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<1>
Accession Number
2013335343
Authors
Keski-Nisula J. Pesonen E. Olkkola K.T. Peltola K. Neuvonen P.J. Tuominen
N. Sairanen H. Andersson S. Suominen P.K.
Institution
(Keski-Nisula, Peltola, Tuominen, Suominen) Department of Anesthesia and
Intensive Care, Children's Hospital, Helsinki University Central Hospital,
Stenbackinkatu 11, FI-00029 HUS, Helsinki, Finland
(Sairanen) Department of Pediatric Surgery, Children's Hospital, Helsinki
University Central Hospital, Helsinki, Finland
(Andersson) Department of Neonatal Intensive Care, Children's Hospital,
Helsinki University Central Hospital, Helsinki, Finland
(Pesonen) Department of Anesthesia and Intensive Care, Meilahti Hospital,
Helsinki University Central Hospital, Helsinki, Finland
(Neuvonen) Department of Clinical Pharmacology, University of Helsinki and
HUSLAB, Helsinki University Central Hospital, Helsinki, Finland
(Olkkola) Department of Anesthesiology, Intensive Care, Emergency Care,
and Pain Medicine, University of Turku, Turku University Hospital, Turku,
Finland
Title
Methylprednisolone in neonatal cardiac surgery: Reduced inflammation
without improved clinical outcome.
Source
Annals of Thoracic Surgery. 95 (6) (pp 2126-2132), 2013. Date of
Publication: June 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Corticosteroids are widely used in pediatric open-heart
surgery to reduce systemic inflammatory response and to mediate possible
cardioprotective effects. However, the optimal dosing of corticosteroids
is unknown and their administration varies considerably between different
institutions. Methods: Forty neonates undergoing open-heart surgery were
randomized in a double-blind fashion equally into 2 groups. After the
induction of anesthesia, 1 group received 30 mg/kg intravenous
methylprednisolone and the other a placebo. Concentrations in plasma of
interleukin 6 (IL-6), IL-8, IL-10, free methylprednisolone and total
methylprednisolone were obtained for the following: (1) at anesthesia
induction before the study drug was administered; (2) 30 minutes on
cardiopulmonary bypass; (3) 5 minutes after protamine administration; and
(4) 6 hours after weaning from cardiopulmonary bypass. Troponin T was
measured at time points T1, T3, T4, and also at 6:00 on the first
postoperative morning. Physiological and clinical outcome parameters were
also recorded. Results: Intravenous methylprednisolone resulted in high
plasma drug concentrations that peaked at T2. Methylprednisolone
significantly lowered concentrations of proinflammatory cytokines IL-6 and
IL-8 and raised levels of anti-inflammatory IL-10. No significant
differences in troponin T levels were detected. Blood glucose levels were
significantly higher in the methylprednisolone group, and patients in this
group received more often insulin therapy than controls. No significant
differences were observed in other clinical or physiological outcome
measurements. Conclusions: Intravenous 30 mg/kg methylprednisolone
administered before cardiopulmonary bypass resulted in high effective
plasma drug concentrations and a decreased inflammatory response. However,
no cardioprotective effect or better clinical outcome was noticed. 2013
The Society of Thoracic Surgeons.

<2>
Accession Number
2013335356
Authors
Dai C. Lu Z. Zhu H. Xue S. Lian F.
Institution
(Dai, Lu, Zhu, Xue, Lian) Department of Cardiovascular Surgery, Renji
Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
Title
Bilateral internal mammary artery grafting and risk of sternal wound
infection: Evidence from observational studies.
Source
Annals of Thoracic Surgery. 95 (6) (pp 1938-1945), 2013. Date of
Publication: June 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: The advantageous survival outcome of bilateral internal
mammary artery grafting (BIMA) has been well established. However, this
meta-analysis aims to make clear whether BIMA grafting increases the risk
of sternal wound infection (SWI) when compared with single internal
mammary artery grafting (SIMA). Methods: A literature search was performed
in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials.
The observational studies reporting a comparison between SIMA and BIMA
were included. The outcome of interest was the risk of SWI. Literature
search, data extraction, and quality assessment were performed.
Sensitivity and publication bias were also assessed in this research.
Results: We identified 4,701 titles and included 32 studies finally. The
meta-analysis showed that the risk of SWI in the BIMA group was higher
(relative risk [RR] 0.62, 95% confidence interval [CI] 0.55 to 0.71) than
that in the SIMA group. Moreover, BIMA grafting was also associated with a
higher risk of SWI in diabetic patients (RR 0.65, 95% CI 0.52 to 0.81) as
well as elderly patients (RR 0.45, 95% CI 0.33 to 0.62). When
skeletonization technique was adopted, the risk of SWI in BIMA patients
was just a little higher than that in SIMA patients, but the difference
did not reach statistical significance (RR 0.84, 95% CI 0.54 to 1.31).
Conclusions: The BIMA grafting increases the risk of SWI when compared
with SIMA grafting. This adverse effect further extends to diabetic and
elderly patients. As regarding the method of procurement, skeletonized
BIMA is safe and effective, thus it should be the procedure recommended.
2013 The Society of Thoracic Surgeons.

<3>
Accession Number
2013335358
Authors
Bishawi M. Shroyer A.L. Rumsfeld J.S. Spertus J.A. Baltz J.H. Collins J.F.
Quin J.A. Almassi G.H. Grover F.L. Hattler B.
Institution
(Bishawi, Shroyer) Northport Veterans Administration Medical Center,
Northport, NY, United States
(Shroyer, Rumsfeld, Baltz, Grover, Hattler) Eastern Colorado Healthcare
System, Department of Veterans Affairs, Denver, CO, United States
(Collins) Mid America Heart Institute, University of Missouri, Kansas
City, MO, United States
(Quin) Cooperative Studies Program Coordinating Center, Veterans Affairs
Medical Center, Perry Point, MD, United States
(Almassi) Veterans Administration Boston Healthcare System, West Roxbury,
MA, United States
(Grover, Hattler) Clement J. Zablocki Veterans Affairs (VA), Medical
Center, Milwaukee, WI, United States
(Spertus) University of Colorado School of Medicine, Anschutz Medical
Campus, Aurora, CO, United States
Title
Changes in health-related quality of life in off-pump versus on-pump
cardiac surgery: Veterans affairs randomized on/off bypass trial.
Source
Annals of Thoracic Surgery. 95 (6) (pp 1946-1951), 2013. Date of
Publication: June 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: The relative benefits of performing coronary artery bypass
graft surgery off-pump versus on-pump continue to be debated. A critical,
patient-centered outcome is health-related quality of life; yet there has
been limited evaluation in large-scale, multicenter trials of the off-pump
versus on-pump impact upon quality of life. Methods: The Veterans Affairs
Randomized On/Off Bypass trial randomized 2,203 nonemergent patients to
off-pump or on-pump from February 2002 to May 2007. Patients completed a
general quality of life survey (VR-36) and a disease-specific quality of
life survey, the Seattle Angina Questionnaire (SAQ), prior to surgery,
then again at 3 and 12 months post-bypass. Results: Of the 2,130 1-year
survivors, 1,805 patients (85%) completed 1-year surveys. Randomization
resulted in comparable baseline patient characteristics, including VR-36
and SAQ scores. At 3 months and 1-year post-procedure, there were no
clinically relevant differences between off-pump and on-pump patients in
any of the quality of life measures. Both groups had statistically
significant, comparable improvements in the physical component scale of
the VR-36, and in the SAQ scales. Conclusions: For this trial's male,
low-to-moderate risk, veteran population, there were no significant
differences between off-pump and on-pump with regard to 1-year general and
disease-specific quality of life outcomes. Both treatment arms experienced
some improvements by 3 months, with continued improvements through 1-year
post-bypass. 2013 The Society of Thoracic Surgeons.

