recipients, traditionally by invasive
coronary angiography (ICA). Recent advances in imaging technology,
specifically intravascular ultrasound, now also permit detection of
subangiographic CAV. Noninvasive stress testing and multislice coronary
computed tomography angiography have been investigated as noninvasive
alternatives to routine ICA. However, currently available noninvasive
tests remain limited with respect to their sensitivity and specificity for
CAV. Given the multiple available diagnostic modalities, no consensus
definition for the classification of CAV has been widely accepted,
although new guidelines that rely heavily on ICA have recently been
published by the International Society of Heart and Lung Transplantation.
This review summarizes imaging modalities that are utilized in the
diagnosis and surveillance of CAV and explores newer imaging techniques
that may play a future role. 2013 American College of Cardiology
Foundation.

<19>
Accession Number
2013300006
Authors
Johnman C. Mackay D.F. Oldroyd K.G. Pell J.P.
Institution
(Johnman, Mackay, Pell) Institute of Health and Wellbeing, Public Health
and Health Policy, University of Glasgow, 1 Lilybank Gardens, Glasgow G12
8RZ, United Kingdom
(Oldroyd) West of Scotland Regional Heart and Lung Centre, Golden Jubilee
National Hospital, Glasgow, United Kingdom
Title
Quality of life following percutaneous coronary interventions in
octogenarians: A systematic review.
Source
Heart. 99 (11) (pp 779-784), 2013. Date of Publication: June 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: Overall, percutaneous coronary intervention (PCI) can improve
the symptoms and quality of life (QoL) of patients with coronary artery
disease. Older patients account for an increasing number and proportion of
PCIs, however they are more prone to adverse events. This study
systematically reviews the QoL benefits in this subgroup. Design and
setting A systematic review was undertaken, in accordance with the
Preferred Reporting Items for Systematic reviews and Meta-analysis
(PRISMA) guidelines, using Medline, Embase and Science Direct databases.
The search was limited to studies available in English; last run on 31
December 2012. Patients Patients aged >=80 years. Intervention PCI. Main
outcome measure QoL. Results: The process identified 11 articles which
reported QoL outcomes in octogenarians following PCI. In total, there were
700 octogenarian patients identified within the 11 studies with a mean age
of 82.9 years. Studies were heterogeneity in the populations, methodology
and QoL tools utilised. Overall, the literature suggests that QoL for
octogenarians improves following PCI. Older patients improve at least as
much as younger patients and may gain more in the areas of physical
functioning and improved angina status. The benefits are greatest in the
first 6 months and may continue until at least 3 years. Conclusions: QoL
following PCI in octogenarians improves at least as much as in younger
patients. Given the small number of studies resulting in a total of 700
octogenarian patients, further studies would be useful in determining
those octogenarian patients who are likely to derive the greatest benefit.

<20>
Accession Number
2013299984
Authors
Agostini P. Naidu B. Cieslik H. Steyn R. Rajesh P.B. Bishay E. Kalkat M.S.
Singh S.
Institution
(Agostini, Cieslik) Department of Physiotherapy, Heartlands Hospital,
Bordesley Green East, Birmingham B9 5SS, United Kingdom
(Naidu) School of Clinical and Experimental Medicine, University of
Birmingham, Birmingham, United Kingdom
(Naidu, Steyn, Rajesh, Bishay, Kalkat) Department of Thoracic Surgery,
Heart of England NHS Foundation Trust, Birmingham, United Kingdom
(Singh) Faculty of Health and Life Sciences, Coventry University,
Coventry, United Kingdom
Title
Effectiveness of incentive spirometry in patients Following thoracotomy
and lung resection including those at high risk for developing pulmonary
complications.
Source
Thorax. 68 (6) (pp 580-585), 2013. Date of Publication: June 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: Following thoracotomy, patients frequently receive routine
respiratory physiotherapy which may include incentive spirometry, a
breathing technique characterised by deep breathing performed through a
device offering visual feedback. This type of physiotherapy is recommended
and considered important in the care of thoracic surgery patients, but
high quality evidence for specific interventions such as incentive
spirometry remains lacking. Methods: 180 patients undergoing thoracotomy
and lung resection participated in a prospective single-blind randomised
controlled trial. All patients received postoperative breathing exercises,
airway clearance and early mobilisation; the control group performed
thoracic expansion exercises and the intervention group performed
incentive spirometry. Results: No difference was observed between the
intervention and control groups in the mean drop in forced expiratory
volume in 1 s on postoperative day 4 (40% vs 41%, 95% CI -5.3% to 4.2%,
p=0.817), the frequency of postoperative pulmonary complications (PPC)
(12.5% vs 15%, 95% CI -7.9% to 12.9%, p=0.803) or in any other secondary
outcome measure. A high-risk subgroup (defined by >=2 independent risk
factors; age >=75 years, American Society of Anaesthesiologists score >=3,
chronic obstructive pulmonary disease (COPD), smoking status, body mass
index >=30) also demonstrated no difference in outcomes, although a larger
difference in the frequency of PPC was observed (14% vs 23%) with 95% CIs
indicating possible benefit of intervention (-7.4% to 2.6%). Conclusions:
Incentive spirometry did not improve overall recovery of lung function,
frequency of PPC or length of stay. For patients at higher risk for the
development of PPC, in particular those with COPD or current/recent
ex-smokers, there were larger observed actual differences in the frequency
of PPC in favour of the intervention, indicating that investigations
regarding the physiotherapy management of these patients need to be
developed further.

