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<1>
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Accession Number
2013354036
Authors
Bittl J.A. He Y. Jacobs A.K. Yancy C.W. Normand S.-L.T.
Institution
(Bittl) Ocala Heart Institute, Munroe Regional Medical Center, 1221 SE 5th
St, Ocala, FL 34471, United States
(He, Normand) Department of Health Care Policy, Harvard Medical School,
Boston, MA, United States
(Jacobs) Department of Medicine, Section of Cardiology, Boston Medical
Center, Boston, MA, United States
(Yancy) Department of Medicine, Division of Cardiology, Northwestern
University, Chicago, IL, United States
(Normand) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
Title
Bayesian Methods affirm the use of percutaneous coronary intervention to
improve survival in patients with unprotected left main coronary artery
disease.
Source
Circulation. 127 (22) (pp 2177-2185), 2013. Date of Publication: 04 Jun
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Several randomized clinical trials support the use of coronary
artery bypass grafting (CABG) for patients with unprotected left main
coronary artery disease. Studies suggesting the equivalence of
percutaneous coronary intervention (PCI) with CABG for this indication
indirectly support the 2011 American College of Cardiology
Foundation/American Heart Association Class IIa recommendation for PCI to
improve survival in patients with unprotected left main coronary artery
disease. We tested whether bayesian approaches uphold the new
recommendation. Methods and Results: We performed a bayesian cross-design
and network meta-analysis of 12 studies (4 randomized clinical trials and
8 observational studies) comparing CABG with PCI (n=4574 patients) and of
7 studies (2 randomized clinical trials and 5 observational studies)
comparing CABG with medical therapy (n=3224 patients). The odds ratios of
1-year mortality after PCI compared with CABG using bayesian cross-design
meta-analysis were not different among randomized clinical trials (odds
ratio, 0.99; 95% bayesian credible interval, 0.67-1.43), matched cohort
studies (odds ratio, 1.10; 95% bayesian credible interval, 0.76-1.73), and
other types of cohort studies (odds ratio, 0.93; 95% bayesian credible
interval, 0.58-1.35). A network meta-analysis suggested that medical
therapy is associated with higher 1-year mortality than the use of PCI for
patients with unprotected left main coronary artery disease (odds ratio,
3.22; 95% bayesian credible interval, 1.96-5.30). Conclusions: Bayesian
methods support the current guidelines, which were based on traditional
statistical methods and have proposed that PCI, like CABG, improves
survival for patients with unprotected left main coronary artery disease
compared with medical therapy. An integrated approach using both direct
and indirect evidence may yield new insights to enhance the translation of
clinical trial data into practice. 2013 American Heart Association, Inc.

<2>
Accession Number
2013353494
Authors
Bilotta F. Gelb A.W. Stazi E. Titi L. Paoloni F.P. Rosa G.
Institution
(Bilotta, Stazi, Titi, Rosa) Department of Anesthesiology, Critical Care
and Pain Medicine, Section of Neuroanesthesia and Neurocritical Care,
'Sapienza' University of Rome, Rome, Italy
(Gelb) Department of Anesthesia and Perioperative Care, University of
California, San Francisco, CA, United States
(Paoloni) G.I.M.E.M.A. Onlus, Rome, Italy
Title
Pharmacological perioperative brain neuroprotection: A qualitative review
of randomized clinical trials.
Source
British Journal of Anaesthesia. 110 (SUPPL.1) (pp i113-i120), 2013. Date
of Publication: June 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
SummaryPerioperative cerebral damage may be associated with surgery and
anaesthesia. Pharmacological perioperative neuroprotection is associated
with conflicting results. In this qualitative review of randomized
controlled clinical trials on perioperative pharmacological brain
neuroprotection, we report the effects of tested therapies on new
postoperative neurological deficit, postoperative cognitive decline
(POCD), and mortality rate. Studies were identified from Cochrane Central
Register and MEDLINE and by hand-searching. Of 5904 retrieved studies, 25
randomized trials met our inclusion criteria. Tested therapies were:
lidocaine, thiopental, S(+)-ketamine, propofol, nimodipine, GM1
ganglioside, lexipafant, glutamate/aspartate and xenon remacemide,
atorvastatin, magnesium sulphate, erythropoietin, piracetam, rivastigmine,
pegorgotein, and 17beta-estradiol. The use of atorvastatin and magnesium
sulphate was associated with a lower incidence of new postoperative
neurological deficit. The use of lidocaine, ketamine, and magnesium
sulphate was associated with controversial results on POCD. The POCD did
not differ between treated patients and control group for other tested
drugs (thiopental, propofol, nimodipine, GM1 ganglioside, lexipafant,
glutamate/aspartate, xenon, erythropoietin, remacemide, piracetam,
rivastigmine, pegorgotein, and 17beta-estradiol). None of the tested drugs
was associated with a reduction in mortality rate.Drugs with various
mechanisms of action have been tested over time; current evidence suggests
that pharmacological brain neuroprotection might reduce the incidence of
new postoperative neurological deficits and POCD, while no benefits on
perioperative mortality are described. Of importance from this review is
the need for shared methodological approach when clinical studies on
pharmacological neuroprotection are designed. 2013 The Author [2013].

<3>
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Accession Number
2013354044
Authors
Rumsfeld J.S. Alexander K.P. Goff Jr. D.C. Graham M.M. Ho P.M. Masoudi
F.A. Moser D.K. Roger V.L. Slaughter M.S. Smolderen K.G. Spertus J.A.
Sullivan M.D. Treat-Jacobson D. Zerwic J.J.
Title
Cardiovascular health: The importance of measuring patient-reported health
status a scientific statement from the American heart association.
Source
Circulation. 127 (22) (pp 2233-2249), 2013. Date of Publication: 04 Jun
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<4>
Accession Number
2013327704
Authors
Kiani A. Sadeghi M.M. Gharipour M. Farahmand N. Hoveida L.
Institution
(Kiani) Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Sadeghi) Hypertension Research Center, Isfahan Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Gharipour) Isfahan Cardiovascular Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Farahmand) Islamic Azad University, Isfahan AND 5 Delasa Heart Center,
Sina Hospital, Isfahan, Iran, Islamic Republic of
(Hoveida) Department of Microbiology, Felavarjan Branch, Islamic Azad
University, Isfahan, Iran, Islamic Republic of
Title
Preconditioning by isoflurane as a volatile anesthetic in elective
coronary artery bypass surgery.
Source
ARYA Atherosclerosis. 9 (3) (pp 192-197), 2013. Date of Publication: 2013.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Some pharmacological preconditioning approaches are utilized
as an effective adjunct to myocardial protection, particularly following
cardiac procedures. The current study addressed the potential clinical
implications and protective effects of isoflurane as an anesthetic most
applicable on postoperative myocardial function measured by cardiac
biomarkers. METHODS: 46 patients were included in the study. In 23 of
them, preconditioning was elicited after the onset of cardiopulmonary
bypass via a 5-minute exposure to isoflurane (2.5 minimum alveolar
concentration), followed by a 10-minute washout before aortic cross
clamping and cardioplegic arrest. 23 case-matched control patients
underwent an equivalent period (15 minutes) of pre-arrest isoflurane-free
bypass. Outcome measurements included creatine phosphokinase and creatine
kinase-MB levels until 24 hours after the surgery. RESULTS: None of the
differences in enzyme levels at baseline and 24 hours after surgery
between the two groups reached the threshold of statistical significance.
The level of CPK was significantly reduced 24 hours after surgery compared
with the baseline in the two groups. However, the postoperative release of
CPK was consistently smaller in the isofluranepreconditioned group than in
the control group. The release of CK-MB displayed a statistically similar
pattern. Multivariable linear analysis showed the effect of isoflurane
regimen on reducing CPK level within the 24 hours after surgery compared
with placebo. CONCLUSION: Our study supports the cardio protective effect
of isoflurane and the role of pharmacological preconditioning of the human
heart by this volatile anesthetic during elective coronary artery bypass
surgery.