<4>
Accession Number
2013320975
Authors
Offley S. Coyne E. Horodyski M. Rubery P. Zeidman S. Rechtine G.
Institution
(Offley, Coyne, Rubery, Zeidman) Department of Orthopaedic Surgery, URMC
Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, NY, United
States
(Rechtine) Department of Veterans Affairs, Bay Pines VA Health Care
System, Bay Pines, FL, United States
(Horodyski) Department of Orthopaedics and Rehabilitation, UF Orthopaedics
and Sports Medicine Institute, Gainesville, FL, United States
Title
Randomized trial demonstrates that extended-release epidural morphine may
provide safe pain control for lumbar surgery patients.
Source
Surgical Neurology International. 4 (SUPPL.2) (pp S51-S57), 2013. Date of
Publication: 01 Apr 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Safe and effective postoperative pain control remains an issue
in complex spine surgery. Spinal narcotics have been used for decades but
have not become commonplace because of safety or re-dosing concerns. An
extended release epidural morphine (EREM) preparation has been used
successfully in obstetric, abdominal, thoracic, and extremity surgery done
with epidural anesthesia. This has not been studied in open spinal
surgery. Methods: Ninety-eight patients having complex posterior lumbar
surgery were enrolled in a partially randomized clinical trial (PRCT) of
low to moderate doses of EREM. Surgery included levels from L3 to S1 with
procedures involving combinations of decompression, instrumented
arthrodesis, and interbody grafting. The patients were randomized to
receive either 10 or 15 mg of EREM through an epidural catheter placed
under direct vision at the conclusion of surgery. Multiple safety measures
were employed to prevent or detect respiratory depression. Postoperative
pain scores, narcotic utilization, and adverse events were recorded.
Results: There were no significant differences between the two groups as
to supplemental narcotic requirements, pain scores, or adverse events.
There were no cases of respiratory depression. The epidural narcotic
effect persisted from 3 to 36 hours after the injection. Conclusion: By
utilizing appropriate safety measures, EREM can be used safely for
postoperative pain control in lumbar surgery patients. As there was no
apparent advantage to the use of 15 mg, the lower 10 mg dose should be
used. 2013 Offley SC.

<5>
Accession Number
2013330387
Authors
Ahlers S.J.G.M. Elens L.L. van Gulik L. van Schaik R.H. van Dongen E.P.A.
Bruins P. Tibboel D. Knibbe C.A.J.
Institution
(Ahlers, Knibbe) Department of Clinical Pharmacy, St Antonius Hospital,
3440 EM Nieuwegein, Netherlands
(Ahlers, Tibboel, Knibbe) Intensive Care and Department of Pediatric
Surgery, Erasmus Medical Centre, Sophia Children's Hospital, 3015 GJ
Rotterdam, Netherlands
(Elens, van Schaik) Department of Clinical Chemistry, Erasmus University
Medical Center, 3015 CE Rotterdam, Netherlands
(van Gulik, van Dongen, Bruins) Department of Anaesthesiology, Intensive
Care and Pain management, St Antonius Hospital, 3440 EM Nieuwegein,
Netherlands
(Knibbe) Division of Pharmacology, Leiden/Amsterdam Center for Drug
Research, Leiden, 2333 CC, Netherlands
Title
The Val158Met polymorphism of the COMT gene is associated with increased
pain sensitivity in morphine-treated patients undergoing a painful
procedure after cardiac surgery.
Source
British Journal of Clinical Pharmacology. 75 (6) (pp 1506-1515), 2013.
Date of Publication: June 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Aims: The catechol-O-methyltransferase (COMT) Val158Met polymorphism
affected pain sensitivity of healthy volunteers upon application of
experimental pain stimuli. The relevance of these findings in
morphine-treated postoperative cardiac patients undergoing painful
healthcare procedures is unknown; therefore, the aim of this study was to
investigate whether the COMTVal158Met polymorphism increases pain
sensitivity in morphine-treated patients undergoing an unavoidable painful
routine procedure after cardiac surgery. Methods: One hundred and
seventeen postoperative cardiac patients in the intensive care unit were
genotyped for the COMTVal158Met polymorphism. All patients were treated
with continuous morphine infusions for pain at rest, and received a bolus
of morphine (2.5 or 7.5mg) before a painful procedure (turning and/or
chest drain removal) on the first postoperative day. Numerical rating
scale (NRS) scores were evaluated at the following four time points: at
baseline (at rest), and before, during and after the painful procedure.
Results: Overall mean NRS scores were significantly higher in patients
carrying the Met-variant allele. During the painful procedure, the mean
NRS score was significantly higher for Met/Met patients compared with
Val/Met and Val/Val patients (mean NRS 3.4 +/- 2.8, 2.7 +/- 2.4 and 1.7
+/- 1.7, respectively; P = 0.04). In Met/Met patients, the increase in NRS
scores during the painful procedure compared with the baseline NRS score
was clinically relevant (NRS >= 1.3) and statistically significant and
appeared to be independent of sex and the morphine bolus dose.
Conclusions: Our results show that the COMTVal158Met polymorphism
contributes to variability in pain sensitivity after cardiac surgery of
morphine-treated patients in the intensive care unit, because Met-allele
carriers were more sensitive to overall pain and procedure-related pain.
2012 The British Pharmacological Society.

<6>
Accession Number
2013326297
Authors
Madsen M.T. Rosenberg J. Gogenur I.
Institution
(Madsen, Rosenberg, Gogenur) Department of Surgical Gastroenterology,
University of Copenhagen, Herlev Hospital, Herlev Ringvej 75, DK-2730,
Herlev, Denmark
Title
Actigraphy for measurement of sleep and sleep-wake rhythms in relation to
surgery.
Source
Journal of Clinical Sleep Medicine. 9 (4) (pp 387-394), 2013. Date of
Publication: 2013.
Publisher
American Academy of Sleep Medicine (2510 N. Frontage Road, Darien IL
60561, United States)
Abstract
Study Objectives: Patients undergoing surgery have severe sleep and
sleep-wake rhythm disturbances resulting in increased morbidity.
Actigraphy is a tool that can be used to quantify these disturbances. The
aim of this manuscript was to present the literature where actigraphy has
been used to measure sleep and sleep-wake rhythms in relation to surgery.
Methods: A systematic review was performed in 3 databases (Medline,
Embase, and Psycinfo), including all literature until July 2012. Results:
Thirty-two studies were included in the review. Actigraphy could
demonstrate that total sleep time and sleep efficiency was reduced after
surgery and number of awakenings was increased in patients undergoing
major surgery. Disturbances were less severe in patients undergoing minor
surgery. Actigraphy could be used to differentiate between delirious and
non-delirious patients after major surgery. Actigraphy measurements could
determine a differential effect of surgery based on the patient's age. The
effect of pharmacological interventions (chronobiotics and hypnotics) in
surgical patients could also be demonstrated by actigraphy. Conclusion:
Actigraphy can be used to measure sleep and sleep-wake rhythms in patients
undergoing surgery.