<21>
Accession Number
2013246121
Authors
Jacobs A.K. Normand S.-L.T. Massaro J.M. Cutlip D.E. Carrozza Jr. J.P.
Marks A.D. Murphy N. Romm I.K. Biondolillo M. Mauri L.
Institution
(Jacobs) Boston University School of Medicine, Department of Medicine,
Boston Medical Center, Boston, MA, United States
(Normand, Cutlip, Mauri) Harvard Medical School, Boston, MA, United States
(Normand) Harvard School of Public Health, Boston, MA, United States
(Massaro) Boston University, Boston, MA, United States
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Carrozza Jr.) Tufts University School of Medicine, St. Elizabeth's
Medical Center, Boston, MA, United States
(Murphy, Romm, Biondolillo) Massachusetts Department of Public Health,
Boston, MA, United States
(Mauri) Cardiovascular Medicine, Department of Medicine, Brigham and
Women's Hospital, Boston, MA, United States
(Marks) Cardiovascular Center, South Shore Hospital, Weymouth, MA, United
States
Title
Nonemergency PCI at hospitals with or without on-site cardiac surgery.
Source
New England Journal of Medicine. 368 (16) (pp 1498-1508), 2013. Date of
Publication: 18 Apr 2013.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Emergency surgery has become a rare event after percutaneous
coronary intervention (PCI). Whether having cardiac-surgery services
available on-site is essential for ensuring the best possible outcomes
during and after PCI remains uncertain. METHODS: We enrolled patients with
indications for nonemergency PCI who presented at hospitals in
Massachusetts without on-site cardiac surgery and randomly assigned these
patients, in a 3:1 ratio, to undergo PCI at that hospital or at a partner
hospital that had cardiac surgery services available. A total of 10
hospitals without on-site cardiac surgery and 7 with on-site cardiac
surgery participated. The coprimary end points were the rates of major
adverse cardiac events - a composite of death, myocardial infarction,
repeat revascularization, or stroke - at 30 days (safety end point) and at
12 months (effectiveness end point). The primary end points were analyzed
according to the intention-to-treat principle and were tested with the use
of multiplicative noninferiority margins of 1.5 (for safety) and 1.3 (for
effectiveness). RESULTS: A total of 3691 patients were randomly assigned
to undergo PCI at a hospital without on-site cardiac surgery (2774
patients) or at a hospital with on-site cardiac surgery (917 patients).
The rates of major adverse cardiac events were 9.5% in hospitals without
on-site cardiac surgery and 9.4% in hospitals with on-site cardiac surgery
at 30 days (relative risk, 1.00; 95% one-sided upper confidence limit,
1.22; P<0.001 for noninferiority) and 17.3% and 17.8%, respectively, at 12
months (relative risk, 0.98; 95% one-sided upper confidence limit, 1.13;
P<0.001 for noninferiority). The rates of death, myocardial infarction,
repeat revascularization, and stroke (the components of the primary end
point) did not differ significantly between the groups at either time
point. CONCLUSIONS: Nonemergency PCI procedures performed at hospitals in
Massachusetts without on-site surgical services were noninferior to
procedures performed at hospitals with on-site surgical services with
respect to the 30-day and 1-year rates of clinical events. (Funded by the
participating hospitals without on-site cardiac surgery; MASS COM
ClinicalTrials.gov number, NCT01116882.) Copyright 2013 Massachusetts
Medical Society.

<22>
Accession Number
2013303407
Authors
Huang X. Lei S. Zhu M.-F. Jiang R.-L. Huang L.-Q. Xia G.-L. Zhi Y.-H.
Institution
(Huang) Department of Gastroenterology, First Affiliated Hospital,
Zhejiang Chinese Medical University, Hangzhou 310006, China
(Lei, Zhu, Jiang, Huang, Xia, Zhi) Department of Critical Care Medicine,
First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou
310006, China
Title
Levosimendan versus dobutamine in critically ill patients: A meta-analysis
of randomized controlled trials.
Source
Journal of Zhejiang University: Science B. 14 (5) (pp 400-415), 2013. Date
of Publication: May 2013.
Publisher
Zhejiang University Press (Hangzhou Post Bureau, Hangzhou 310000, China)
Abstract
Objective: To evaluate the clinical efficacy of levosimendan versus
dobutamine in critically ill patients requiring inotropic support.
Methods: Clinical trials were searched in PubMed, EMBASE, and the Cochrane
Central Registry of Clinical Trials, as well as Web of Science. Studies
were included if they compared levosimendan with dobutamine in critically
ill patients requiring inotropic support, and provided at least one
outcome of interest. Outcomes of interest included mortality, incidence of
hypotension, supraventricular arrhythmias, and ventricular arrhythmias.
Results: Data from a total of 3 052 patients from 22 randomized controlled
trials (RCTs) were included in the analysis. Overall analysis showed that
the use of levosimendan was associated with a significant reduction in
mortality (269 of 1 373 [19.6%] in the levosimendan group, versus 328 of 1
278 [25.7%] in the dobutamine group, risk ratio (RR)=0.81, 95% confidence
interval (CI) 0.70-0.92, P for effect=0.002). Subgroup analysis indicated
that the benefit from levosimendan could be found in the subpopulations of
cardiac surgery, ischemic heart failure, and concomitant beta-blocker
therapy in comparison with dobutamine. There was no significant difference
in the incidence of hypotension, supraventricular arrhythmias, or
ventricular arrhythmias between the two drugs. Conclusions: In contrast
with dobutamine, levosimendan is associated with a significant improvement
in mortality in critically ill patients requiring inotropic support.
Patients having cardiac surgery, with ischemic heart failure, and
receiving concomitant beta-blocker therapy may benefit from levosimendan.
More RCTs are required to address the questions about no positive outcomes
in the subpopulation in a cardiology setting, and to confirm the
advantages in long-term prognosis. 2013 Zhejiang University and
Springer-Verlag Berlin Heidelberg.