<5>
Accession Number
2013339585
Authors
Kelly D.J. McCann G.P. Blackman D. Curzen N.P. Dalby M. Greenwood J.P.
Fairbrother K. Shipley L. Kelion A. Heatherington S. Khan J.N. Nazir S.
Alahmar A. Flather M. Swanton H. Schofield P. Gunning M. Hall R. Gershlick
A.H.
Institution
(Kelly, McCann, Fairbrother, Shipley, Khan, Nazir, Alahmar, Gershlick)
Department of Cardiology, University Hospitals of Leicester, Leicester,
United Kingdom
(McCann, Gershlick) NIHR Leicester Cardiovascular Biomedical Research
Unit, Leicester, United Kingdom
(Blackman, Greenwood) Department of Cardiology, Jubilee Wing, Leeds
General Infirmary, Leeds, United Kingdom
(Curzen) Department of Cardiology, Southampton University Hospitals NHS
Trust, Southampton, United Kingdom
(Dalby, Kelion) Department of Cardiology, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
(Heatherington) Department of Cardiology, Kettering General Hospital,
Kettering, United Kingdom
(Flather) Clinical Trials and Evaluation Unit, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Swanton) University College London Hospitals NHS Foundation Trust,
London, United Kingdom
(Schofield) Papworth Hospital NHS Foundation Trust, Cambridge, United
Kingdom
(Gunning) University Hospital of North Staffordshire NHS Trust,
Stoke-on-Trent, United Kingdom
(Hall) Norfolk and Norwich Hospitals NHS Trust, Norwich, United Kingdom
Title
Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): A
multicentre trial testing management strategies when multivessel disease
is detected at the time of primary PCI: Rationale and design.
Source
EuroIntervention. 8 (10) (pp 1190-1198), 2013. Date of Publication:
February 2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Primary percutaneous coronary intervention (PPCI) is the preferred
strategy for acute ST-segment elevation myocardial infarction (STEMI),
with evidence of improved clinical outcomes compared to fibrinolytic
therapy. However, there is no consensus on how best to manage multivessel
coronary disease detected at the time of PPCI, with little robust data on
best management of angiographically significant stenoses detected in
non-infarct-related (N-IRA) coronary arteries. CVLPRIT will determine the
optimal management of N-IRA lesions detected during PPCI. Methods and
results: CVLPRIT (Complete Versus culprit-Lesion only PRimary PCI Trial)
is an open-label, prospective, randomised, multicentre trial. STEMI
patients undergo verbal "assent" on presentation. Patients are included
when angiographic MVD has been detected, and randomised to culprit
(IRA)-only PCI (n=150) or in-patient complete multivessel PCI (n=150).
Cumulative major adverse cardiac events (MACE) - all-cause mortality,
recurrent MI, heart failure, need for revascularisation (PCI or CABG) will
be recorded at 12 months. Secondary endpoints include safety endpoints of
confirmed ischaemic stroke, intracranial haemorrhage, major
non-intracranial bleeding, and repair of vascular complications. A cardiac
magnetic resonance (CMR) substudy will provide mechanistic data on infarct
size, myocardial salvage index and microvascular obstruction. A cost
efficacy analysis will be undertaken. Conclusions: The management of
multivessel coronary artery disease in the setting of PPCI for STEMI,
including the timing of when to perform non-culprit-artery
revascularisation if undertaken, remains unresolved. CVLPRIT will yield
mechanistic insights into the myocardial consequence of N-IRA intervention
undertaken during the peri-infarct period.

<6>
Accession Number
2013331405
Authors
Pineda A.M. Santana O. Cortes-Bergoderi M. Lamelas J.
Institution
(Pineda, Santana) Division of Cardiology, Mount Sinai Heart Institute,
Columbia University, 4300 Alton Road, Miami Beach, FL 33140, United States
(Cortes-Bergoderi) Department of Internal Medicine, Mount Sinai Heart
Institute, Miami Beach, FL, United States
(Lamelas) Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami
Beach, FL, United States
Title
Is a minimally invasive approach for resection of benign cardiac masses
superior to standard full sternotomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (6) (pp 875-879),
2013. Date of Publication: June 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'is a minimally invasive
approach for resection of benign cardiac masses superior to standard full
sternotomy?' A total of 50 papers were found using the reported search, of
which, 11 represented the best evidence to answer the clinical question.
The authors, country, journal, date of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
All 11 papers were retrospective studies, from which 4 were case-control
studies comparing the minimally invasive approach with conventional full
sternotomy, and 7 were case series. There were two minimally invasive
techniques used, a right mini-thoracotomy and a partial hemi-sternotomy,
the former being the most commonly used. The resection of benign cardiac
masses is a low-risk procedure, with no mortality or conversions to full
sternotomy reported. From the 4 case-control studies, cross-clamp time was
similar in both groups, and only one report found a prolonged perfusion
time with the minimally invasive approach. The incidence of major
postoperative complications, including bleeding requiring reoperation
(average from case-control studies: 0-4.5 vs 0-5.8%), renal failure (0 vs
0-10%) and prolonged ventilation (6-13 vs 11-19%), for the two approaches
was similar. The incidence of postoperative stroke was better for the
minimally invasive approach in one study (0 vs 14%, P = 0.023). The main
advantages of this technique are shorter intensive care unit (26-31 vs
46-60 h) and hospital stay (3.6-5.2 vs 6.2-7.4 days), the minimally
invasive approach being significantly better in one and three reports,
respectively. We conclude that minimally invasive resection of a benign
cardiac mass using a right mini-thoracotomy approach can be performed with
an operative morbidity and mortality at least similar to the standard full
sternotomy approach. The information currently available for the minimally
invasive approach for the resection of benign cardiac masses is limited
and based only on retrospective studies and, therefore, prospective
studies are required to confirm the potential benefits of minimally
invasive surgery. The Author 2013. Published by Oxford University Press
on behalf of the European Association for Cardio-Thoracic Surgery. All
rights reserved.