<7>
Accession Number
2013332634
Authors
Berg K. Langaas M. Ericsson M. Pleym H. Basu S. Nordrum I.S. Vitale N.
Haaverstad R.
Institution
(Berg, Pleym, Vitale, Haaverstad) Department of Circulation and Medical
Imaging, Faculty of Medicine, Norwegian University of Science and
Technology, Trondheim, Norway
(Berg, Ericsson) Department of Cancer Research and Molecular Medicine,
Faculty of Medicine, Norwegian University of Science and Technology,
Trondheim, Norway
(Langaas) Department of Mathematical Sciences, Faculty of Information
Technology, Mathematics and Electrical Engineering, Norwegian University
of Science and Technology, Trondheim, Norway
(Pleym, Haaverstad) Department of Cardiothoracic Surgery, St. Olav
University Hospital, Trondheim, Norway
(Basu) Oxidative Stress and Inflammation, Public Health and Caring
Sciences, Faculty of Medicine, Uppsala University, Sweden
(Basu) Laboratorie de Biochimie, Biologie Moleculaire et Nutrition,
Faculte de Pharmacie, Uniersite d'Auvergne, Clermont-Ferrand, France
(Nordrum) Department of Laboratory Medicine, Children's Health and Women's
Health, Norwegian University of Science and Technology, Trondheim, Norway
(Haaverstad) Institute of Surgical Sciences, Faculty of Medicine and
Dentistry, University of Bergen, Norway
Title
Acetylsalicylic acid treatment until surgery reduces oxidative stress and
inflammation in patients undergoing coronary artery bypass grafting.
Source
European Journal of Cardio-thoracic Surgery. 43 (6) (pp 1154-1163), 2013.
Article Number: ezs591. Date of Publication: June 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: Acetylsalicylic acid (ASA) is a cornerstone in the treatment
of coronary artery disease (CAD) due to its antiplatelet effect. Cessation
of aspirin before coronary artery bypass grafting (CABG) is often
recommended to avoid bleeding, but the practice is controversial because
it is suggested to worsen the underlying CAD. The aims of the present
prospective, randomized study were to assess if ASA administration until
the day before CABG decreases the oxidative load through a reduction of
inflammation and myocardial damage, compared with patients with
preoperative discontinuation of ASA. METHODS: Twenty patients scheduled
for CABG were randomly assigned to either routine ASA-treatment (160 mg
daily) until the time of surgery (ASA), or to ASA-withdrawal 7 days before
surgery (No-ASA). Blood-samples were taken from a radial artery and
coronary sinus, during and after surgery and analysed for
8-iso-prostaglandin (PG) F_2alpha; a major F2-isoprostane,
high-sensitivity C-reactive protein (hs-CRP), cytokines and troponin T.
Left ventricle Tru-Cut biopsies were taken from viable myocardium close to
the left anterior descending artery just after connection to
cardiopulmonary bypass, and before cardioplegia were established for gene
analysis (Illumina HT-12) and immunohistochemistry (CD45). RESULTS:
8-Iso-PGF_2alpha at baseline (t1) were 111 (277) pmol/l and 221
(490) pmol/l for ASA and No-ASA, respectively (P = 0.065). Area under the
curve showed a significantly lower level in plasma concentration of
8-iso-PGF_2alpha and hsCRP in the ASA group compared with the
No-ASA group with (158 pM vs 297 pM, P = 0.035) and hsCRP (8.4 mg/l vs
10.1 mg/l, P = 0.013). All cytokines increased during surgery, but no
significant differences between the two groups were observed. Nine genes
(10 transcripts) were found with a false discovery rate (FDR) <0.1 between
the ASA and No-ASA groups. CONCLUSIONS: Continued ASA treatment until the
time of CABG reduced oxidative and inflammatory responses. Also, a likely
beneficial effect upon myocardial injury was noticed. Although none of the
genes known to be involved in oxidative stress or inflammation took a
different expression in myocardial tissue, the genetic analysis showed
interesting differences in the mRNA level. Further research in this field
is necessary to understand the role of the genes. The Author 2012.
Published by Oxford University Press on behalf of the European Journal of
Cardio-Thoracic Surgery. All rights reserved.

<8>
Accession Number
2013330558
Authors
Boothroyd L.J. Spaziano M. Guertin J.R. Lambert L.J. Rodes-Cabau J.
Noiseux N. Nguyen M. Dumont E. Carrier M. de Varennes B. Ibrahim R.
Martucci G. Xiao Y. Morin J.E. Bogaty P.
Institution
(Boothroyd, Spaziano, Guertin, Lambert, Xiao, Morin, Bogaty) Institut
national d'excellence en sante et en services sociaux (INESSS), Montreal,
QC, Canada
(Rodes-Cabau, Dumont, Bogaty) Institut universitaire de cardiologie et
pneumologie de Quebec, Quebec, QC, Canada
(Noiseux) Centre hospitalier universitaire de Montreal, Montreal, QC,
Canada
(Nguyen) Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC,
Canada
(Carrier, Ibrahim) Institut de cardiologie de Montreal, Montreal, QC,
Canada
(de Varennes, Martucci, Morin) McGill University Health Centre, Montreal,
QC, Canada
Title
Transcatheter Aortic Valve Implantation: Recommendations for Practice
Based on a Multidisciplinary Review Including Cost-Effectiveness and
Ethical and Organizational Issues.
Source
Canadian Journal of Cardiology. 29 (6) (pp 718-726), 2013. Date of
Publication: June 2013.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
Transcatheter aortic valve implantation (TAVI) is a relatively new
technology for the treatment of severe and symptomatic aortic valve
stenosis. TAVI offers an alternative therapy for patients unable to be
treated surgically because of contraindications or severe comorbidities.
It is being rapidly dispersed in Canada, as it is worldwide. The objective
of this article is to present our recommendations for the use of TAVI,
based on a multidisciplinary evaluation of recently published evidence. We
systematically searched and summarized published data (2008-2011) on
benefits, risks, and cost-effectiveness of TAVI. We also examined ethical
issues and organizational aspects of delivering the intervention. We
discussed the soundness and applicability of our recommendations with
clinical experts active in the field. The published TAVI results for
high-risk and/or inoperable patients are promising in terms of survival,
function, quality of life, and cost-effectiveness, although we noted large
variability in the survival rates at 1 year and in the frequency of
important adverse outcomes such as stroke. Until more data from randomized
controlled trials and registries become available, prudence and
discernment are necessary in the choice of patients most likely to
benefit. Patients need to be well-informed about gaps in the evidence
base. Our recommendations support the use of TAVI in the context of strict
conditions with respect to patient eligibility, the patient selection
process, organizational requirements, and the tracking of patient outcomes
with a mandatory registry. 2013 Canadian Cardiovascular Society.

<9>
Accession Number
2013306450
Authors
Krul S.P.J. Driessen A.H.G. Zwinderman A.H. Van Boven W.J. Wilde A.A.M. De
Bakker J.M.T. De Groot J.R.
Institution
(Krul, Driessen, Wilde, De Bakker, De Groot) Heart Failure Research
Center, Department of Clinical and Experimental Cardiology, University of
Amsterdam, Amsterdam, Netherlands
(Driessen) Department of Cardiothoracic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Zwinderman) Department of Clinical Epidemiology, Biostatistics and
Bioinformatics, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Van Boven) Department of Cardiothoracic Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
(De Bakker) Interuniversity Cardiology Institute of the Netherlands,
Utrecht, Netherlands
Title
Navigating the mini-maze: Systematic review of the first results and
progress of minimally-invasive surgery in the treatment of atrial
fibrillation.
Source
International Journal of Cardiology. 166 (1) (pp 132-140), 2013. Date of
Publication: 05 Jun 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: In this paper we present a systematic literature overview and
analysis of the first results and progress made with minimally-invasive
surgery using RF energy in the treatment of AF. The minimally-invasive
treatment for atrial fibrillation (AF) tries to combine the success rate
of surgical treatment with a less invasive approach to surgery. It has the
additional potential advantage of ganglion plexus (GP) ablation and left
atrial appendage exclusion. Furthermore, additional left atrial ablation
lines (ALAL) can be created in non-paroxysmal AF patients. Methods: For
the search query multiple databases were used. Exclusion and inclusion
criteria were applied to select the publications to be screened. All
remaining articles were critically appraised and only relevant and valid
articles were included in our results. Results: Twenty-three studies were
included. In 15 studies GPs around the pulmonary veins were ablated. In
four studies ALAL were performed. Single procedure success rate was 69%
(95% CI, range 58%-78%) without antiarrhythmic drugs (AAD) and 79% (95%
CI, range 71%-85%) with AAD at one year follow-up. Mortality was 0.4%, and
various complications were reported (3.2% surgical, 3.2% post-surgical,
2.6% cardiac, 2.1% pulmonary, 1.7% other). Conclusions: Twenty-three
studies of minimally-invasive surgery for AF have been reviewed with
success rates between that of the standard maze procedure and catheter
ablation. These first combined results show promise; however,
minimally-invasive surgery is still evolving, for instance by the recent
inclusion of electrophysiological endpoints. Furthermore, the type of ALAL
and the additional value of GP ablation have to be elucidated. 2011
Elsevier Ireland Ltd.