<23>
Accession Number
2013306939
Authors
Shah B.N. Khattar R.S. Senior R.
Institution
(Shah, Khattar, Senior) Department of Cardiology, Royal Brompton Hospital,
Sydney Street, London SW3 6NP, United Kingdom
(Shah, Khattar, Senior) Cardiovascular Biomedical Research Unit, Imperial
College, Royal Brompton Hospital, London, United Kingdom
Title
The hibernating myocardium: Current concepts, diagnostic dilemmas, and
clinical challenges in the post-STICH era.
Source
European Heart Journal. 34 (18) (pp 1323-1336), 2013. Date of Publication:
07 May 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A very large body of evidence - predominantly retrospective - suggests
that revascularization is superior to optimal medical therapy in patients
with a significant amount of 'hibernating' myocardium. Contemporary
cardiological practice has embraced this standard of practice, as many
centres worldwide place great emphasis upon the results of viability
testing by non-invasive imaging techniques in determining the need for
coronary revascularization. This practice has been challenged by the
recent results of the Surgical Treatment for Ischaemic Heart Failure
(STICH) trial, which suggested both lack of mortality benefit from
revascularization and also from viability testing. In this review article,
we have summarized the pathophysiology of hibernating myocardium, briefly
discussed each of the non-invasive imaging modalities used in contemporary
practice for detecting myocardial hibernation before critically appraising
the prospective studies in this field, most importantly the main STICH
trial and viability sub-study. STICH was clearly a complex trial but has
not ended the question over the benefit of revascularization in ischaemic
heart failure. Finally, we have suggested a possible methodology for an
'ideal trial' designed to evaluate the role of revascularization in such
patients and also explored how viability testing should be used in
clinical practice in the post-STICH era. 2013 Published on behalf of the
European Society of Cardiology. All rights reserved. The Author 2013.

<24>
Accession Number
71064796
Authors
Alrabte S.A.H. Bezanti K.
Institution
(Alrabte, Bezanti) Tripoli Children Hospital, Tripoli, Libyan Arab
Jamahiriya
Title
Role of intravenous immunoglobulin in the treatment of acute myocarditis.
Source
Cardiology in the Young. Conference: 47th Annual Meeting of the
Association for European Paediatric Cardiology, AEPC with Joint Sessions
with the Japanese Society of Pediatric Cardiology and Cardiac Surgery and
Asia-Pacific Pediatric Cardiac Society London United Kingdom. Conference
Start: 20130522 Conference End: 20130525. Conference Publication:
(var.pagings). 23 (pp S96), 2013. Date of Publication: May 2013.
Publisher
Cambridge University Press
Abstract
Background: Acute myocarditis is rare disease in infants and childhood,
the role of Immunosuppressive agents and Intravenous Immunoglobulin in the
treatment of this disease was investigated by many researchers. The
immunosuppressive agents found to be not effective. The potential benefits
of Intravenous Immunoglobulin (IVIG) are promising in the treatment of
patients with acute myocarditis and recent onset Dilated Cardiomyopathy
(DCM). The aim of this study: Is to investigate the benefit of IVIG in the
patient with acute myocarditis and dilated cardiomyopathy as indicated by
the analysis of the improvement in the ventricular contractility. Patient
and method: A nonrandomized controlled clinical trial conducted in the
cardiology department at Tripoli Children's Hospital from 2002-2005. Forty
patients (40) were diagnosed with acute myocarditis and Dilated
Cardiomyopathy based on clinical features, laboratory data and
echocardiograph findings. Left Ventricular Ejection Fraction (LVEF) ,55%
were the main inclusion criteria. The Age at presentation, sex and the
presenting symptoms, of the patient were recorded they were followed up at
3, 6, and 12 months after the treatment. Results: The median for the age
at presentation was 9 months, Male to female ratio is 1:1.5, and
congestive heart failure was the common presenting symptom. Thirteen
patients (13) were treated with Intravenous Immunoglobulin (IVIG) (0.4
g/kg/day) for 5 days; all patients were followed to see the changes of
left Ventricular Ejection Fraction (LVEF). In this group the LVEF
determined by Echocardiogram improved from 0.44+/-0.025 (mean+/- S.D) at
base line to 0.59+/-0.36 at follow up over the course of one year
(P<0.01). LVEF improved 15 EF units in those patients received IVIG
compared with the other group who did not receive IVIG where the LVEF
changed from 0.36+/-0.029 at base line to 0.40+/-0.06 at the end of one
year follow up (P=0.08) and the LVEF improved just 9 EF units. Conclusion
and Recommendation: IVIG seems to be a promising agent in the treatment of
acute myocarditis. The effectiveness of intravenous immunoglobulin therapy
in acute myocarditis should be evaluated further in randomised multicenter
trials.