<7>
Accession Number
2013331394
Authors
Jayaramakrishnan K. Wotton R. Bradley A. Naidu B.
Institution
(Jayaramakrishnan, Wotton, Bradley, Naidu) Department of Thoracic Surgery,
Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9
5SS, United Kingdom
(Naidu) University of Warwick, Coventry, United Kingdom
Title
Does repair of pectus excavatum improve cardiopulmonary function?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (6) (pp 865-870),
2013. Date of Publication: June 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was 'Does repair of pectus excavatum (PE) improve
cardiopulmonary function?' One hundred and sixty-eight papers were found
using the reported search, 19 level III evidence papers and three
meta-analyses were relevant. Studies were divided into four groups based
on the surgical technique applied and pulmonary and cardiac functions in
these groups were analysed. The meta-analyses show conflicting results for
improvements in pulmonary and cardiac functions when comparing surgical
techniques, while four more recent studies show improved long-term results
using the Nuss technique. The best evidence of papers studying the PE
repair using the minimally invasive Nuss technique demonstrates a decrease
in pulmonary function during the early postoperative period, however,
there is a small but significant improvement during the late postoperative
period and after bar removal. The best evidence for cardiac function in
this group suggests an early improvement that is sustained during further
follow-up. The best evidence of papers studying the PE repair using the
Ravitch technique shows that pulmonary function decreased during the early
postoperative period, however, there is a small but significant
improvement during the late postoperative period. The best evidence for
cardiac function in this group suggests an early improvement that is
sustained during further follow-up. The best evidence of papers studying
the PE repair using other techniques (modified Daniel's technique,
modified Baronofsky's technique, sterno-costal turn-over technique and
sterno-costal elevation technique) or where surgical techniques used were
not described (preceding year 1985) suggests that there is no improvement
in pulmonary function after surgery. There is some evidence that certain
aspects of cardiac function improved after surgery in this group. The
Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<8>
Accession Number
2013331391
Authors
Dooley A. Asimakopoulos G.
Institution
(Dooley) University of Bristol, Bristol, United Kingdom
(Asimakopoulos) Department of Cardiac Surgery, Bristol Heart Institute,
University Hospitals Bristol, Bristol, United Kingdom
Title
Does a minimally invasive approach result in better pulmonary function
postoperatively when compared with median sternotomy for coronary artery
bypass graft?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (6) (pp 880-885),
2013. Date of Publication: June 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Does a minimally invasive
approach result in better pulmonary function postoperatively when compared
with median sternotomy for coronary artery bypass graft?'. Procedures such
as limited sternotomy and minimally invasive direct coronary artery bypass
(MIDCAB) though a minithoracotomy were regarded as minimally invasive.
Overall, 681 papers were found, of which eight represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, evidence level,
relevant outcomes and results of these papers were tabulated. Three
randomized, controlled trials (RCT) were included: One study suggested
that ministernotomy dividing the corpus sterni (n = 50) offers no
advantage over standard sternotomy (n = 50) during the first 10
postoperative days. Two further studies reported on minithoracotomy: one
trial presented data suggesting that minithoracotomy (n = 21) is as safe
as standard sternotomy with (n = 18) or without (n = 19) cardiopulmonary
bypass, but without the benefit ascribed to the minimally invasive
incision. A two-centre report investigated pulmonary function as a
secondary outcome and claimed that minithoracotomy worsens FEV₁
and FVC. The study was not powered to detect these differences as
pulmonary function data were available only for one of the centres. Five
non-randomized reports were also included in this analysis: These
investigated outcomes after minithoracotomy or limited sternotomy compared
with standard sternotomy. Patient groups were small, involving <20
subjects per group. Non-randomized studies suggested a benefit to
postoperative lung function in using thoracotomy. One of these reports
included only patients with severe chronic obstructive pulmonary disease
(COPD) (FEV₁ <70% of predicted) and detected benefits in
selected patients undergoing MIDCAB. A further study was in agreement with
the above statement in patients without COPD. MIDCAB may be more painful
initially, but results in quicker recovery of lung function. Demonstrating
the benefits of ministernotomy compared with the standard sternal incision
was less clear. One paper demonstrates better outcomes when compared with
standard sternotomy, while another reports no difference. We conclude that
non-randomized studies support the hypothesis that minimally invasive
coronary artery bypass benefits postoperative lung function in patients
with known respiratory problems. The Author 2013. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<9>
Accession Number
2013331385
Authors
De Oliveira Sa M.P.B. Ferraz P.E. Escobar R.R. Vasconcelos F.P. Ferraz
A.A.B. Braile D.M. Lima R.C.
Institution
(De Oliveira Sa, Ferraz, Escobar, Vasconcelos, Lima) Division of
Cardiovascular Surgery of Pronto Socorro Cardiologico de Pernambuco,
PROCAPE, Recife, Brazil
(De Oliveira Sa, Ferraz, Escobar, Vasconcelos, Lima) University of
Pernambuco, UPE, Recife, Brazil
(De Oliveira Sa, Ferraz) Federal University of Pernambuco, UFPE, Recife,
Brazil
(Ferraz) Division of General Surgery of Hospital das Clinicas de
Pernambuco, HC/PE, Pernambuco, Brazil
(Braile) Faculty of Medicine of Sao Jose do Rio Preto, FAMERP, Sao Jose do
Rio Preto, Brazil
Title
Skeletonized versus pedicled internal thoracic artery and risk of sternal
wound infection after coronary bypass surgery: Meta-analysis and
meta-regression of 4817 patients.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (6) (pp 849-857),
2013. Date of Publication: June 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
It is suggested that the internal thoracic artery (ITA) harvesting
technique influences the incidence of sternal wound infection (SWI) after
coronary artery bypass graft (CABG). To determine if there is any real
difference between skeletonized vs pedicled ITA, we performed a
meta-analysis to determine if there is any real difference between these
two established techniques in terms of SWI. We performed a systematic
review using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar
and reference lists of relevant articles to search for studies that
compared the incidence of SWI after CABG between skeletonized vs pedicled
ITA until June 2012. The principal summary measures were odds ratio (OR)
with 95% confidence interval (CI) and P values (statistically significant
when <0.05). The ORs were combined across studies using the weighted
DerSimonian-Laird random effects model and weighted Mantel-Haenszel fixed
effects. Meta-analysis, sensitivity analysis and meta-regression were
completed using the software Comprehensive Meta-Analysis version 2
(Biostat, Inc., Englewood, NJ, USA). Twenty-two studies involving 4817
patients (2424 skeletonized; 2393 pedicled) met the eligibility criteria.
There was no evidence for important heterogeneity of effects among the
studies. The overall OR (95% CI) of SWI showed a statistically significant
difference in favour of skeletonized ITA (fixed effect model: OR 0.443,
95% CI 0.323-0.608, P < 0.001; random effect model: OR 0.443, 95% CI
0.323-0.608, P < 0.001). In the sensitivity analysis, the difference in
favour of skeletonized ITA was also observed in subgroups such as
diabetic, bilateral ITA and diabetic with bilateral ITA; we also observed
that there was a difference in the type of study, since non-randomized
studies together demonstrated the benefit of skeletonized ITA in
comparison with pedicled ITA, but the randomized studies together did not
show this difference (although close to statistical significance and with
the tendency to favour the skeletonized group). In meta-regression, we
observed a statistically significant coefficient for SWI and proportion of
diabetic patients (coefficient -0.02, 95% CI -0.03 to -0.01, P = 0.016).
In conclusion, skeletonized ITA appears to reduce the incidence of
postoperative SWI in comparison with pedicled ITA after CABG, with this
effect being modulated by the presence of diabetes. The Author 2013.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<10>
Accession Number
2013338850
Authors
Chaudhary A.K. Singh D. Bogra J.S. Saxena S. Chandra G. Bhusan S. Singh
P.K.
Institution
(Chaudhary, Singh, Bogra, Saxena, Chandra, Bhusan, Singh) Department of
Anesthesiology, K.G.M. College, Lucknow (UP), 226003, India
Title
Thoracic epidural for post-thoracotomy and thoracomyoplasty pain: A
comparative study of three concentrations of fentanyl with plain
ropivacaine.
Source
Anaesthesia, Pain and Intensive Care. 17 (1) (pp 22-27), 2013. Date of
Publication: April 2013.
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS (60-A, Nazim-ud-Din
Road, F-8/4, Islamabad, Pakistan)
Abstract
Aim: Optimum pain relief after thoracotomy is essential to reduce
atelectasis and postoperative pneumonias. The aim of this prospective,
double blind, randomised controlled trial was to compare the analgesic and
adverse effects of three concentrations of fentanyl with 0.2% ropivacaine
in thoracic epidural in patients undergoing thoracotomy
andthoracomyolpasty. Methodology: After getting approval from Ethical
Committee, this study was performed in 60 patients of either sex, aged
18-60 years, American Society of Anaesthesiology (ASA) grade I to III.
Informed consent was taken from all of the patients, who were recruited
and divided into three groups of 20 patients in each group. Patients
scheduled for elective thoracotomy surgery were enrolled in the study.
Patients with preexisting motor and sensory deficit, addicted to
hypnosedative drugs, on chronic opioid or analgesic therapy, sensitive to
local anaesthetic or study medication, or having contraindications to
regional anesthesia were excluded from this study. In patients, with whom
communication difficulties prevented reliable assessment, were also
excluded. Patients received either 2.5mug/ml (Group I), 5.0mug/ml (Group
II) or 7.5mug/ml of fentanyl (Group III) respectively, with ropivacaine
0.2% via thoracic epidural. Postoperatively, pain at rest, on coughing and
with ambulation was assessed using a visual analogue scale (VAS) and
observer verbal ranking score (OVRS) at 2, 6, 12 and 24 hours. Sedation
scores were also noted. Adverse effects were simultaneously assessed.
Results: There was no significant difference in the baseline
characteristics between the three groups. The number of patients with
episodes of unsatisfactory pain relief, i.e. a VAS scores >40 and OVRS >2,
at each of the four assessments postoperatively, was higher in Group I
than with Group II or Group III (p < 0.05). In Group III, four (20%)
patients had a sedation score >3 compared with one (5%) in Group II. No
patient in Group I had a sedation score >3 (p < 0.05). In addition, all
patients experienced pruritus in Group I compared with 10% and 5% in Group
II and Group I respectively. 30% of the patients had emetic symptoms in
Group III, compared to 20% and 5% in Group II and Group I respectively (p
< 05). Conclusion: We conclude that a thoracic epidural bolus of 10 ml
ropivacaine 0.2% with fentanyl 5.0 mug/ml provides the optimal balance
between pain relief and sedation.