<10>
Accession Number
2013306439
Authors
Nasu K. Oikawa Y. Yoshikawa R. Kadotani M. Takeda Y. Ota H. Kamiya H. Muto
M. Okamura A. Yamaki M. Usui S. Tohara S. Yamashita J. Suzuki M. Kawaguchi
R. Kawajiri K. Nakatsu Y. Uchida Y. Kashima Y. Kawashima N. Ozaki T. Ogawa
T. Aizawa T. Suzuki T.
Institution
(Nasu, Suzuki) Department of Cardiology, Toyohashi Heart Center, 21-1
Gobutori, Oyamacho, Toyohashi, 441-8530, Aichi, Japan
(Oikawa, Aizawa) Department of Cardiology, Cardiovascular Institute,
Tokyo, Japan
(Yoshikawa) Department of Cardiology, Sanda City Hospital, Hyogo, Japan
(Kadotani) Department of Cardiology, Shinko Kakogawa Hospital, Hyogo,
Japan
(Takeda) Department of Cardiology, Rinku General Medical Center, Osaka,
Japan
(Ota) Department of Cardiology, Itabashi Chuo Medical Center, Tokyo, Japan
(Kamiya) Department of Cardiology, Japanese Red Cross Nagoya Daiichi
Hospital, Aichi, Japan
(Muto) Department of Cardiology, Southern Tohoku Research Institute for
Neuroscience, Fukushima, Japan
(Okamura) Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka,
Japan
(Yamaki) Department of Cardiology, Kihara Cardiovascular Hospital,
Hokkaido, Japan
(Usui) Department of Cardiology, JR Tokyo General Hospital, Tokyo, Japan
(Tohara) Department of Cardiology, Kasukabe Chuo General Hospital,
Saitama, Japan
(Yamashita) Department of Cardiology, Tokyo Medical University Hospital,
Tokyo, Japan
(Suzuki) Department of Cardiology, Tokyo Metropolitan Police Hospital,
Tokyo, Japan
(Kawaguchi) Department of Cardiology, Gunma Prefectural Cardiovascular
Center, Gunma, Japan
(Kawajiri) Department of Cardiology, Matsubara Tokushukai Hospital, Osaka,
Japan
(Nakatsu) Department of Cardiology, Teikyo University Chiba Medical
Center, Chiba, Japan
(Uchida) Department of Cardiology, Kainan Hospital, Mie, Japan
(Kashima) Department of Cardiology, Higashi Cardiovascular Clinic, Aichi,
Japan
(Kawashima) Department of Cardiology, Hokkaido University Hospital,
Hokkaido, Japan
(Ozaki) Department of Cardiology, Chitose City Hospital, Hokkaido, Japan
(Ogawa) Department of Cardiology, Jikei University School of Medicine,
Tokyo, Japan
Title
A randomized comparison of sirolimus- vs. paclitaxel-eluting stents for
treatment of bifurcation lesions by single stent and kissing balloon:
Results of the SINGLE KISS trial.
Source
International Journal of Cardiology. 166 (1) (pp 187-192), 2013. Date of
Publication: 05 Jun 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: In the treatment of bifurcation lesions, routine stenting of
both branches has thus far failed to demonstrate a clear clinical
advantage over a provisional one-stent strategy. On the other hand, large
scale data evaluating different stent types for clinical outcomes after
one-stent treatment with final kissing inflation (FKI) of bifurcation
lesions is also limited. This prospective study evaluated the clinical and
angiographic outcomes of paclitaxel-eluting stents (PES) vs.
sirolimus-eluting stents (SES) in single crossover main branch stenting
followed by FKI in patients with bifurcation lesions. Methods: We
randomized 800 patients with single bifurcation lesions to PES (n = 400)
and SES (n = 400) groups. Results: Crossover rates to the two-stent
strategy were low in both groups (PES 1.5%, SES 2.8%; p = 0.23). At 1
year, there was no significant difference in the primary endpoint of this
study, target lesion revascularization rate (PES 3.8%, SES 3.2%, hazard
ratio 0.83; 95% confidence interval 0.39 to 1.76; p = 0.62). Stent
thrombosis occurred in only 1 case in the SES group after 282 days. At 9
months, a total of 593 patients underwent quantitative coronary
measurement. The main branch restenosis rate in the PES group was
significantly higher than that of the SES group (PES 12.2%, SES 5.5%; p =
0.004), however both groups exhibited similar high side branch restenosis
rates (PES 17.2%, SES 19.3%; p = 0.6). Conclusions: In patients with
bifurcation lesions, a single stent strategy using PES and SES with FKI
indicated similar 1 year clinical outcomes and safety profiles. 2011
Elsevier Ireland Ltd.

<11>
Accession Number
2013311698
Authors
Angelidis C. Deftereos S. Giannopoulos G. Anatoliotakis N. Bouras G.
Hatzis G. Panagopoulou V. Pyrgakis V. Cleman M.W.
Institution
(Angelidis, Deftereos, Giannopoulos, Anatoliotakis, Bouras, Panagopoulou,
Pyrgakis, Cleman) Cardiology Department and Cardiac Catheterization
Laboratory, Athens General Hospital G. Gennimatas, Athens, Greece
(Hatzis) 1st Department of Cardiology, School of Medicine, University of
Athens, Athens, Greece
(Giannopoulos) Section of Cardiovascular Medicine, Department of Internal
Medicine, Yale University School of Medicine, New Haven, CT, United States
Title
Cystatin C: An emerging biomarker in cardiovascular disease.
Source
Current Topics in Medicinal Chemistry. 13 (2) (pp 164-179), 2013. Date of
Publication: 2013.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Cystatin C (cys-C) is a small protein molecule (120 amino acid peptide
chain, approximately 13kDa) produced by virtually all nucleated cells in
the human body. It belongs to the family of papain-like cysteine proteases
and its main biological role is the extracellular inhibition of
cathepsins. It's near constant production rate, the fact that it is freely
filtered from the glomerular membrane and then completely reabsorbed
without being secreted from the proximal tubular cells, made it an almost
perfect candidate for estimating renal function. The strong correlation
between chronic kidney disease (CKD) and cardiovascular disease (CVD)
along with the growing understanding of the role of cysteinyl cathepsins
in the pathophysiology of CVD inspired researchers to explore the
potential association of cys-C with CVD. Throughout the spectrum of CVD
(peripheral arterial disease, stroke, abdominal aortic aneurysm, heart
failure, coronary artery disease) adverse outcomes and risk stratification
have been associated with high plasma levels of cys-C. The exact
mechanisms behind the observed correlations have not been comprehensively
clarified. Plausible links between high cys-C levels and poor
cardiovascular outcome could be impaired renal function, atherogenesis and
inflammatory mediators, remodeling of myocardial tissue and others
(genetic factors, aging and social habits). The scope of the present
article is to systematically review the current knowledge about cys-C
biochemistry, metabolism, methods of detection and quantification and
pathophysiological associations with different aspects of CVD. 2013
Bentham Science Publishers.

