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<1>
Accession Number
22884136
Authors
Lu J.K. Zhu C. Jing H. Wang Y.J. Qing E.M.
Institution
(Lu) Department of Anesthesiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing 100029, China.
Title
Application of intraoperative arterial pressure-based cardiac output
monitoring for patients undergoing coronary artery bypass grafting
surgery.
Source
Chinese medical journal. 125 (12) (pp 2099-2103), 2012. Date of
Publication: Jun 2012.
Abstract
For patients undergoing off-pump coronary artery bypass grafting (OPCABG),
it is important to establish a hemodynamic monitoring system to obtain
powerful parameters for better intraoperative treatment. This study aimed
to observe the clinical feasibility of arterial pressure-based cardiac
output (APCO) for cardiac output (CO) monitoring and to evaluate the
correlation between APCO and pulmonary artery catheter (PAC) for CO
measurement for patients undergoing OPCABG intraoperatively. Fifty
patients of American Society of Anaesthesiologists (ASA) classification
II-III, undergoing elective OPCABG at Beijing Anzhen Hospital were
randomly enrolled into this study. All patients were assigned to CO
monitoring by PAC and APCO simultaneously. Patients with pacemaker, severe
valvular heart disease, left ventricular ejection fraction (EF) < 40%,
cardiac arrhythmias, peripheral vascular disease, application of
intra-aortic balloon pump (IABP) and emergent diversion to cardiac
pulmonary bypass were excluded. The radial artery waveform was analyzed to
estimate the stroke volume (SV) and heart rate (HR) continuously. CO was
calculated as SV ' HR; other derived parameters were cardiac index (CI),
stroke volume index (SVI), systemic vascular resistance (SVR), and
systemic vascular resistance index (SVRI). PAC was placed via right
internal jugular vein and the correct position was confirmed by PAC
waveforms. Continuous cardiac output (CCO), CI and other hemodynamic
parameters were monitored at following 5 time points: immediate after
anesthesia induction (baseline value), anastomosis of left internal
mammary artery to left anterior descending artery (LAD), anastomosis of
left circumflex (LCX), anastomosis of posterior descending artery (PDA)
and immediate after sternal closure. In the 50 patients, preoperative
echocardiography measured left ventricular EF was (52.8 +/- 11.5)%, and 35
patients (70%) showed regional wall motion abnormalities. The correlation
coefficient of CO monitored by APCO and PAC were 0.70, 0.59, 0.78, 0.74
and 0.85 at each time point. The bias range of CI monitored from both APCO
and PAC were (0.39 +/- 0.06) Lxmin(-1)xm(-2), (0.48 +/- 0.12)
Lxmin(-1)xm(-2), (0.26 +/- 0.06) Lxmin(-1)xm(-2), (0.27 +/- 0.06)
Lxmin(-1)xm(-2), (0.30 +/- 0.05) Lxmin(-1)xm(-2) at each time point. The
results of SVR by two hemodynamic monitoring techniques had good
correlation during OPCABG. The variation trends of SVR were opposite
comparing with the results of CO. SVR collected from PAC obtained the
highest value of (1220.0 +/- 254.0) dynxsxcm(-5) at PDA anastomosis, but
the highest value obtained from APCO was (1206.0 +/- 226.5) dynxsxcm(-5)
in LCX anastomosis. APCO is feasible in hemodynamic monitoring for
patients undergoing OPCABG. The results of hemodynamic monitoring derived
from APCO and PAC are closely correlated. Its characterizations of timely,
accurate and continuous display of hemodynamic parameters are also
obviously demonstrated in the present study.

<2>
Accession Number
22436170
Authors
Tagarakis G.I. Voucharas C. Tsolaki F. Daskalopoulos M.E. Papaliagkas V.
Parisis C. Gogaki E. Tsagalas I. Sataitidis I. Tsolaki M. Tsilimingas N.B.
Institution
(Tagarakis) Department of Cardiovascular and Thoracic Surgery, University
Hospital of Larissa, Thessaly, Greece.
Title
Ondasetron versus haloperidol for the treatment of postcardiotomy
delirium: a prospective, randomized, double-blinded study.
Source
Journal of cardiothoracic surgery. 7 (pp 25), 2012. Date of Publication:
2012.
Abstract
To investigate the controlling efficacy of ondasetron and haloperidol in
regard to the postcardiotomy delirium. We included in this prospective,
randomized, double-blinded study 80 patients who developed delirium after
heart surgery with the application of heart lung-machine. The patients
were divided into two, equally-sized groups, which on detection of
delirium received ondasetron 8 mg iv or haloperidol 5 mg iv respectively.
The statistical analysis compared the baseline and demographic
characteristics of the two groups (age, gender, comorbidities, years of
education, type of surgery etc.). Both ondasetron and haloperidol had very
good delirium controlling effects, without statistically significant
differences. DISCUSSION-CONCLUSIONS: Ondasetron and haloperidol are
efficient agents as far as the treatment of postcardiotomy delirium is
concerned. As, in addition, ondasetron bares milder side-effects, we
believe this could be the agent of choice in patients developing
postcardiotomy delirium in the future.