<11>
Accession Number
2013335019
Authors
Li Y. Han Y. Zhang L. Jing Q. Wang X. Yan G. Ma Y. Wang G. Wang S. Chen X.
Yang L. Zhu G. Liu H. Jiang T.
Institution
(Li, Han, Zhang, Jing, Wang, Yan, Ma, Wang, Chen) Department of
Cardiology, Shenyang Northern Hospital, Shenyang 110840, China
(Wang) No. 306 Hospital of People's Liberation Army, Beijing, China
(Yang) Kunming General Hospital of Chengdu Military Region, Kunming, China
(Zhu) Wuhan Asia Heart Hospital, Wuhan, China
(Liu) General Hospital of Armed Police Forces, Beijing, China
(Jiang) Affiliated Hospital of Chinese People's Armed Police Forces
Medical College, Tianjin, China
Title
Clinical efficacy and safety of biodegradable polymer-based
sirolimus-eluting stents in patients with diabetes mellitus insight from
the 4-year results of the CREATE study.
Source
Catheterization and Cardiovascular Interventions. 81 (7) (pp 1127-1133),
2013. Date of Publication: 01 Jun 2013.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background Diabetes mellitus is an independent predictor of adverse
clinical events after drug-eluting stent implantation. Objectives The
objective of this study is to evaluate the long-term clinical efficacy and
safety of biodegradable polymer-based sirolimus-eluting stents in diabetic
versus non-diabetic patients. Methods A total of 2077 "all comers,"
including 440 (21.2%) diabetic patients and 1637 (78.8%) non-diabetic
patients, were prospectively enrolled in the CREATE study at 59 centers in
four countries. The recommended antiplatelet regimen was clopidogrel and
aspirin for 6 months followed by chronic aspirin therapy. The primary
outcome was the rate of major adverse cardiac events (MACE), defined as a
composite of cardiac death, non-fatal myocardial infarction (MI), and
target lesion revascularization (TLR). Results Diabetic patients had
higher risks of all-cause death (8.2% vs. 3.4%, P < 0.001) and cardiac
death (4.1% vs. 1.4%, P < 0.001) compared with non-diabetic patients at 4
years. The rates of non-fatal MI (0.2% vs. 0.9%, P = 0.218), TLR (2.0% vs.
2.8%, P = 0.357), MACE (5.9% vs. 4.4%, P = 0.227), and overall stent
thrombosis (1.6% vs. 1.6%, P = 0.932) were not significantly different
between diabetic and non-diabetic patients. A landmark analysis showed
that prolonged clopidogrel therapy (>6 months) was not beneficial in
reducing the cumulative hazards of MACE either in diabetic or non-diabetic
patients (log rank P = 0.810). Conclusions Biodegradable polymer-based
sirolimus-eluting stents for the treatment of diabetic patients had a
similar clinical event rate at 4 years compared with non-diabetic
patients, except for a higher mortality rate. 2012 Wiley Periodicals,
Inc.

<12>
Accession Number
2013335010
Authors
Geng D.-F. Meng Z. Yan H.-Y. Nie R.-Q. Deng J. Wang J.-F.
Institution
(Geng, Nie, Deng, Wang) Department of Cardiology, Sun Yat-Sen University,
Sun Yat-Sen Memorial Hospital, No.107 West Yanjiang Road, Guangzhou
510120, China
(Meng) Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun
Yat-Sen University, Guangzhou 510120, China
(Yan) Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital,
Sun Yat-sen University, Guangzhou 510120, China
Title
Bare-metal stent versus drug-eluting stent in large coronary arteries:
Meta-analysis of randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. 81 (7) (pp 1087-1094),
2013. Date of Publication: 01 Jun 2013.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background Uncertainties exist with regard to the efficacy of drug-eluting
stent (DES) versus bare-metal stent (BMS) in large coronary arteries.
Objective and Methods The aim of this study was to investigate the
efficacy of BMS versus DES in terms of clinical events in large coronary
vessels (>=3.0 mm) by performing a meta-analysis of all relevant
randomized controlled trials (RCTs). Results Six RCTs with 4,399 patients
were included in this study. Overall, there were no significant
between-group differences in the risks of the composite of cardiac death
and nonfatal myocardial infarction (cardiac death/MI), cardiac death,
myocardial infarction, and stent thrombosis, however, DES was associated
with significant reduction in the risk of target vessel revascularization
(TVR) compared with BMS [0.48 (0.33, 0.70)] with consistent benefits among
patients with reference vessel diameter >= 3.5 mm, reference vessel
diameter >= 4.0 mm, stent length <= 15 mm, first-generation DES or
second-generation DES. In patients with >= 3-year follow-up, there were no
significant between-group differences in the risk of cardiac death/MI,
TVR, cardiac death, myocardial infarction or stent thrombosis. Conclusions
This meta-analysis suggests that DES is superior to BMS in terms of
adverse cardiac events in large coronary arteries at the mid-term
follow-up. The long-term efficacy of newer-generation DES versus BMS in
larger coronary arteries is still worth further evaluation. 2012 Wiley
Periodicals, Inc.

<13>
Accession Number
2013326382
Authors
Athanasiou T. Ashrafian H. Mukherjee D. Harling L. Okabayashi K.
Institution
(Athanasiou, Ashrafian, Mukherjee, Harling, Okabayashi) Department of
Surgery and Cancer, Imperial College London, St. Mary's Hospital Campus,
Praed Street, London W2 1NY, United Kingdom
(Okabayashi) Department of Surgery, Keio University School of Medicine,
Tokyo, Japan
Title
Are arterial grafts superior to vein grafts for revascularisation of the
right coronary system? A systematic review.
Source
Heart. 99 (12) (pp 835-842), 2013. Date of Publication: June 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: The optimal conduit choice in revascularisation of the right
coronary system (RCA) remains uncertain. This study aims to identify if
arterial grafts are superior to saphenous vein (SV) grafts and whether
graft failure rates vary between proximal and distal RCA anastomoses.
Methods: 29 studies identified by systematic review were analysed for
study quality and length of follow-up using Bayesian hierarchical random
effects modelling. Heterogeneity was assessed and sensitivity analysis
performed. Primary endpoints were graft patency at early, mid and
late-term follow-up when compared with SV grafts. Results: There was no
difference in early failure of radial artery (RA) or right gastroepiploic
artery grafts when compared with SV (OR 0.82, 95% CI (0.14 to 2.68) and OR
1.19 (0.08 to 4.66), respectively). However, mid-term ORs based on
observational study data demonstrated increased graft failure with right
gastroepiploic artery and right internal thoracic artery compared with SV
(OR 2.76 (1.26 to 5.48) and OR 2.07 (0.96 to 3.98), respectively),
although right internal thoracic artery did not achieve statistical
significance. No significant difference was observed in late graft failure
for RA compared with SV (OR 0.47 (0.09 to 1.41)) without study-type
disparity. However, simplified statistical pooling revealed significantly
lower graft failure was observed with RA grafts to the proximal RCA when
compared with SV (chi² 6.15, p=0.01). Conclusions: Arterial
grafts do not demonstrate a beneficial reduction of angiographic graft
failure when compared with SV grafts on the RCA with the exception of RA
to the proximal RCA. Future research should focus on clinical and
patient-reported endpoints to identify any benefits of RCA arterial
revascularisation.