<12>
Accession Number
23255849
Authors
Lee B.-K. Kim Y.-H. Park D.-W. Yun S.-C. Ahn J.-M. Song H.G. Lee J.-Y. Kim
W.-J. Kang S.-J. Lee S.-W. Lee C.W. Lee J.-H. Seong I.-W. Park S.-W. Park
S.-J.
Institution
(Lee) Division of Cardiology, Department of Internal Medicine, Kangwon
National University School of Medicine, Chuncheon, South Korea
(Kim, Park, Ahn, Song, Lee, Kim, Kang, Lee, Lee, Park, Park) Department of
Cardiology, University of Ulsan College of Medicine, Asan Medical Center,
Seoul, South Korea
(Yun) Division of Biostatistics, Center for Medical Research and
Information, University of Ulsan College of Medicine, Asan Medical Center,
Seoul, South Korea
(Lee, Seong) Department of Cardiology, Chungnam National University
Hospital, Daejeon, South Korea
Title
Acute and long-term angiographic outcomes of side branch stenosis after
randomized treatment of zotarolimus-, sirolimus-, and paclitaxel-eluting
stent for coronary artery stenosis.
Source
Journal of Korean Medical Science. 27 (12) (pp 1499-1506), 2012. Date of
Publication: 2012.
Publisher
Korean Academy of Medical Science (302-75 Dong bu Ichon-dong, Yongsan-ku,
Seoul 140-031, South Korea)
Abstract
This was designed to assess the outcomes of side branch (SB) stenosis
after implantation of three drug-eluting stents (DES). From 2,645 patients
in the ZEST (Comparison of the Efficacy and Safety of Zotarolimus-Eluting
Stent with Sirolimus-Eluting and PacliTaxel-Eluting Stent for Coronary
Lesions) Trial, 788 patients had 923 bifurcation lesions with SB >= 1.5 mm
were included. SB was treated in 150 lesions, including 35 (3.8%)
receiving SB stenting. Of untreated SB with baseline stenosis < 50%, the
incidences of periprocedural SB compromise was similar in the zotarolimus
(15.8%), sirolimus (17.2%), and paclitaxel (16.6%) stent groups (P =
0.92). At follow-up angiography, delayed SB compromise occurred in 13.9%,
3.2%, and 9.4% (P = 0.010) of these groups. When classified into four
groups (< 50%, 50%-70%, 70%-99%, and 100%), 9.0% of untreated SB were
worsened, whereas improvement and stationary were observed in 9.6% and
81.4%. In a multivariable logistic regression model, main branch (MB)
stenosis at follow-up (%) was the only independent predictor of SB
stenosis worsening (odds ratio, 1.03; 95% confidence interval, 1.01-1.04;
P < 0.001). After MB stenting in bifurcation lesions, a minority of SB
appears to worsen. DES with strong anti-restenotic efficacy may help
maintain SB patency. 2012 The Korean Academy of Medical Sciences.

<13>
Accession Number
71069874
Authors
Goodnough L.
Institution
(Goodnough) Stanford University, Stanford, CA, United States
Title
Blood utilization.
Source
Vox Sanguinis. Conference: 23rd Regional Congress of the International
Society of Blood Transfusion Amsterdam Netherlands. Conference Start:
20130602 Conference End: 20130605. Conference Publication: (var.pagings).
105 (pp 17-18), 2013. Date of Publication: June 2013.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Blood transfusions occur in over 10% of all hospital stays
that include a procedure. The American Medical Association (AMA) has
identified the overuse of five medical treatments, and blood transfusions
were on the list (along with heart stents, ear tubes, antibiotics, and the
induction of birth in pregnant women). While blood transfusions are
believed to be life-saving, this has never been demonstrated in a
controlled clinical trial. In fact, blood transfusions have been decreed
to be 'unavoidably, unsafe, and inherently dangerous' as the basis for the
Blood Shield laws in the U.S. Thus, the perceived benefits relative to the
known risks of a blood transfusion are important elements in the bedside
discussion for patients' informed consent, particularly in the management
of anemia using available alternatives other than blood transfusion. Aims:
The above considerations have given rise to the field of blood management,
supported by corresponding initiatives by medical societies, on a mission
to 'promote the appropriate use of blood and blood components, with a goal
of minimizing their use'. This movement has been motivated by the need to:
(i) improve blood safety and patient outcomes; (ii) preserve the blood
inventory; and (iii) constrain escalating costs. Patient Blood Management
has been recognized by the World Health Organization (World Health
Alliance Resolution A63.R12) as a means to 'promote the availability of
transfusion alternatives'. Blood Management was cited recently as one of
the ten key advances in transfusion medicine over the last 50 years.
Methods: Awareness of the risks, costs, and impact on blood inventory has
led providers to look at institution-based initiatives in Patient Blood
Management, including the adoption of clinical practice guidelines to
improve blood utilization. Patient Blood Management encompasses an
evidence-based medical and surgical approach that is multidisciplinary
(transfusion medicine specialists, surgeons, anesthesiologists, and
critical care specialists) and multiprofessional (physicians, nurses, pump
technologists and pharmacists). Preventative strategies are emphasized: to
identify, evaluate, and manage anemia in medical and surgical patients,
including pharmacologic interventions along with reducing iatrogenic blood
losses from unnecessary diagnostic testing); to optimize hemostasis with
utilization of point of care testing); and to establish clinical practice
guidelines for blood transfusions. Results: Recent progress has been made
in identifying and implementing restrictive transfusion practices: based
on evidence-based clinical trials, published clinical practice guidelines,
and process improvements for improving blood utilization and clinical
patient outcomes (Figure). However, substantial variability persists in
transfusion outcomes for patients in certain clinical settings such as
cardiothoracic surgical patients. This may be due to lack of knowledge
regarding published guidelines; heterogeneity among the medical societies'
recommendations, including the specification of a hemoglobin concentration
(Hb) threshold that should be used as a 'transfusion trigger'; the value
of Hb as a surrogate indicator reflecting changes in concentration rather
than in absolute red cell mass; and/or disagreement on the validity of the
Level 1 evidence for the clinical practice guidelines. Conclusion:
Institutional and national databases indicate that restrictive blood
transfusion practices are being successfully implemented. (Figure
presented).