<25>
Accession Number
71064793
Authors
Duppen N. Kapusta L. De Rijke Y. Snoeren M. Kuipers I.M. Blank A.C. Blom
N.A. Dulfer K. Utens E.M.W.J. Hopman M. Helbing W.A.
Institution
(Duppen, De Rijke, Dulfer, Utens, Helbing) Erasmus MC, Rotterdam,
Netherlands
(Kapusta, Snoeren, Hopman) Radboud University, Nijmegen Medical Center,
Nijmegen, Netherlands
(Kuipers) Academic Medical Center, Amsterdam, Netherlands
(Blank) University MC Utrecht, Utrecht, Netherlands
(Blom) Leiden University Medical Center, Leiden, Netherlands
Title
Exercise training improves fitness without adverse cardiac remodelling in
patients after repair of tetralogy of fallot: Preliminary results of the
TOFFIT study.
Source
Cardiology in the Young. Conference: 47th Annual Meeting of the
Association for European Paediatric Cardiology, AEPC with Joint Sessions
with the Japanese Society of Pediatric Cardiology and Cardiac Surgery and
Asia-Pacific Pediatric Cardiac Society London United Kingdom. Conference
Start: 20130522 Conference End: 20130525. Conference Publication:
(var.pagings). 23 (pp S95), 2013. Date of Publication: May 2013.
Publisher
Cambridge University Press
Abstract
Objective: To assess a) whether aerobic exercise training (AET) improves
exercise capacity and b) if AETresults in adverse cardiac remodelling, in
children and young adults after repair of tetralogy of Fallot (TOF).
Methods: Design: multicenter randomized controlled trial. Fortyseven
participants after repair of TOF were recruited from 5 tertiary referral
centres. Participants were assigned to an interventional or control group.
All underwent cardiopulmonary exercise testing and cardiac MRI before and
after a 12 week period. Patients in the intervention group performed
supervised aerobic exercise training (AET) for 12 weeks. AET consisted of
2-3 sessions/week, for 1 hour/session at an exercise level predicted by
60-70% of heart rate reserve. The control group did not change their life
style. Results: Preliminary results of the 47 participants after TOF
repair: baseline characteristics of the intervention (AET) group (n=27):
age 15.5+/-2.8 years; 21 males; controls (n=20): age 16.0+/-2.6; 12 males.
After the 12 week AET program peak VO2 of the intervention group improved
slightly and significantly (35.6+/-7.1 vs 37.8+/-8.1 ml/kg/min, p=0.02).
In the control group no changes were noted (33.8+/-8.0 vs
34.8+/-8.0ml/kg/min). Maximal work load of the intervention group improved
significantly (170+/-56 vs 179+/-53 Watt, p=0.001). The control group did
not show any change (167+/-36 vs 168+/-39 Watt). The oxygen uptake
efficiency slope (OUES) did not change in either group. Cardiac MRI did
not reveal significant changes for right and left ventricular size and
function in either group. For the AET TOF group vs TOF controls: RVEDV AET
group: pre-intervention 127+/-37 vs 122+/-30 ml/m²
post-intervention; controls 132+/-39 vs 130+/-42 ml/m². RVSV
AET: pre-intervention 61+/-14 vs 61+/-14 ml/m²
post-intervention; controls 66+/-17 vs 65+/-19 ml/m². RVEFAET:
pre-intervention 50+/-9 vs 51+/-7% post-intervention; controls 51+/-7 vs
51+/-6%. LVEDV AET: 82+/-13 vs 84+/-21 ml/m²; controls 83+/-7
vs 81+/-12ml/m². LVSV AET: 48+/-6 vs 47+/-6ml/m²;
controls 51+/-7 vs 50+/-9ml/m². LVEF AET: 60+/-10 vs 60+/-9%;
controls 51+/-7% vs 51+/-6%. Conclusion: Aerobic exercise training
improves exercise capacity of children and young adults after repair of
tetralogy of Fallot. Interim analysis did not show adverse cardiac
remodelling.