<14>
Accession Number
2013326217
Authors
Rosenson R.S. Gotto Jr. A.M.
Institution
(Rosenson) Icahn School of Medicine, Mount Sinai, One Gustave L. Levy
Place, New York, NY 10029, United States
(Gotto Jr.) Weill Cornell Medical College, Cornell University, 1305 York
Avenue Y-805, New York, NY 10021, United States
Title
When clinical trials fail to address treatment gaps: The failure of
niacin-laropiprant to reduce cardiovascular events.
Source
Current Atherosclerosis Reports. 15 (6) , 2013. Article Number: 332. Date
of Publication: 2013.
Publisher
Current Medicine Group LLC (400 Market St, Ste 700 Philadelphia PA 19106,
United States)

<15>
Accession Number
71075176
Authors
Iseki K. Arima H.
Institution
(Iseki) University Hospital of the Ryukyus, Dialysis Unit, Nishihara,
Japan
(Arima) George Institute, Sydney, Australia
Title
Comparison of the effects of pre-HD and home blood pressure on death and
cardiovascular outcomes among chronic hemodialysis patients: A
sub-analysis of octopus.
Source
Nephrology Dialysis Transplantation. Conference: 50th ERA-EDTA Congress
Istanbul Turkey. Conference Start: 20130518 Conference End: 20130521.
Conference Publication: (var.pagings). 28 (pp i64), 2013. Date of
Publication: May 2013.
Publisher
Oxford University Press
Abstract
Introduction and Aims: There has been reported to be U-shape phenomenon
between pre-hemodialysis (HD) blood pressure and the risks of death or
cardiovascular disease among chronic HD patients. However, there remains
significant uncertainty surrounding the effects of home blood pressure. In
the present analysis, we compared the effects of pre-HD and home blood
pressure on the risks of death and cardiovascular outcomes among HD
patients who participated in OCTOPUS (NDT 2013 in press). Methods: OCTOPUS
was a randomised controlled trial which investigated the effects of
angiotensin receptor blockade olmesartan among HD patients. The present
analysis included 251 patients (54% out of 469 randomised) with morning
home blood pressure measurements. At each HD session, pre-HD blood
pressure was measured using a standard sphygmomanometer with the patient
in supine position after 5 minutes rest. Home blood pressure was measured
in sitting position after 5 minutes rest using an automatic device
(HITACHI 9700) based on the cuff oscillometric method on the morning of
non-HD days. Data on pre-HD and home blood pressure was collected for 6
days (3 measurements for each) every 6 months and the mean value was used
in the present analysis. Outcome was composite of death, nonfatal stroke,
nonfatal myocardial infarction, and coronary revascularization. The
effects of achieved follow-up pre-HD and home blood pressure on the
outcome were evaluated using a time-dependent Cox proportional hazards
model. Results: At baseline, there were normal blood pressure in 4 (2%),
white coat hypertension in 28 (13%), masked hypertension in 6 (3%), and
persistent hypertension in 172 (82%). Home systolic blood pressure was 8.3
mmHg lower than pre-HD blood pressure, while home diastolic blood pressure
was 2.9 mmHg higher. Although there was trend towards an inverse
association between pre-HD systolic blood pressure and the composite
outcome (hazard ratio 0.92, 95% CI 0.80-1.06), home systolic blood
pressure was tended to be associated with increased risks of the outcome
(hazard ratio 1.08, 95% CI 0.96-1.23). Conclusions: Compared to pre-HD
blood pressure, home blood pressure seemed to be better in predicting
mortality and cardiovascular outcomes.

<16>
Accession Number
71074988
Title
Late-Breaking Clinical Trial and Clinical Science: Special Reports
Abstracts from the American Heart Association's Scientific Sessions 2012.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (23) , 2012. Date of Publication: 04 Dec
2012.
Publisher
Lippincott Williams and Wilkins
Abstract
The proceedings contain 62 papers. The topics discussed include: Aspirin
for the prevention of recurrent venous thromboembolism after a first
unprovoked event: results of the aspire randomized controlled trial; a
randomized trial of bedside platelet function monitoring to adjust
antiplatelet therapy versus standard of care in patients undergoing drug
eluting stent implantation: the ARCTIC study; main results of the future
revascularization evaluation in patients with diabetes mellitus: optimal
management of multivessel disease (FREEDOM) trial; economic outcomes of
percutaneous coronary intervention performed at sites with and without
on-site cardiac surgery; prospective evaluation of outcomes with stress
perfusion imaging versus stress wall motion imaging during dobutamine or
exercise echocardiography; and fish oil for the prevention of
post-operative atrial fibrillation - the omega-3 fatty acids for
prevention of post-operative atrial fibrillation (OPERA) trial.

<17>
Accession Number
71074936
Authors
Marchioli R. Mozaffarian D. Silletta G. Macchia A. Ferrazzi P. Gardner T.
Latini R. Libby P. Lombardi F. O'Gara P. Page R. Santini M. Tavazzi L.
Tognoni G.
Institution
(Marchioli, Silletta, Tognoni) Consorzio Mario Negri Sud, Santa-Maria
Imbaro, Italy
(Mozaffarian, Libby, O'Gara) Harvard Med Sch, Boston, MA, United States
(Macchia) GESICA Foundation, Buenos Aires, Argentina
(Ferrazzi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Gardner) Christiana Care Health System, Newark, DE, United States
(Latini) Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
(Lombardi) Univ of Milan, Milan, Italy
(Page) Univ of Wisconsin, Madison, WI, United States
(Santini) Ospedale San Filippo Neri, Rome, Italy
(Tavazzi) GVM Hosps of Care and Rsch, Cotignola, Italy
Title
Fish oil for the prevention of post-operative atrial fibrillation - the
omega-3 fatty acids for prevention of post-operative atrial fibrillation
(OPERA) trial.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (23) (pp 2781), 2012. Date of Publication:
04 Dec 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Post-operative atrial fibrillation/flutter (PoAF) is a major
complication of cardiac surgery, with associated increased morbidity,
higher long-term mortality, and healthcare costs. A few small trials have
evaluated whether fish oil reduces PoAF, with mixed results. Methods:
OPERA is a randomized, double-blind, placebo-controlled, clinical trial to
investigate effects of fish oil supplementation on risk of PoAF. A total
of 1,516 patients >=age 18 undergoing any cardiac surgery were recruited
from 28 centers in Argentina, the US, and Italy and block-randomized to
fish oil (omega-3 polyunsaturated fatty acids) or placebo (olive oil).
Study drug was provided by a total preoperative loading dose of 8 -10 g
divided over 2-5 days, followed by 2 g/d post-operatively until hospital
discharge or for 10 days, whichever occurred first. The primary endpoint
was occurrence of any PoAF >30 sec, confirmed by rhythm strip or 12-lead
ECG and adjudicated by a centralized events committee. Secondary endpoints
included prolonged (>1 hr) or symptomatic PoAF, other arrhythmias,
cognitive decline, major adverse cardiovascular events, other adverse
events (including bleeding), hospital length-of-stay, and 30-day and
1-year mortality. OPERA was designed to provide 90% power to detect 25%
reduction in PoAF, based on estimated 30% event rate in controls and
two-sided alpha=0.05. Results: Between Aug 2010 and Jun 2012, 1,516
patients were enrolled, with mean+/-SD age 64+/-13 years, 72% male, and
41% undergoing coronary bypass alone, 52% valve surgery with or without
coronary bypass, and 7% other cardiac surgery. The overall rate of the
primary endpoint was 29%, achieving our estimates for power calculations.
The main findings for the primary endpoint and most secondary endpoints
will be presented at the AHA meeting as late-breaking clinical trial
results. Conclusions: OPERA will provide robust evidence on whether fish
oil reduces risk of post-op AF in an appropriately powered, multinational
clinical trial including a broad cross-section of real-world patients.
Findings will directly inform potential clinical use of this simple,
low-cost intervention to prevent PoAF.