<3>
Accession Number
2013407444
Authors
Metz D. Stiller M. Silber R.-E. Kroll H. Hofmann H.-S. Diez C.
Institution
(Metz) Klinik fur Herz-, Thorax- und Gefaschirurgie, MediClin Herzzentrum
Coswig, Coswig, Germany
(Stiller, Silber) Klinik fur Herz- und Thoraxchirurgie,
Universitatsklinikum Halle (Saale), Halle, Germany
(Kroll) Klinik fur Anasthesiologie, Universitatsklinikum Halle (Saale),
Halle, Germany
(Hofmann) Abteilung fur Thoraxchirurgie, Universitatsklinikum Regensburg,
Regensburg, Germany
(Diez) Klinik fur Herz-, Thorax- und herznahe Gefaschirurgie,
Universitatsklinikum Regensburg, Franz-Josef-Straus-Allee 11, 93052
Regensburg, Germany
Title
Prophylactic intraaortic balloon pumping in high-risk cardiac surgery
patients.
Source
Medizinische Klinik - Intensivmedizin und Notfallmedizin. 106 (2) (pp
125-131), 2011. Date of Publication: 2011.
Publisher
Springer-Verlag (Germany)
Abstract
Background: We examined the impact of prophylactic IABP insertion in
EuroSCORE-stratified high-risk cardiac surgery patients with a score >=8.
Material and methods: A randomized trial with 104 patients either without
prophylactic IABP insertion (group A, n=52) or with IABP (group B, n=52)
was conducted. The primary endpoint was 30-day mortality. Results: The
median age of the patients was 74 years and 43% of participants were
females. The 30-day mortality did not differ between group A (17.3%) and
group B (13.4%; p=0.78). The median hospital stay was 14 days in both
groups. Intra- and postoperative IABP support was required by 13 patients
(21%) in group A. The median ventilation time (14 hours versus 13 hours),
median catecholamine dose, frequency of dialysis-dependent acute renal
failure (28% versus 18%), cardiac indices, and frequency of a low cardiac
output syndrome (26% versus 25%) did not significantly differ between
groups. Conclusion: Prophylactic preoperative IABP insertion in
EuroSCORE-stratified high-risk patients is not associated with decreased
30-day mortality. 2011 Urban & Vogel, Muenchen.

<4>
Accession Number
21591581
Authors
Karimabad H.M. Shabestari M. Baharvand H. Vosough A. Gourabi H. Shahverdi
A. Shamsian A. Abdolhoseini S. Moazzami K. Marjanimehr M.M. Emami F.
Bidkhori H.R. Hamedanchi A. Talebi S. Farrokhi F. Jabbari-Azad F. Fadavi
M. Garivani U. Mahmoodi M. Aghdami N.
Institution
(Karimabad) Razavi Hospital, Mashhad.
Title
Lack of beneficial effects of granulocyte colony-stimulating factor in
patients with subacute myocardial infarction undergoing late
revascularization: a double-blind, randomized, placebo-controlled clinical
trial.
Source
Acta cardiologica. 66 (2) (pp 219-224), 2011. Date of Publication: Apr
2011.
Abstract
Early clinical studies have suggested that administration of
granulocyte-colony stimulating factor (G-CSF) may improve the clinical
condition of patients suffering from myocardial infarction (MI).This
prospective, randomized, double-blind, placebo-controlled single-centre
trial aims to assess the safety and clinical efficacy of G-CSF
administration in patients with subacute MI and impaired LV function
undergoing delayed primary percutaneous coronary intervention (PCI). A
total of 16 patients (13 men, mean age 51 years) with subacute ST-segment
elevation MI and a left ventricular (LV) ejection fraction (EF) of less
than 45% at baseline who underwent late revascularization, were included
in the study. Patients were randomized in a double-blind fashion to
receive either G-CSF (at a dose of 10 microg/kg body weight) or placebo
for five consecutive days. End points consisted of assessment of safety
parameters as well as changes of global and regional myocardial function
from baseline until six months following PCI. G-CSF administration
resulted in a significant mobilization of different cell populations
(four-fold increase in WBC count and a six-fold increase in CD34+ cells).
G-CSF treatment was well tolerated in most patients and no major adverse
cardiac events or severe G-CSF-related side effects were identified during
hospitalization and at follow-up. No significant differences were observed
between the G-CSF and placebo groups regarding global and regional
myocardial function parameters. G-CSF administration is safe, but not
effective, in improving impaired LV functional parameters in patients with
subacute MI who had an impaired baseline EF of less than 45%.