<26>
Accession Number
71064563
Authors
Prendiville T. Clapp A. Ozonoff A. Abrams D.
Institution
(Prendiville, Clapp, Ozonoff, Abrams) Boston Children's Hospital, Boston,
United States
Title
Defining cardiac ion channelopathies in sudden infant death syndrome: A
systematic review.
Source
Cardiology in the Young. Conference: 47th Annual Meeting of the
Association for European Paediatric Cardiology, AEPC with Joint Sessions
with the Japanese Society of Pediatric Cardiology and Cardiac Surgery and
Asia-Pacific Pediatric Cardiac Society London United Kingdom. Conference
Start: 20130522 Conference End: 20130525. Conference Publication:
(var.pagings). 23 (pp S6-S7), 2013. Date of Publication: May 2013.
Publisher
Cambridge University Press
Abstract
Introduction (or Basis or Objectives): Sudden Infant Death Syndrome (SIDS)
is the third leading cause of death in infancy. Cardiac ion
channelopathies have been implicated in a proportion of the deaths based
on retrospective DNA analysis in case reports and SIDS registry material.
Our aim was to collate and accurately define the reported contribution of
lethal ion channelopathies in SIDS victims that have been robustly
characterized and functionally confirmed. Methods: With a formally
constructed search algorithm, we reviewed the National Library of
Medicine's MEDLINE database for all putative cardiac ion channelopathy
mutations associated with a SIDS death. 614 abstracts were screened for
relevance with 128 full-text articles pulled for review. Fourteen original
studies that met full inclusion criteria were selected for quantitative
synthesis. Results: We identified 36 SIDS victims in 6 countries from
2001-2012 who died from a functionally confirmed mutation in one of 11
cardiac ion channels, namely SCN5A (n=10), KCNH2 (n=4), KCNQ1 (N=4), CAV3
(n=3), SNTA1 (n=3), GPD1-L (n=3), SCNb (n=3), KCNJ8 (n=2), RYR2 (n=2),
GJA1 (n=1), and KCNE2 (n=1). One SIDS victim was a compound heterozygote
for a known pathological SCN5A mutation (S1333Y) and a novel KCNE1
mutation (T20I; no functional data provided). A further two SIDS victims
had known pathological mutations in KCNH2 (T895M) and SCN5A (del AL
586-587) with rare polymorphisms in SCN5A (G1084S) and CAV3 (T78M),
respectively. Excluding case reports, the prevalence of specific cardiac
ion channelopathies was calculated with the denominator being all SIDS
victims screened. The aggregate proportion of SIDS victims with
functionally confirmed cardiac ion channel mutations was 12.4%. For the
averaged prevalence of a specific cardiac ion channel mutation in SIDS
victims, please see table. Conclusions: The specific ion channelopathies
identified in SIDS victims differ in their prevalence to that of the
general population at large, having implications on the order and priority
of which ion channel genes are screened for first.

<27>
Accession Number
71067127
Authors
Mohari N. Starr J.P. Gates R.N. Domico M.B. Batra A.S.
Institution
(Mohari, Starr, Gates, Domico, Batra) CHOC/H-UCLA, Torrance, CA USA, CHOC,
Orange, CA USA
Title
Clinical reliability of bipolar versus unipolar temporary epicardial
pacing leads in patients after surgery for congenital heart disease:
Interim results of a prospective, randomized, controlled study.
Source
Heart Rhythm. Conference: 34th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2013 Denver, CO United States. Conference
Start: 20130508 Conference End: 20130511. Conference Publication:
(var.pagings). 10 (5 SUPPL. 1) (pp S286), 2013. Date of Publication: May
2013.
Publisher
Elsevier
Abstract
Introduction: There have been no studies comparing the clinical
reliability of bipolar vs. unipolar temporary epicardial pacing leads in
patients after surgeryfor congenital heart disease (CHD). This study was
undertaken to compare the sensing and pacing thresholds of unipolar vs.
bipolar temporary epicardial pacing leads in patients after surgeryfor CHD
over time. Methods: This was a prospective randomized controlled study of
patients undergoing surgeryfor CHD. Thirty patients were randomized to
receive either unipolar or bipolar temporary epicardial pacing leads in
the ventricles at the time of surgery. The pacing threshold (mA) and
sensing threshold (mV) were recorded daily until the removal of leads or
for a maximum duration of 7 post-operative days (PODs). Results: Patients
were randomized to bipolar (n=16, males=9, age=2.85+/-1.19years) and
unipolar (n=14, males=7, age=3.68+/-1.32 years). There was no statistical
difference in the sensing or pacing thresholds between the 2 groups for
the first three PODs (Figure). However, the mean sensing and pacing
thresholds were superior for bipolar leads when compared to unipolar leads
from POD 3. There were no sensing or pacing failures of bipolar or
unipolar leads. Conclusion: The bipolar temporary pacing leads tend to
have superior sensing and pacing thresholds from POD3 when compared to
unipolar leads in patients undergoing surgeryfor CHD. (Figure presented).