<18>
Accession Number
71074930
Authors
Fuster V. Farkouh M.E.
Institution
(Fuster, Farkouh) Mount Sinai Sch of Medicine, New York, NY, United States
Title
Main Results of the Future REvascularization evaluation in patients with
diabetes mellitus: Optimal management of multivessel disease (FREEDOM)
trial.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (23) (pp 2779), 2012. Date of Publication:
04 Dec 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Prior randomized trials suggested that coronary artery bypass
grafting (CABG) produced results superior to balloon angioplasty or
bare-metal stenting in patients with diabetes. Whether this remains the
case in the current era in which drug eluting stents (DESs) are available
and routinely used is unknown. FREEDOM is an NHLBI -sponsored,
international, randomized controlled trial designed to determine whether
CABG or percutaneous coronary intervention (PCI) is the superior approach
for revascularization of diabetic patients with multivessel coronary
disease (MVD). Methods: In the FREEDOM trial, a total of 1900 diabetic
subjects with MVD were randomized to PCI or CABG worldwide from April
2005-March 2010 and followed for a mean of 4.37 years (minimum 2 years).
FREEDOM was designed to have 80% power to detect a 27.0% relative
reduction in a composite endpoint composed of all-cause mortality,
nonfatal myocardial infarction, or stroke (ClinicalTrials.gov number, NCT
00086450). Results: The randomized cohort was 63.1+/-9.1 years old and 29%
female with median diabetes duration 10.2+/-8.9 years. Results for the
primary outcome measure will be available November 2012. Conclusions: The
FREEDOM trial definitively determines whether PCI or CABG results in a
superior outcome (all cause mortality, myocardial infarction or stroke) in
patients with diabetes and multivessel coronary artery disease.

<19>
Accession Number
2013339480
Authors
Zhang C.-Y. Ma Z.-S. Ma L.-L. Wang L.-X.
Institution
(Zhang, Ma) Department of Cardiac Surgery, Charles Sturt University, Wagga
Wagga, NSW, Australia
(Ma, Ma, Wang) School of Biomedical Sciences, Charles Sturt University,
Wagga Wagga, NSW 2678, Australia
(Ma, Wang) Cardiology, Liaocheng People's Hospital of Taishan Medical
University, Liaocheng, Shandong, 252000, China
Title
Effect of prostaglandin E1 inhalation on pulmonary hypertension following
corrective surgery for congenital heart disease.
Source
Experimental and Clinical Cardiology. 18 (1) (pp 13-16), 2013. Date of
Publication: Spring 2013.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
BACKGROUND: Intravenous infusion of prostaglandin E1 (PGE1) has been used
to treat pulmonary arterial hypertension (PAH); however, the efficacy and
safety of inhaled PGE1 is unclear. Objectives: To investigate the effect
of inhaled PGE1 on PAH following corrective surgery for congenital heart
disease. METHODS: Sixty patients with postoperative residual PAH following
corrective surgery for congenital heart disease were randomly assigned to
a control group, a PGE1 infusion group (intravenous PGE1 infusion; 30
ng/kg/min daily for 10 days) or a PGE1 inhalation group (100 mug nebulized
PGE1 every 8 h for 10 days). Systolic blood pressure, mean pulmonary
arterial pressure, arterial oxygen pressure, oxygen saturation and serum
endothelin-1 level were measured before and after the treatment. RESULTS:
At the end of the study, the mean pulmonary arterial pressure in the two
PGE1 groups were lower than in the control group (P<0.01), whereas the
mean arterial oxygen pressure was higher (P<0.01). Compared with the PGE1
infusion group, the mean pulmonary arterial pressure in the PGE1
inhalation group was lower (P<0.01) whereas the arterial oxygen pressure
was higher (P<0.01). The mean endothelin-1 levels in the two PGE1 groups
were lower than in the control group (P<0.01), but there was no
statistically significant difference in endothelin-1 levels between the
PGE1 inhalation and infusion groups (P>0.05). CONCLUSIONS: In pediatric
patients with PAH, PGE1 inhalation was associated with a reduction in
pulmonary arterial pressure and improvement in arterial blood oxygen
levels. 2013 Pulsus Group Inc. All rights reserved.

<20>
Accession Number
2013338354
Authors
Johansson T. Fritsch G. Flamm M. Hansbauer B. Bachofner N. Mann E. Bock M.
Sonnichsen A.C.
Institution
(Johansson, Flamm, Hansbauer, Bachofner, Mann, Sonnichsen) Institute of
General Practice, Family Medicine and Preventive Medicine, Paracelsus
Medical University, Strubergasse 21, 5020 Salzburg, Austria
(Fritsch, Bock) Department of Anaesthesiology, Perioperative Medicine and
Intensive Care, Paracelsus Medical University, Muellner Hauptrstrasse 48,
5020 Salzburg, Austria
(Flamm) Department of Evidence-based Medicine and Clinical Epidemiology,
Danube University, Krems, Dr-Karl-Dorrek-Strasse 30, 3500 Krems, Austria
(Bock) Department of Anaesthesiology and Intensive Care Medicine I,
Hospital of Bolzano, Via Lorenz Boehler 5, 39100 Bolzano, Italy
(Sonnichsen) Institute of General Practice and Family Medicine, University
of Witten/Herdecke, Alfred-Herrhausen-Strase 50, 58448 Witten, Germany
Title
Effectiveness of non-cardiac preoperative testing in non-cardiac elective
surgery: A systematic review.
Source
British Journal of Anaesthesia. 110 (6) (pp 926-939), 2013. Date of
Publication: June 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
SummaryElective surgery is usually preceded by preoperative diagnostics to
minimize risk. The results are assumed to elicit preventive measures or
even cancellation of surgery. Moreover, physicians perform preoperative
tests as a baseline to detect subsequent changes. This systematic review
aims to explore whether preoperative testing leads to changes in
management or reduces perioperative mortality or morbidity in unselected
patients undergoing elective, non-cardiac surgery. We systematically
searched all relevant databases from January 2001 to February 2011 for
studies investigating the relationship between preoperative diagnostics
and perioperative outcome. Our methodology was based on the manual of the
Ludwig Boltzmann Institute for Health Technology Assessment, the Scottish
Intercollegiate Guidelines Network (SIGN) handbook, and the PRISMA
statement for reporting systematic reviews. One hundred and one of the 25
281 publications retrieved met our inclusion criteria. Three test grid
studies used a randomized controlled design and 98 studies used an
observational design. The test grid studies show that in cataract surgery
and ambulatory surgery, there are no significant differences between
patients with indicated preoperative testing and no testing regarding
perioperative outcome. The observational studies do not provide valid
evidence that preoperative testing is beneficial in healthy adults
undergoing non-cardiac surgery. There is no evidence derived from
high-quality studies that supports routine preoperative testing in healthy
adults undergoing non-cardiac surgery. Testing according to pathological
findings in a patient's medical history or physical examination seems
justified, although the evidence is scarce. High-quality studies,
especially large randomized controlled trials, are needed to explore the
effectiveness of indicated preoperative testing. 2013 The Author.
Published by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved.