<5>
Accession Number
21881326
Authors
Holinski S. Schmeck B. Claus B. Radtke H. Elgeti T. Holzhausen M. Konertz
W.
Institution
(Holinski, Schmeck, Claus, Konertz) Departments of Cardiovascular Surgery,
Humboldt University, Berlin, Germany
(Radtke) Institute of Transfusion Medicine, Charite, Humboldt University,
Berlin, Germany
(Elgeti) Department of Radiology, Charite, Humboldt University, Berlin,
Germany
(Holzhausen) Department of Biometry, Charite, Humboldt University, Berlin,
Germany
Title
Encouraging experience with intracardiac transplantation of unselected
autologous bone marrow cells concomitant with coronary artery bypass
surgery after myocardial infarction.
Source
Annals of Thoracic and Cardiovascular Surgery. 17 (4) (pp 383-389), 2011.
Date of Publication: 2011.
Publisher
Japanese Association for Coronary Artery Surgery (2-1 Nibancho,
Chiyoda-ku, Tokyo 102-0084, Japan)
Abstract
Background: Chronic heart failure after myocardial infarction is still a
serious problem without a fundamental therapy. Experimental
transplantation of bone marrow cells (BMC) into infarcted myocardium
resulted in regeneration and functional improvement. Objective: Clinical
investigation of safety and efficacy of intracardiac transplantation of
unselected autologous BMC. Method: 22 patients scheduled for elective and
isolated coronary artery bypass grafting (CABG) with a reduced LVEF due to
myocardial infarction were included. Intraoperatively, sternal bone marrow
blood was aspirated, and a sterile buffy coat was prepared and applicated.
19 age, LVEF and coronary disease matched patients served as controls.
Heart function, geometry, and scar proportion were assessed by
echocardiography and Gadolinium-MRI at the time of the operation and 6
months thereafter. Results: Transplanted patients received a mean number
of 360 x 10⁶ BMC. We did not notice any significant differences
in early or late complications in the transplant group as compared to
controls. At six months follow up only the transplanted patients showed a
significant improvement of NYHA classes from 2.7 to 1.5 and of LVEF from
36 to 43%, (p < 0.05). Furthermore, only CABG concomitant with BMC-TX led
to a significant reduction of left ventricular end diastolic diameter
(LVEDD) from 59 to 54 mm and of scar proportion of the infarcted segments
from 2.53 to 2.42, (p<0.05). Conclusion: Intracardiac transplantation of
unselected, autologous BMC is safe and feasible. In adjunct with coronary
revascularization it leads to an improvement of ventricular geometry and
function. Moreover, it reduces myocardial scar proportion and heart
failure symptoms. 2011 The Editorial Committee of Annals of Thoracic and
Cardiovascular Surgery. All rights reserved.