<28>
Accession Number
71067093
Authors
Lee G. Hunter R. Berriman T.J. Kamdar R. Baker V. Goromonzi F. Sawhney V.
Page S. Unsworth B. Mayet J. Dhinoja M. Earley M. Sporton S. Schilling R.
Institution
(Lee, Hunter, Berriman, Kamdar, Baker, Goromonzi, Sawhney, Page, Unsworth,
Mayet, Dhinoja, Earley, Sporton, Schilling) Barts and the London NHS,
London, United Kingdom
Title
Cost effectiveness of catheter ablation versus a rate control strategy for
treatment of persistent atrial fibrillation in patients with advanced
heart failure. An analysis of the camtaf study.
Source
Heart Rhythm. Conference: 34th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2013 Denver, CO United States. Conference
Start: 20130508 Conference End: 20130511. Conference Publication:
(var.pagings). 10 (5 SUPPL. 1) (pp S273), 2013. Date of Publication: May
2013.
Publisher
Elsevier
Abstract
Introduction: Persistent atrial fibrillation (PerAF) and heart failure
(HF) both result in significant morbidity, reduction in quality of life
and substantial utilization of healthcare resources. The aim of this study
was to evaluate the cost effectiveness of catheter ablation (CA) compared
to a rate control strategy in patients with PerAF and HF as performed in
the randomized controlled study CAMTAF. Methods: We performed an economic
analysis looking at direct health care cost and quality adjusted life year
(QALY) data obtained from the CAMTAF. An incremental cost effective ratio
analysis (ICER) was performed at 6 months. Costs for each patient were
individually determined using National Health Service reimbursement tariff
data. Results: 26 patients underwent CAfor PerAF and 25 patients underwent
a rate control strategy. Baseline characteristics were similar between the
two arms. Freedom from AF was achieved in 21/26 (81%) in the CA group at 6
months. CA was associated with a greater improvement in QALY at 6 months
compared to a rate control strategy (0.76+/-0.17vs. 0.59+/-0.19, p<0.05).
Improvements were sustained at one-yearfollow up. There was an absolute
improvement in QALY of 0.209 for CA at an additional cost of 3833.10. The
incremental cost effective ratio cost of CA vs. a rate control strategy
was 31,637. This is comparable to similar cost effective interventions
such as renal dialysis (ICER=21,970) or TAVI (ICER=36, 326) Conclusion:
Catheter ablation of PerAF in patients with HF is a cost-effective
strategy that leads to restoration of sinus rhythm, improvement in quality
of life and left ventricular function compared to a rate control strategy.

<29>
Accession Number
71066256
Authors
Thoma B. Pizzi L. McDaniel C. Jefferson T. Li J. Mearns E. Wordell C.
Cavarocchi N.
Institution
(Thoma, Wordell) Thomas Jefferson University Hospital, United States
(Pizzi, Mearns) Thomas Jefferson University, School of Pharmacy, United
States
(McDaniel, Jefferson) University Hospital, United States
(Li) South Texas Veterans Health Care System, United States
(Cavarocchi) Thomas Jefferson University, United States
Title
Dexmedetomidine versus propofol and midazolam in patients undergoing
coronary artery bypass grafting surgery.
Source
Critical Care Medicine. Conference: 42nd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2013 San Juan Puerto Rico.
Conference Start: 20130119 Conference End: 20130123. Conference
Publication: (var.pagings). 40 (12 SUPPL. 1) (pp 283), 2012. Date of
Publication: December 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Propofol (PROP) has been shown to reduce duration of
mechanical ventilation (DMV) in patients undergoing coronary artery bypass
grafting surgery (CABG) without increasing postoperative complications.
Due to a nationwide shortage of PROP, utilization of alternative agents
such as midazolam (MIDAZ) and dexmedetomidine (DEX) has been necessary.
Drug costs favor use of MIDAZ, but based on its pharmacology, DEX may have
better outcomes. Hypothesis: Use of DEX, as compared to PROP or MIDAZ,
will decrease DMV, ICU length of stay (LOS), and postoperative LOS in
patients undergoing elective, isolated CABG, with favorable economic
outcomes. Methods: A retrospective cohort study of patients (pts)
undergoing elective isolated CABG between January 2008-December 2011 at a
single institution was performed. Pts were identified via a surgery
database and MS-DRG codes and separated into 3 treatment groups based on
sedative agent used immediately postoperatively. Pts were matched 1:1:1
based on age, sex, number of vessels, and bypass time. Results: Ninety
patients were included, 42 pts each in the DEX and PROP groups and 6 in
the MIDAZ group. Baseline demographics were similar between all groups.
More pts in the DEX group were extubated?6h (p<0.001). Fewer pts in the
DEX group required DMV? 24h (p=0.005). There was a trend towards ICU
LOS?48h in the DEX group compared to PROP and MIDAZ groups, though not
significant (p=0.06). More pts in the DEX group had postop hospital LOS?5d
(p=0.01) and overall hospital LOS?7d (p<0.001). Average cost of drug
therapy was greater in the DEX arm but was offset by savings in cost of
room/board associated with a decrease in LOS: the per-patient total
hospital room/board savings was $4,246 for choosing DEX versus PROP, and
$9,988 for choosing DEX versus MIDAZ (p=0.035). Conclusions: DEX was shown
to have significantly better outcomes with respect to DMV, ICU LOS,
overall hospital LOS when analyzed based on significant time points, and
is associated with significant cost savings. Randomized, controlled
studies are needed to confirm these results.