<21>
Accession Number
2013322170
Authors
Mozaffarian D. Wu J.H.Y. De Oliveira Otto M.C. Sandesara C.M. Metcalf R.G.
Latini R. Libby P. Lombardi F. O'Gara P.T. Page R.L. Silletta M.G. Tavazzi
L. Marchioli R.
Institution
(Mozaffarian, Libby, O'Gara) Department of Medicine, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, 665 Huntington
Avenue, Boston, MA 02115, United States
(Mozaffarian) Channing Division of Network Medicine, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
(Mozaffarian, Wu, De Oliveira Otto) Department of Epidemiology, Harvard
School of Public Health, Boston, MA, United States
(Mozaffarian) Department of Nutrition, Harvard School of Public Health,
Boston, MA, United States
(Sandesara) Virginia Cardiovascular Associates, Manassas, VA, United
States
(Metcalf) Center for Heart Rhythm Disorders, University of Adelaide and
Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
(Latini) Department of Cardiovascular Research, Istituto di Ricerche
Farmacologiche Mario Negri, Milan, Italy
(Lombardi) Department of Health Sciences, University of Milan, Milan,
Italy
(Page) Department of Medicine, University of Wisconsin, School of Medicine
and Public Health, Madison, WI, United States
(Silletta, Marchioli) Department of Clinical Pharmacology and
Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
(Tavazzi) GVM Hospitals of Care and Research, Villa Maria Cecilia
Hospital, Cotignola, Italy
Title
Fish oil and post-operative atrial fibrillation: A meta-analysis of
randomized controlled trials.
Source
Journal of the American College of Cardiology. 61 (21) (pp 2194-2196),
2013. Date of Publication: 28 May 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)

<22>
Accession Number
2013320606
Authors
Khan M.F. Datta S. Chisti M.M. Movahed M.R.
Institution
(Khan) Southern Arizona VA Medical Center, Tucson, AZ, United States
(Khan) University of Arizona, Tucson, AZ, United States
(Datta) Marion General Hospital/Ohio Health, Marion, OH, United States
(Chisti) Department of Hematology and Oncology, William Beaumont Hospital,
Royal Oak, MI, United States
(Chisti) Department of Hematology and Oncology, Oakland University William
Beaumont School of Medicine, Royal Oak, MI, United States
(Movahed) Division of Cardiology, Southern Arizona VA Medical Center,
Tucson, AZ, United States
(Movahed) Division of Cardiology, University of Arizona, Tucson, AZ,
United States
Title
Cardiac paraganglioma: Clinical presentation, diagnostic approach and
factors affecting short and long-term outcomes.
Source
International Journal of Cardiology. 166 (2) (pp 315-320), 2013. Date of
Publication: 20 Jun 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: We describe our experience of the case of a young female who
presented with chest pain and was found to have an intra-pericardial mass
that was later confirmed to be a paraganglioma. Although preoperative
magnetic resonance imaging (MRI) did not show any left atrial invasion,
the patient died in the peri-operative period due to irreparable damage of
the cardiac structures from extensive neoplastic invasion. We then
performed a retrospective analysis of the available literature to find the
factors associated with adverse surgical and long-term outcomes in
patients with cardiac paraganglioma. Methods: We found 93 case reports of
cardiac and/or pericardial paragangliomas in the literature. After
exclusions, 82 cases were included in the final analysis. The patients
were divided into two groups based on the outcome of surgical management.
Univariate analysis was performed using SPSS software (Chicago, IL version
18), and the statistical significance was defined as a p-value < 0.05.
Results and conclusions: The comparison of available demographic,
clinical, pathological and laboratory parameters between the deceased and
the surviving patients revealed that only the intra-cardiac location
(p-value = 0.021) and the development of metastases (p-value < 0.001) were
independently associated with increased surgical and long-term mortality,
respectively. The size of a paraganglioma, its functional status or
invasion into the surrounding structures does not appear to affect
short-or long-term survival in these patients. The Kaplan-Meier survival
curve showed excellent long-term prognosis for patients with a complete
surgical removal of the neoplasm. Based on our experience, we also suggest
preoperative imaging with a three dimensional cardiac CT and evaluation
for cardiac transplantation before embarking on the surgical resection of
these tumors.

<23>
Accession Number
2013320627
Authors
Ribeiro R.A. Ziegelmann P.K. Duncan B.B. Stella S.F. Da Costa Vieira J.L.
Restelatto L.M.F. Moriguchi E.H. Polanczyk C.A.
Institution
(Ribeiro, Duncan, Polanczyk) Graduate Program in Epidemiology, Federal
University of Rio Grande Do sul, Porto Alegre, Brazil
(Ribeiro, Ziegelmann, Duncan, Stella, Polanczyk) National Institute of
Science and Technology for Health Technology Assessment, CNPq, Brazil
(Ziegelmann) Statistics Department, Federal University of Rio Grande Do
sul, Porto Alegre, Brazil
(Stella, Moriguchi, Polanczyk) Graduate Program in Cardiology and
Cardiovascular Sciences, Federal University of Rio Grande Do sul, Porto
Alegre, Brazil
(Da Costa Vieira) Instituto de Cardiologia, Fundacao Universitaria de
Cardiologia, Porto Alegre, Brazil
(Restelatto, Polanczyk) Cardiovascular Division, Hospital de Clinicas de
Porto Alegre, Brazil
Title
Impact of statin dose on major cardiovascular events: A mixed treatment
comparison meta-analysis involving more than 175,000 patients.
Source
International Journal of Cardiology. 166 (2) (pp 431-439), 2013. Date of
Publication: 20 Jun 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: The benefit of statins in the reduction of cardiovascular
events was demonstrated in several placebo-controlled trials. More
intensive therapy seems to be associated with greater benefit. Our
objective was to compare different statin doses in the reduction of
cardiovascular events and deaths, combining direct and indirect evidence,
through mixed treatment comparisons (MTC). Methods: We conducted a
systematic review in MEDLINE and Cochrane CENTRAL. A random-effects
Bayesian MTC model was used to combine placebo-controlled and direct
statin comparison trials. Intensity of statin doses was classified
according to expected LDL-cholesterol reduction effect: <= 30% as low;
30-40%, intermediate, and >= 40%, high. Outcomes evaluated were non-fatal
myocardial infarction (MI), stroke, coronary revascularization and
coronary, cardiovascular and all-cause death. Inconsistency was assessed
with split-node methodology. Results: 47 trials (11 with direct statin
comparisons) were included. High doses reduced non-fatal MI by 28% (95%
CI: 18%-36%) and by 14% (7%-21%) when compared to low and intermediate
doses, respectively. High doses also diminished revascularization [RR
versus low and intermediate doses of 0.81 (0.69-0.95) and 0.88
(0.77-0.99), respectively] and stroke [RR of 0.83 (0.68-0.99) against low
doses]. Regimen intensity did not change death rates (e.g., for all-cause
mortality, RRs of 0.93 (0.80-1.06) and 0.98 (0.87-1.08) for high vs. low
and intermediate doses, respectively). No statistical inconsistencies were
found in the analyses. Conclusions: In this study, in which all available
evidence from statin trials was simultaneously analyzed, the benefit of
more intensive therapy was restricted to non-fatal events. 2011 Elsevier
Ireland Ltd.

<24>
Accession Number
2013332082
Authors
Romero J. Mejia-Lopez E. Manrique C. Lucariello R.
Institution
(Romero, Mejia-Lopez, Lucariello) Division of Cardiology,
Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical
Center,Albert Eeinstein College of Medicine, Bronx, NY, United States
(Manrique) Division of Cardiology, Jacobi Medical Center, Albert Einstein
College of Medicine, Bronx, NY, United States
Title
Arrhythmogenic right ventricular cardiomyopathy (ARVC/D): A systematic
literature review.
Source
Clinical Medicine Insights: Cardiology. 7 (pp 97-114), 2013. Date of
Publication: 21 May 2013.
Publisher
Libertas Academica Ltd. (PO Box 300-874, Albany 0751, Mairangi Bay,
Auckland 0751, New Zealand)
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a
genetic form of cardiomyopathy (CM) usually transmitted with an autosomal
dominant pattern. It primary affects the right ventricle (RV), but may
involve the left ventricle (LV) and culminate in biventricular heart
failure (HF), life threatening ventricular arrhythmias and sudden cardiac
death (SCD). It accounts for 11%-22% of cases of SCD in the young athlete
population. Pathologically is characterized by myocardial atrophy,
fibrofatty replacement and chamber dilation. Diagnosis is often difficult
due to the nonspecific nature of the disease and the broad spectrum of
phenotypic variations. Therefore consensus diagnostic criteria have been
developed and combined electrocardiography, echocardiography, cardiac
magnetic resonance imaging (CMRI) and myocardial biopsy. Early detection,
family screening and risk stratification are the cornerstones in the
diagnostic evaluation. Implantable cardioverter-defibrillator (ICD)
implantation, ablative procedures and heart transplantation are currently
the main therapeutic options. the author(s), publisher and licensee
Libertas Academica Ltd.