<14>
Accession Number
2013312006
Authors
Mariani J. Doval H.C. Nul D. Varini S. Grancelli H. Ferrante D. Tognoni G.
Macchia A.
Institution
(Mariani, Doval, Nul, Varini, Grancelli, Ferrante, Macchia) Fundacion
GESICA, Grupo de Estudio de Investigacion Clinica en Argentina, Buenos
Aires, Argentina
(Tognoni, Macchia) Fondazione Mario Negri Sud, Santa Maria Imbaro (CH),
Italy
Title
N-3 polyunsaturated fatty acids to prevent atrial fibrillation: Updated
systematic review and meta-analysis of randomized controlled trials.
Source
Journal of the American Heart Association. 2 (1) , 2013. Article Number:
e005033. Date of Publication: February 2013.
Publisher
American Heart Association Inc. (7272 Greenville Avenue, Dallas TX
75231-4596, United States)
Abstract
Background--Previous studies have suggested that n-3 polyunsaturated fatty
acids (n-3 PUFAs) have antiarrhythmic effects on atrial fibrillation (AF).
We aimed to assess the effects of therapy with n-3 PUFAs on the incidence
of recurrent AF and on postoperative AF. Methods and Results--Electronic
searches were conducted in Web of Science, Medline, Biological Abstracts,
Journal Citation Reports, and the Cochrane Central Register of Controlled
Trials databases. In addition, data from the recently completed FORxARD
and OPERA trials were included. We included randomized controlled trials
comparing treatment with n-3 PUFAs versus control to (1) prevent recurrent
AF in patients who underwent reversion of AF or (2) prevent incident
postoperative AF after cardiac surgery. Of identified studies, 12.9% (16
of 124) were included, providing data on 4677 patients. Eight studies
(1990 patients) evaluated n-3 PUFA effects on AF recurrence among patients
with reverted AF and 8 trials (2687 patients) on postoperative AF. Pooled
risk ratios through random-effects models showed no significant effects on
AF recurrence (RR, 0.95; 95% CI, 0.79 to 1.13; I2, 72%) or on
postoperative AF (0.86; 95% CI, 0.71 to 1.04; I2, 53.1%). A funnel plot
suggested publication bias among postoperative trials but not among
persistent AF trials. Meta-regression analysis did not find any
relationship between doses and effects (P=0.887 and 0.833 for recurrent
and postoperative AF, respectively). Conclusions--Published clinical
trials do not support n-3 PUFAs as agents aimed at preventing either
postoperative or recurrent AF.

<15>
Accession Number
2013330759
Authors
Falk-Brynhildsen K. Soderquist B. Friberg O. Nilsson U.G.
Institution
(Falk-Brynhildsen, Friberg) Department of Cardiothoracic and Vascular
Surgery, Orebro University Hospital, Orebro, Sweden
(Soderquist) Department of Laboratory Medicine, Clinical Microbiology,
Orebro University Hospital, Orebro, Sweden
(Falk-Brynhildsen, Soderquist, Nilsson) School of Medicine and Health,
Orebro University, Orebro, Sweden
(Nilsson) Centre for Health Care Sciences, Orebro University Hospital,
Sweden
Title
Bacterial recolonization of the skin and wound contamination during
cardiac surgery: A randomized controlled trial of the use of plastic
adhesive drape compared with bare skin.
Source
Journal of Hospital Infection. 84 (2) (pp 151-158), 2013. Date of
Publication: June 2013.
Publisher
W.B. Saunders Ltd (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Background: Sternal wound infection after cardiac surgery is a serious
complication. Various perioperative strategies, including plastic adhesive
drapes, are used to reduce bacterial contamination of surgical wounds.
Aim: To compare plastic adhesive drape to bare skin regarding bacterial
growth in wound and time to recolonization of the adjacent skin
intraoperatively, in cardiac surgery patients. Methods: This
single-blinded randomized controlled trial (May 2010 to May 2011) included
140 patients scheduled for cardiac surgery via median sternotomy. The
patients were randomly allocated to the adhesive drape (chest covered with
plastic adhesive drape) or bare skin group. Bacterial samples were taken
preoperatively and intraoperatively every hour during surgery until skin
closure. Results: Disinfection with 0.5% chlorhexidine solution in 70%
alcohol decreased coagulase-negative staphylococci (CoNS), while the
proportion colonized with Propionibacterium acnes was not significantly
reduced and was still present in more than 50% of skin samples. P. acnes
was significantly more common in men than in women. Progressive bacterial
recolonization of the skin occurred within 2-3 h. At 120 min there were
significantly more positive cultures in the adhesive drape group versus
bare skin group for P. acnes (63% vs 44%; P = 0.034) and for CoNS (45% vs
24%; P = 0.013). The only statistically significant difference in
bacterial growth in the surgical wound was higher proportion of CoNS at
the end of surgery in the adhesive drape group (14.7% vs 4.4%; P = 0.044).
Conclusion: Plastic adhesive drape does not reduce bacterial
recolonization. P. acnes colonized men more frequently, and was not
decreased by disinfection with chlorhexidine solution in alcohol. 2013
The Healthcare Infection Society.

<16>
Accession Number
2013312046
Authors
Sandesara C.M. Chung M.K. Van Wagoner D.R. Barringer T.A. Allen K. Ismail
H.M. Zimmerman B. Olshansky B.
Institution
(Sandesara) Virginia Cardiovascular Associates, Manassas, VA, United
States
(Chung, Van Wagoner) The Cleveland Clinic, Cleveland, OH, United States
(Barringer) Presbyterian Heart and Wellness, Charlotte, NC, United States
(Allen) Mid America Heart and Vascular Institute, Kansas City, MO, United
States
(Ismail) Detroit Medical Center Cardiovascular Institute, Wayne State
University, Detroit, MI, United States
(Zimmerman, Olshansky) University of Iowa Hospitals and Clinics, Iowa
City, IA, United States
Title
A randomized, placebo-controlled trial of omega-3 fatty acids for
inhibition of supraventricular arrhythmias after cardiac surgery: The fish
trial.
Source
Journal of the American Heart Association. 1 (3) , 2012. Article Number:
e000547. Date of Publication: June 2012.
Publisher
American Heart Association Inc. (7272 Greenville Avenue, Dallas TX
75231-4596, United States)
Abstract
Background--Omega-3 polyunsaturated fatty acids (n3-PUFAs) might have
antiarrhythmic properties, but data conflict on whether n3-PUFAs reduce
rates of atrial fibrillation (AF) after coronary artery bypass graft
surgery (CABG). We hypothesized that n3-PUFAs would reduce post-CABG AF,
and we tested this hypothesis in a well-powered, randomized, double-blind,
placebo-controlled, multicenter clinical trial. Methods and Results--
Patients undergoing CABG were randomized to pharmaceutical-grade n3-PUFAs
2 g orally twice daily (minimum of 6 g) or a matched placebo =24 hours
before surgery. Gas chromatography was used to assess plasma fatty acid
composition of samples collected on the day of screening, day of surgery,
and postoperative day 4. Treatment continued either until the primary end
point, clinically significant AF requiring treatment, occurred or for a
maximum of 2 weeks after surgery. Two hundred sixty patients were enrolled
and randomized. Before surgery, n3-PUFA dosing increased plasma n3-PUFA
levels from 2.9% to 4% and reduced the n6:n3-PUFA ratio from 9.1 to 6.4
(both P<0.001). Similar changes were noted on postoperative day 4. There
were no lipid changes in the placebo group. The rate of post-CABG AF was
similar in both groups (30% n3-PUFAs versus 33% placebo, P=0.67). The
post-CABG AF odds ratio for n3-PUFAs relative to placebo was 0.89 (95%
confidence interval 0.52-1.53). There were no differences in any secondary
end points. Conclusions--Oral n3-PUFA supplementation begun 2 days before
CABG did not reduce AF or other complications after surgery. Clinical
Trial Registration--URL: www.clinicaltrials.gov Unique identifier:
NCT00446966. 2012. The Authors.