<30>
Accession Number
71066073
Authors
Thoma B. Kipp K. Cavarocchi N.
Institution
(Thoma, Kipp) Thomas Jefferson University Hospital, United States
(Cavarocchi) Thomas Jefferson University, United States
Title
Continuous infusions of high dose bumetanide to induce diuresis in volume
overloaded critically ill cardiac and cardiothoracic surgery patients.
Source
Critical Care Medicine. Conference: 42nd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2013 San Juan Puerto Rico.
Conference Start: 20130119 Conference End: 20130123. Conference
Publication: (var.pagings). 40 (12 SUPPL. 1) (pp 235), 2012. Date of
Publication: December 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Continuous infusions (CI) of loop diuretics provide constant
delivery of drug to site of action in the kidney, resulting in a
continuous natriuretic effect. Data supporting the efficacy/safety of CI
of high dose bumetanide (CIHDB) are sparse. A detailed review of a single
institution's experience will help fill the gap in literature. Hypothesis:
CIHDB are effective in inducing diuresis and achieving dry weight in
critically ill cardiac and cardiothoracic (CT) surgery patients (pts) with
significant volume overload without causing new-onset acute renal failure.
Methods: A retrospective electronic/paper chart review of all pts treated
with a CIHDB at a single institution was performed. Pts receiving an
infusion of 1-2 mg/hr bumetanide with sufficient data were included. Pts
were excluded if the infusion rate remained <1 mg/hr or if receiving
concomitant renal replacement therapy (RRT) or aquaphoresis. Data
collected included weights, dosing of intermittent loop diuretics and
CIHDB, urine output (UOP), serum creatinine, need for RRT. Kidney Disease:
Improving Global Outcomes (KDIGO) criteria were used to stage severity of
acute kidney injury (AKI). Results: Thirty-eight pts treated for a mean of
53 hours were included. All pts received at least one dose of IV loop
diuretics in the 24 hours preceding CIHDB, while 74% received a bolus of
bumetanide IV 2-4 mg within 2 hours preceding CIHDB. Prior to initiation
of CIHDB, mean volume overload was +6.2 kg (-1.8 to 11.8 kg) above dry
weight; mean UOP was 0.9 cc/kg/hr (0.2-3 cc/kg/hr). After the first 24
hours, UOP increased to 1.6 cc/kg/ hr (p<0.001) and to 1.9 cc/kg/hr
(p<0.001) after the second 24 hours. Mean weight loss following CIHDB was
5.2 kg. At baseline, 16 (42%) had stage 1-2 AKI. Following CIDHB, 6 (38%)
of these pts progressed to stage 3 AKI, but were maintained on CIHDB for
3-48 hours prior to RRT. After CIHDB, an additional 12 pts had stage 1-2
AKI, 10 of which were new onset. Conclusions: CIHDB is effective at
improving UOP and achieving significant weight loss in critically ill
cardiac and CT surgery pts. Optimizing diuretic therapy may potentially
delay/avoid RRT. Further randomized, controlled studies are needed to
support these results.

<31>
Accession Number
71065690
Authors
Mohari N. Starr J. Gates R. Domico M. Batra A.
Institution
(Mohari) H-UCLA and Children's Hospital of Orange County, United States
(Starr, Gates) St. Joseph Hospital, United States
(Domico) Children's Hospital of Orange county, United States
(Batra) UCI and Children's Hospital of Orange County, United States
Title
Prospective randomized controlled study of bipolar versus unipolar
temporary epicardial pacing leads in patients after surgery for congenital
heart disease: Interim analysis.
Source
Critical Care Medicine. Conference: 42nd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2013 San Juan Puerto Rico.
Conference Start: 20130119 Conference End: 20130123. Conference
Publication: (var.pagings). 40 (12 SUPPL. 1) (pp 135-136), 2012. Date of
Publication: December 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Bipolar temporary epicardial pacing leads have been designed
to have better conduction characteristics than unipolar leads. In adults
undergoing surgery for coronary artery disease, bipolar ventricular leads
have been reported to be superior to unipolar leads. This study has been
undertaken to compare the characteristics of unipolar and bipolar
temporary epicardial pacing leads in the patients undergoing surgery for
congenital heart disease, as no trials have been reported in this
population. Hypothesis: We hypothesize that bipolar temporary epicardial
pacing leads have superior pacing and sensing capabilities when compared
with unipolar epicardial pacing leads. Methods: This is a prospective
randomized unblinded controlled study of patients undergoing surgery for
congenital heart disease in Cardiovascular Intensive Care Unit. Patients
are randomized to receive either unipolar or bipolar temporary epicardial
pacing ventricular leads at the time of surgery. The minimum current
required to pace the heart (in milliamperes, mA), pacing threshold and
minimum voltage sensed by the leads (in millivolt, mV), sensing threshold
is studied until the day of removal of leads or for a maximum duration of
7 post-operative days (POD). The median (interquartile range) thresholds
were obtained. Results: Interim analysis of data from 18 patients showed a
trend of lower median pacing thresholds of bipolar leads 0.8 mA (0.5-1.75)
on POD 1 and 1.5 mA (1.25-3.25) on POD 2 as compared with unipolar leads
1.5 mA (1-2 mA) on POD 1 and 2.5 mA (1.75-5.25) on POD 2. In addition, the
median sensing thresholds were superior for bipolar leads 14 mV (6-20) on
POD 1 and 12 mV (6-16) on POD 2 as compared with unipolar leads 10 mV
(10-18) on POD 1 and 10.5 mV (6.5-16) on POD 2. There were no sensing or
pacing failures of bipolar and unipolar leads in the ventricular position.
Conclusions: The bipolar pacing leads are clinically reliable in the
ventricular position in patients undergoing surgery for congenital heart
disease and likely have superior sensing and lower pacing thresholds when
compared to unipolar leads. Additional data with patients having the leads
for longer duration is necessary to assess the thresholds beyond the
second POD.