<25>
Accession Number
2013331380
Authors
Sepsas E. Misthos P. Anagnostopulu M. Toparlaki O. Voyagis G. Kakaris S.
Institution
(Sepsas, Misthos, Kakaris) Department of Thoracic Surgery, 'Sotiria'
General Hospital for Chest Diseases, 16-18 Markou Avgeri Street, 15343
Agia Paraskevi, Athens, Greece
(Anagnostopulu, Voyagis) Department of Anaesthesiology, 'Sotiria' General
Hospital For Chest Diseases, Athens, Greece
(Toparlaki) Nurse Sevice, 'Sotiria' General Hospital For Chest Diseases,
Athens, Greece
Title
The role of intercostal cryoanalgesia in post-thoracotomy analgesia.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (6) (pp 814-818),
2013. Date of Publication: June 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: Patients undergoing thoracotomy were studied to compare the
effects of cryoanalgesia, combined with intravenous patient-controlled
analgesia (IVPCA), against IVPCA alone during the four days following
surgery. METHODS: Fifty patients were randomized into two groups: an IVPCA
group (n = 25) and an IVPCA-cryo group (n = 25). Subjective pain intensity
was assessed on a verbal analogue scale at rest and during coughing. The
intensity and the incidence of post-thoracotomy pain, numbness, epigastric
distension and/or back pain, the analgesic requirements, as well as the
blood gas values and respiratory function tests were evaluated up to the
second postoperative (postop) month. Haemodynamic data and episodes of
nausea and/or vomiting were recorded over the four postop days. RESULTS:
In the cryo group there was a statistically significant improvement in
postop pain scores (P = 10^-4), reduction in consumption of
morphine (P = 10^-4) and other analgesics (P = 10^-4),
optimization (less acidosis) of the pH values of blood gases (P < 0.015
over 72 hours postop and P < 0.03 on the first and second postop months),
increase in systolic blood pressure (P < 0.05 over 96 hours postop),
reduction in heart rate (P < 0.05 over 96 hours postop), increase in
values of FEV₁ (P < 0.02) and FVC (P < 0.05) at the first and
second postop months, reduction in the incidence of nausea (0.05 < P < 0.1
over 18 hours postop), numbness, epigastric distension and back pain (P <
0.05 at days 5, 6, 7, 14, 30 and 60 following surgery). CONCLUSIONS: We
suggest that cryoanalgesia be considered as a simple, safe, inexpensive,
long-term form of post-thoracotomy pain relief. Cryoanalgesia effectively
restores FEV ₁ values at the second postop month. The Author
2013. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<26>
Accession Number
2013329575
Authors
Houlind K. Kjeldsen B.J. Madsen S.N. Rasmussen B.S. Holme S.J. Pallesen
P.A. Mortensen P.E. Fenger-Gron M. Beck S.J. Ehlers L.H.
Institution
(Houlind) Department of Cardiothoracic Surgery, Skejby Hospital, Aarhus
University Hospital, Aarhus, Denmark
(Houlind) Department of Vascular Surgery, University of Southern Denmark,
Institute of Regional Health Services Research, Skovvangen 2-8, 6000
Kolding, Denmark
(Kjeldsen, Pallesen, Mortensen) Department of Cardiothoracic Surgery,
Odense University Hospital, Odense, Denmark
(Madsen) Department of Cardiothoracic Surgery, Aalborg Hospital, Aarhus
University Hospital, Aalborg, Denmark
(Rasmussen) Department of Anaesthesia, Aalborg Hospital, Aarhus University
Hospital, Aalborg, Denmark
(Holme) Department of Cardiothoracic Surgery, Gentofte Hospital, Gentofte,
Denmark
(Fenger-Gron) Department of Clinical Epidemiology, Aarhus University,
Aarhus University Hospital, Aarhus, Denmark
(Beck) Central Denmark Region and Department of HTA, School of Public
Health, Aarhus University, Aarhus, Denmark
(Ehlers) Department of Business and Management, Aalborg University,
Aalborg, Denmark
Title
OPCAB surgery is cost-effective for elderly patients.
Source
Scandinavian Cardiovascular Journal. 47 (3) (pp 185-192), 2013. Date of
Publication: 2013.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objective. To determine the cost-effective operative strategy for coronary
artery bypass surgery in patients above 70 years. Design. Randomized,
controlled trial of 900 patients above 70 years of age subjected to
coronary artery bypass surgery. Patients were randomized to either on-pump
or off-pump coronary artery bypass surgery. Data on direct and indirect
costs were prospectively collected. Preoperatively and six months
postoperatively, quality of life was assessed using EuroQol-5D
questionnaires. Perioperative in-hospital costs and costs of
re-intervention were included. Results. The Summary Score of EuroQol-5D
increased in both groups between preoperatively and postoperatively. In
the on-pump group, it increased from 0.75 (0.16) (mean (SD)) to 0.84
(0.17), while the increase in the off-pump group was from 0.75 (0.15) to
0.84 (0.18). The difference between the groups was 0.0016 QALY and not
significantly different. The mean costs were 148.940 D.Kr (CI, 130.623
D.Kr-167.252 D.Kr) for an on-pump patient and 138.693 D.Kr (CI, 123.167
D.Kr-154.220 D.Kr) for an off-pump patient. The ICER base-case point
estimate was 6,829,999 D.Kr/QALY. The cost-effectiveness acceptability
curve showed 89% probability of off-pump being cost-effective at a
threshold value of 269,400 D.Kr/QALY. Conclusions. Off-pump surgery tends
to be more cost-effective than on-pump surgery. Long-term comparisons are
warranted. 2013 Informa Healthcare.

<27>
Accession Number
2013338787
Authors
Chen Y.-Y. Wang J.-F. Zhang Y.-J. Xie S.-L. Nie R.-Q.
Institution
(Chen, Wang, Xie, Nie) Department of Cardiology, Second Affiliated
Hospital, Sun Yat-sen University, West Yanjiang Road 107, Guangzhou,
Guangdong 510120, China
(Zhang) Department of Anesthesiology, Sun Yat-sen University Cancer
Center, 651 Dongfeng East Road, Guangzhou, Guangdong 510060, China
Title
Optimal strategy of coronary revascularization in chronic kidney disease
patients: A meta-analysis.
Source
European Journal of Internal Medicine. 24 (4) (pp 354-361), 2013. Date of
Publication: June 2013.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background Patients with chronic kidney disease (CKD) have high risks of
coronary artery disease (CAD). Coronary revascularization is beneficial
for long-term survival, but the optimal strategy remains still
controversial. Methods We searched studies that have compared percutaneous
coronary intervention (PCI) and coronary artery bypass graft (CABG) for
revascularization of the coronary arteries in CKD patients. Short-term (30
days or in-hospital) mortality, long-term (at least 12 months) all-cause
mortality, cardiac mortality and the incidence of late myocardial
infarction and recurrence of revascularization were estimated. Results 28
studies with 38,740 patients were included. All were retrospective studies
from 1977 to 2012. Meta-analysis showed that PCI group had lower
short-term mortality (OR 0.55, 95% CI 0.41 to 0.73, P < 0.01), but had
higher long-term all-cause mortality (OR 1.29, 95% CI 1.23 to 1.35, P <
0.01). Higher cardiac mortality (OR 1.08, 95% CI 1.01 to 1.15, P < 0.05),
higher incidence of late myocardial infarction (OR 1.78, 95% CI 1.65 to
1.91, P < 0.01) and recurring revascularization rate (OR 2.94, 95%CI 2.15
to 4.01, P < 0.01) is found amongst PCI treated patients compared to CABG
group. Conclusions CKD patients with CAD received CABG had higher risk of
short-term mortality but lower risks of long-term all-cause mortality,
cardiac mortality and late myocardial infarction compared to PCI. This
could be due to less probable repeated revascularization. 2013 European
Federation of Internal Medicine.