<17>
Accession Number
2013320809
Authors
Firstenberg M.S. Dyke C.M. Angiolillo D.J. Ramaiahm C. Price M. Brtko M.
Welsby I. Chandna H. Holmes D.R. Voeltz M. Tummala P. Hutyra M. Manoukian
S.V. Prats J. Todd M. Liu T. Chronos N. Dietrich M. Montalescot G. Cannon
L.A. Topol E.J.
Institution
(Firstenberg) Department of Surgery (Cardiothoracic), Akron City Hospital,
Northeast Ohio Medical University, Akron, OH 44309, United States
(Dyke, Voeltz) Department of Cardiovascular Surgery, Sanford Medical
Center, Fargo, ND, United States
(Angiolillo) Department of Cardiology, University of Florida,
Jacksonville, FL, United States
(Ramaiahm) Department of Surgery, University of Kentucky, Lexington, KY,
United States
(Price, Topol) Department of Cardiology, Scripps Clinic, Scripps
Translational Science Institute, San Diego, CA, United States
(Brtko) Department of Cardiac Surgery, University Hospital, Hradec
Kralove, Czech Republic
(Welsby) Duke University, Durham, NC, United States
(Chandna) Department of Cardiology, Detar Hospital, Victoria, TX, United
States
(Holmes) Department of Cardiology, Mayo Clinic, Rochester, MN, United
States
(Tummala) Department of Cardiology, Northeast Georgia Heart Center,
Gainesville, GA, United States
(Hutyra) 1st Internal Clinic, Faculty Hospital Olomouc, Olomouc, Czech
Republic
(Manoukian) Sarah Cannon Research Institute, Nashville, TN, United States
(Prats, Todd, Liu, Dietrich) Medicines Company, Parsippany, NJ, United
States
(Chronos) Saint Joseph's Translational Research Institute, Atlanta, GA,
United States
(Montalescot) Department of Cardiology, Pitie-Salpetriere Hospital, Paris,
France
(Cannon) Cardiac and Vascular Research Center, Northern Michigan Hospital,
Petoskey, MI, United States
Title
Safety and efficacy of cangrelor, an intravenous, short-acting platelet
inhibitor in patients requiring coronary artery bypass surgery.
Source
Heart Surgery Forum. 16 (2) (pp E60-E69), 2013. Date of Publication: April
2013.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Objective: Oral P2Y₁₂ platelet receptor inhibitors are a
cornerstone of reducing complications in patients with acute coronary
syndromes or coronary stents. Guidelines advocate discontinuing treatment
with P2Y ₁₂ platelet receptor inhibitors before surgery.
Cangrelor, a short-acting, reversible, intravenously administered
P2Y₁₂ platelet inhibitor is effective in achieving appropriate
platelet inhibition in patients who are awaiting coronary artery bypass
grafting (CABG) and require P2Y ₁₂ inhibition. The objective of
this study was to assess the effects of preoperative cangrelor on the
incidence of perioperative complications, which are currently unknown.
Methods: Patients (n = 210) requiring preoperative clini cal
administration of thienopyridine therapy were randomized in a multicenter,
double-blinded study to receive cangrelor or placebo while awaiting CABG
after discontinuation of the thienopyridine. Optimal platelet reactivity,
which was defined as <240 P2Y₁₂ platelet reaction units, was
measured with serial point-of-care testing (VerifyNow). Pre- and
post-operative outcomes, bleeding values, and transfusion rates were
compared. To quantify potential risk factors for bleeding, we developed a
multivariate logistic model. Results: The differences between the groups
in bleeding and perioperative transfusion rates were not significantly
different. The rate of CABG-related bleeding was 11.8% (12/102) in
cangrelor-treated patients and 10.4% (10/96) in the placebo group (P =
.763). Transfusion rates for the groups were similar. Serious
postoperative adverse events for the cangrelor and placebo groups were
7.8% (8/102) and 5.2% (5/96), respectively ( P = .454). Conclusions:
Compared with placebo, bridging patients with cangrelor prior to CABG
effectively maintains platelet inhibition without increasing post-CABG
complications, including bleeding and the need for transfusions. These
data suggest cangrelor treatment is a potential strategy for bridging
patients requiring P2Y12 receptor inhibition while they await surgery.
2013 Forum Multimedia Publishing, LLC.

<18>
Accession Number
2013322245
Authors
Ribeiro H.B. Nombela-Franco L. Urena M. Mok M. Pasian S. Doyle D.
Delarochelliere R. Cote M. Laflamme L. Delarochelliere H. Allende R.
Dumont E. Rodes-Cabau J.
Institution
(Ribeiro, Nombela-Franco, Urena, Mok, Pasian, Doyle, Delarochelliere,
Cote, Laflamme, Delarochelliere, Allende, Dumont, Rodes-Cabau) Quebec
Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec
City, QC G1V 4G5, Canada
Title
Coronary obstruction following transcatheter aortic valve implantation: A
systematic review.
Source
JACC: Cardiovascular Interventions. 6 (5) (pp 452-461), 2013. Date of
Publication: May 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to evaluate, through a systematic review of
the published data, the main baseline characteristics, management, and
clinical outcomes of patients suffering coronary obstruction as a
complication of transcatheter aortic valve implantation (TAVI).
Background: Very few data exist on coronary obstruction after TAVI.
Methods: Studies published between 2002 and 2012, with regard to coronary
obstruction as a complication of TAVI, were identified with a systematic
electronic search. Only the studies reporting data on the main baseline
and procedural characteristics, management of the complication, and
clinical outcomes were analyzed. Results: A total of 18 publications
describing 24 patients were identified. Most (83%) patients were women,
with a mean age of 83 +/- 7 years and a mean logistic European System for
Cardiac Operative Risk Evaluation score of 25.1 +/- 12.0%. Mean left
coronary artery (LCA) ostium height and aortic root width were 10.3 +/-
1.6 mm and 27.8 +/- 2.8 mm, respectively. Most patients (88%) had received
a balloon-expandable valve, and coronary obstruction occurred more
frequently in the LCA (88%). Percutaneous coronary intervention was
attempted in 23 cases (95.8%) and was successful in all but 2 patients
(91.3%). At 30-day follow-up, there were no cases of stent thrombosis or
repeat revascularization, and the mortality rate was 8.3%. Conclusions:
Reported cases of coronary obstruction after TAVI occurred more frequently
in women, in patients receiving a balloon-expandable valve, and the LCA
was the most commonly involved artery. Percutaneous coronary intervention
was a feasible and successful treatment in most cases. Continuous efforts
should be made to identify the factors associated with this
life-threatening complication to implement the appropriate measures for
its prevention. 2013 American College of Cardiology Foundation.

<19>
Accession Number
22572234
Authors
Ishikawa Y. Maehara T. Nishii T. Yamanaka K. Adachi H. Saito S. Masuda M.
Institution
(Ishikawa) Department of Thoracic Surgery, National Hospital Organization,
Yokohama Medical Center, Yokohama, Kanagawa, Japan
(Maehara, Nishii, Yamanaka, Saito) Department of General Thoracic Surgery,
Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
(Adachi, Masuda) Department of Surgery, Yokohama City University Hospital,
Yokohama, Kanagawa, Japan
Title
Intrapleural analgesia using ropivacaine for postoperative pain relief
after minimally invasive thoracoscopic surgery.
Source
Annals of Thoracic and Cardiovascular Surgery. 18 (5) (pp 429-433), 2012.
Date of Publication: 2012.
Publisher
Japanese Association for Coronary Artery Surgery (2-1 Nibancho,
Chiyoda-ku, Tokyo 102-0084, Japan)
Abstract
Purpose: to evaluate the efficacy and safety of intrapleural analgesia
(IPA) using ropivacaine after thoracoscopic surgery, compared with
thoracic epidural analgesia (TEA) using ropivacaine. Methods: forty
patients undergoing thoracoscopic bullectomy for spontaneous pneumothorax
were randomly assigned to one of two groups. IPA group (n = 20) received
intermittent bolus injection of 0.375% ropivacaine into intrapleural space
two times; at the end of operation and one more time as the pain
increased. TEA group (n = 20) received continuous epidural analgesia with
0.375% ropivacaine. Transrectal diclofenac was administered as an
additional analgesic. Pain was assessed on the basis of additional
analgesics requirements and by using a visual analog scale (VAS). Results:
the time courses of VAS scores along the postoperative time course were
not significantly different (p = 0.175). Consumption of transrectal
diclofenac was significantly smaller in IPA group (p = 0.025). No major
complications appeared in both groups, and incidence of adverse symptoms
was not different. Conclusions: in IPA group, pain was managed with less
consumption of additional analgesics. IPA could be one of the good choices
after thoracoscopic surgery for its efficacy, safety, and benefit of easy
placement of the catheter. 2012 The Editorial Committee of Annals of
Thoracic and Cardiovascular Surgery. All rights reserved.