<32>
Accession Number
71065562
Authors
Parke R. McGuinness S. Jull A. Dixon R.
Institution
(Parke) Cardiothoracic and Vascular ICU, Auckland District Health Board,
New Zealand
(McGuinness) Auckland District Health Board, New Zealand
(Jull, Dixon) University of Auckland, New Zealand
Title
Randomised controlled trial of prophylactic nasal high flow oxygen after
cardiac surgery.
Source
Critical Care Medicine. Conference: 42nd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2013 San Juan Puerto Rico.
Conference Start: 20130119 Conference End: 20130123. Conference
Publication: (var.pagings). 40 (12 SUPPL. 1) (pp 102), 2012. Date of
Publication: December 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Respiratory complications are well recognised following
cardiac surgery and have been shown to increase morbidity, mortality and
length of stay. Previous studies suggest that delivery of positive airway
pressure following extubation may be beneficial. Hypothesis: We
hypothesised that the administration of prophylactic nasal high flow
oxygen therapy (NHF) would improve pulmonary function after cardiac
surgery. Methods: A prospective randomised controlled trial was
undertaken. Participants received either NHF (45L/min) or standard care
from extubation to post-operative day 2. For both groups, oxygen
concentration was controlled by the treating clinician to achieve a target
oxygen saturation of? 93%. The primary outcome was SpO2/FiO2ratio? 445 on
post-operative day 3. Sample size was calculated on a 15% absolute
reduction in primary outcome -? = 0.05 and 90% power to detect treatment
effect. Secondary outcomes included atelectasis score on chest x-ray;
spirometry; readmission to ICU for respiratory causes; ICU and hospital
length of stay; mortality and incidence of respiratory complications at
day 28; oxygenation variables; use of adjunctive respiratory support
therapies; escalation of respiratory support; adverse events and patient
comfort during administration of oxygen therapy. Results: Over 14 months
340 patients were randomised. The number of patients with a SpO2/FiO2
ratio? 445 on day 3 was 78 (46.4%) in the NHF group vs 72 (42.4%) in the
standard care group (p= 0.45; Odds Ratio 1.18 95%CI 0.77 to 1.81). PaCO2
was significantly reduced at both 4 hours post-extubation and at 0900
hours day 1 (NHF 39.7 vs standard care 41.3mmHg p=0.029 and NHF 38.2 vs
standard care 39.7mmHg p=0.029 respectively). 47 patients (27.8%)
allocated to NHF required an escalation in support compared to 77 (45%)
standard care (p=0.001; Odds Ratio 0.47 95% CI 0.29 - 0.7). Subgroup
analysis demonstrated that gender and BMI had no influence on the primary
outcome. Conclusions: The use of NHF was not associated with an increase
in SpO2/FiO2 ratio on day 3 post-operative, although it was associated
with a reduction in escalation of respiratory therapy and a significantly
lower PaCO2.

<33>
Accession Number
71065421
Authors
Murthy K. Gowda N. Walters III H. Delius R. Mastropietro C.
Institution
(Murthy, Gowda, Walters III, Delius, Mastropietro) Children's Hospital of
Michigan, United States
Title
Passive peritoneal drainage is more effective than pleural drainage in the
prevention of fluid overload after surgery for congenital heart disease.
Source
Critical Care Medicine. Conference: 42nd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2013 San Juan Puerto Rico.
Conference Start: 20130119 Conference End: 20130123. Conference
Publication: (var.pagings). 40 (12 SUPPL. 1) (pp 65), 2012. Date of
Publication: December 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In some centers, peritoneal drainage (PD) tubes are placed
intraoperatively in addition to or instead of conventional pleural tubes
to help prevent post-operative fluid overload in patients after surgery
for congenital heart disease. The utility of this practice has not been
prospectively studied. Hypothesis: Passive PD more effectively promotes
negative fluid balance as compared to pleural drainage after surgery for
congenital heart disease. Methods: An IRB-approved prospective randomized
controlled study of children < 2 years undergoing repair of isolated right
ventricular outflow tract obstruction (RVOTO) with ventricular septal
defect or complete atrioventricular septal defect (AVSD) was initiated at
our institution in September 2011. Patients were randomized to either PD
or right pleural tube in addition to the requisite mediastinal tube. The
primary outcome measure was fluid balance at 48 hours post-operatively.
Variables were compared between groups using Mann-Whitney U tests.
Results: Thus far, 16 patients have been enrolled: 11 RVOTO and 5 AVSD, of
which 9 had PD and 7 had pleural tubes. Median age, cardiopulmonary bypass
duration, surgeon, and initial postoperative central venous pressure,
vasoactive inotrope score, and ventilation index were not statistically
different between groups. During the first 48 hours, median fluid input,
urine output, mediastinal output, and cumulative furosemide dose were also
not statistically different. Median fluid balance in those with PD and
pleural drainage however, was -35 mL kg-1 (range: -140, +9) and +22 mL
kg-1 (range: -70, +122), respectively, P=0.039. Median PD was 129 mL kg-1
(range: 28, 207) while median pleural drainage was 41 mL kg-1 (range: 25,
72). Median vasoactive inotrope score at 48 hours was not statistically
different between groups. No patients with PD required pleural tubes
post-operatively, while 2 patients with pleural drainage required
placement of additional left pleural tubes post-operatively. Conclusions:
Passive PD as compared to the more conventional pleural drainage may more
effectively prevent fluid overload without adversely affecting
hemodynamics after surgery for congenital heart disease.