<20>
Accession Number
2013324426
Authors
Jiang Y. Qiao B. Wu L. Lin X.
Institution
(Jiang, Qiao, Wu, Lin) Cardiovascular Institution of Jinan Military
General Hospital, Jinan, China
Title
Application of Narcotrend Monitor for Evaluation of Depth of Anesthesia in
Infants Undergoing Cardiac Surgery: A Prospective Control Study.
Source
Revista Brasileira de Anestesiologia. 63 (3) (pp 273-278), 2013. Date of
Publication: May 2013.
Publisher
Elsevier Editora Ltda (Rua Sete de Setembro, 111 15, 16 and 17th floor,
Rio de Janeiro RJ 200550-006, Brazil)
Abstract
Background and objectives: To investigate the clinic effectiveness, safety
and feasibility of Narcotrend monitor for evaluation of depth of
anesthesia in congenital heart disease (CHD) infants undergoing cardiac
surgery. Methods: A total of 80 infants receiving general anesthesia in
selective surgery were randomly selected. Infants were assigned into two
groups (n = 40 per group). In the Narcotrend group, the depth of
anesthesia was monitored with the Narcotrend monitor. In the standard
group, the depth of anesthesia was controlled according to the experience.
The mean arterial pressure (MAP) and heart rate (HR) were determined, as
well as the dose of fentanyl, muscle relaxant, recovery time and
extubation time were recorded. Results: In both groups, vital signs were
stable during the surgery. When compared with the standard group, the MAP
and HR were more stable, the total dose of fentanyl and muscle relaxant
were signifi cantly reduced and the recovery time and extubation time were
markedly shortened in the Narcotrend group. Conclusion: The application of
Narcotrend monitor was benefi cial to the control of the depth of
anesthesia in CHD infants receiving total intravenous anesthesia, in which
small amount of narcotics can achieve optimal anesthesia. Moreover, the
recovery time and extubation time are reduced and the harmful consequence
such as intraoperative awareness can be avoided. 2013 Elsevier Editora
Ltda.

<21>
Accession Number
2013310354
Authors
Maron D.J. Hartigan P.M. Neff D.R. Weintraub W.S. Boden W.E.
Institution
(Maron) Vanderbilt University, School of Medicine, Nashville, TN, United
States
(Hartigan) Veterans Affairs Cooperative Studies Program Coordinating
Center, West Haven, CT, United States
(Neff) Merck Sharp and Dohme Corporation, Whitehouse Station, NJ, United
States
(Weintraub) Christiana Care Health System, Newark, DE, United States
(Boden) Samuel S. Stratton Veterans Affairs Medical Center, Albany, NY,
United States
Title
Impact of adding ezetimibe to statin to achieve low-density lipoprotein
cholesterol goal (from the clinical outcomes utilizing revascularization
and aggressive drug evaluation [COURAGE] trial).
Source
American Journal of Cardiology. 111 (11) (pp 1557-1562), 2013. Date of
Publication: 01 Jun 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
In the Clinical Outcomes Utilizing Revascularization and Aggressive Drug
Evaluation (COURAGE) study, a revascularization strategy trial with
optimal medical therapy in both arms, the low-density lipoprotein (LDL)
cholesterol goal was 60 to 85 mg/dl; this was revised to <70 mg/dl in
2004. COURAGE patients (n = 2,287) were titrated with increasing statin
doses to achieve the initial LDL cholesterol goal using a prespecified
protocol. Ezetimibe was not available when study enrollment began in 1999
but became available after approval in 2003. After maximizing statin dose,
ezetimibe was added to reach the LDL cholesterol goal in 34% of patients
(n = 734). Median baseline LDL cholesterol was higher in patients who
received ezetimibe than in those who did not (109 vs 96 mg/dl). At
baseline, 18% of patients who would later receive ezetimibe had LDL
cholesterol <85 mg/dl, and 8% had LDL cholesterol <70 mg/dl. On maximum
tolerated statin (with or without other lipid-lowering drugs), 40% had LDL
cholesterol <85 mg/dl and 23% had LDL cholesterol <70 mg/dl before
starting ezetimibe. At the final study visit, 68% of ezetimibe patients
achieved LDL cholesterol <85 mg/dl, and 46% achieved LDL cholesterol <70
mg/dl. Using Cox regression analysis, the most significant factors
associated with achieving LDL cholesterol goals were lower baseline LDL
cholesterol, average statin dose, and ezetimibe use. In conclusion, after
maximizing statin dose, the addition of ezetimibe results in a substantial
increase in the percentage of patients who reach LDL cholesterol goal, a
key component of optimal medical therapy. 2013 Published by Elsevier Inc.
All rights.

<22>
Accession Number
2013287097
Authors
Dogra J.
Institution
(Dogra) Poly Clinic, Central Government Health Scheme, Jaipur, Rajasthan,
India
Title
Oral azithromycin in extended dosage schedule for chronic, subclinical
Chlamydia pneumoniae infection causing coronary artery disease: A probable
cure in sight? Results of a controlled preliminary trial.
Source
International Journal of General Medicine. 5 (pp 505-509), 2012. Date of
Publication: 2012.
Publisher
DOVE Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: Two mega trials have raised the question as to whether the
hypothesis that infection plays a role in atherosclerosis is still
relevant. This controlled preliminary trial investigated an extended dose
of azithromycin in the treatment of Chlamydia pneumoniae infection causing
coronary artery disease (CAD). Patients and methods: Forty patients with
documentary evidence of CAD were screened for immunoglobulin G titers
against C. pneumoniae and grouped into either the study group (patients
with positive titer, n = 32) or control group (patients with negative
titer, n = 8). Cases who met inclusion criteria could not have had
coronary artery bypass graft surgery or percutaneous coronary intervention
in the preceding 6 months. Informed consent was obtained from every
patient. Baseline blood samples were analyzed for red blood cell indices,
serum creatinine, and liver function tests, and repeated every 2 months. A
primary event was defined as the first occurrence of death by any cause,
recurrent myocardial infarction, coronary revascularization procedure, or
hospitalization for angina. Patients in the study group received 500 mg of
oral azithromycin once daily for 5 days, which was then repeated after a
gap of 10 days (total of 24 courses in the 1-year trial period). The
control group did not have azithromycin added to their standard CAD
treatment. Results: In the study group, 30 patients completed the trial.
Two patients had to undergo percutaneous coronary intervention in the
initial first quarter of the 1-year trial period. In the control group,
one patient died during the trial, one had to undergo coronary artery
bypass graft surgery, and one had percutaneous coronary intervention.
Conclusion: The patients tolerated the therapy well and there was a
positive correlation between azithromycin and secondary prevention of CAD.
2012 Dogra, publisher and licensee Dove Medical Press Ltd.