<6>
Accession Number
21881324
Authors
Morimoto K. Nishimura K. Miyasaka S. Maeta H. Taniguchi I.
Institution
(Morimoto, Nishimura, Miyasaka, Maeta, Taniguchi) Department of Thoracic
and Cardiovascular Surgery, Tottori Prefectural Central Hospital, Tottori
Tottori, Japan
Title
The effect of sivelestat sodium hydrate on severe respiratory failure
after thoracic aortic surgery with deep hypothermia.
Source
Annals of Thoracic and Cardiovascular Surgery. 17 (4) (pp 369-375), 2011.
Date of Publication: 2011.
Publisher
Japanese Association for Coronary Artery Surgery (2-1 Nibancho,
Chiyoda-ku, Tokyo 102-0084, Japan)
Abstract
Patients who undergo thoracic aortic surgery with deep hypothermia
frequently have postoperative respiratory failure as a complication.
Severe lung injury in these patients results in a fatal outcome. A
specific neutrophil elastase inhibitor, sivelestat sodium hydrate, is an
innovative therapeutic drug for acute lung injury. We evaluated the
protective effects of sivelestat sodium hydrate on severe lung injury
after thoracic aortic surgery with deep hypothermia. From January 2002 to
July 2007, 71 consecutive patients underwent thoracic aortic surgery with
deep hypothermia. Of these patients, 22 had postoperative respiratory
failure with PaO₂/FiO₂ ratios of less than 150. They
were randomly assigned to one of two groups. The first group (Group S, n =
10) was administered sivelestat sodium hydrate continuously at 0.2 mg/kg/h
until weaning from mechanical ventilation; the second group (Group C, n =
12) was not administered sivelestat sodium hydrate. The groups were
comparable with respect to clinical data. There were no significant
differences between the two groups in age, operation duration, total
cardiopulmonary bypass time, circulatory ischemia time, cardiac arrest
time, intraoperative blood loss, and total transfusion volume. The
improvement of pulmonary function was observed in the both groups, but
more marked in Group S by statistical analysis using analysis of variance
for repeated measurements. Especially, in the early phase, pulmonary
function improvement was more marked in Group S. The duration of
mechanical ventilation, the length of stay in the intensive care unit, and
the length of hospital stay were shorter in Group S, but not
significantly. Sivelestat sodium hydrate is a specific neutrophil elastase
inhibitor that improves pulmonary function in patients with severe
postoperative respiratory failure following thoracic aortic surgery with
deep hypothermia. The drug may shorten the duration of postoperative
ventilation, intensive care unit stay, and hospital stay. 2011 The
Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All
rights reserved.

<7>
Accession Number
21050973
Authors
Gao G. Zheng Z. Pi Y. Lu B. Lu J. Hu S.
Institution
(Gao) Department of Surgery, Cardiovascular Institute and Fu Wai Hospital,
Chinese Academy of Medical Sciences & Peking Union Medical College,
Beijing, The People's Republic of China.
Title
Aspirin plus clopidogrel therapy increases early venous graft patency
after coronary artery bypass surgery a single-center, randomized,
controlled trial.
Source
Journal of the American College of Cardiology. 56 (20) (pp 1639-1643),
2010. Date of Publication: 9 Nov 2010.
Abstract
We sought to evaluate the effect of aspirin plus clopidogrel versus
aspirin alone on saphenous vein graft occlusion at 3 months after coronary
artery bypass grafting (CABG). Prevalence of graft occlusion is high after
CABG. Aggressive antiplatelet therapy is expected to improve early
post-operative graft patency. From December 2007 through December 2008,
249 consecutive patients undergoing elective CABG at Fuwai Hospital were
randomly assigned to 2 groups: 124 received aspirin (100 mg) plus
clopidogrel (75 mg) daily (AC group), and 125 received aspirin (100 mg)
alone daily (A group). Antiplatelet therapies were initiated when
post-operative chest tube drainage was <= 30 cc/h for 2 h. All
participants were invited for clinical follow-up and 64-slice multislice
computed tomography angiography (MSCTA) analysis at 3 months
post-operatively. Generalized estimating equations analysis was used to
determine predictors of graft patency. One participant, from group A, died
before 3-month follow-up. Of the remaining 248 patients, 224 (90.3%)
underwent MSCTA. Participants had similar pre-operative and intraoperative
characteristics at baseline. No significant differences were observed in
intraoperative transit-time flow measurement findings or major adverse
cardiac-related events. Three-month MSCTA follow-up revealed that
saphenous vein graft patency was 91.6% (219 of 239) in the AC group versus
85.7% (198 of 231) in the A group (p = 0.043). In multivariate analysis,
combined antiplatelet therapy independently increased venous graft patency
(p = 0.045). Aspirin plus clopidogrel is more effective in venous graft
patency than aspirin alone in the short term after CABG, but further,
long-term study is needed. (The Clopidogrel and Aspirin After Surgery for
Coronary Artery Disease; NCT00776477). Copyright 2010 American College of
Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

<8>
Accession Number
20613493
Authors
Harling L. Warren O.J. Rogers P.L. Watret A.L. Choong A.M. Darzi A.
Angelini G.D. Athanasiou T.
Institution
(Harling) Department of BioSurgery and Surgical Technology, Imperial
College, London, UK.
Title
How minimalized extracorporeal circulation compares with the off-pump
technique in coronary artery bypass grafting.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992). 56
(5) (pp 446-456), 2010. Date of Publication: 2010 Sep-Oct.
Abstract
Recognition of the adverse effects of conventional extracorporeal
circulation (CECC) led to the development of alternative technologies and
techniques to minimize their impact while maintaining circulation during
coronary artery bypass grafting (CABG). Off-pump coronary artery bypass
(OPCAB) grafting has become established as one such alternative and more
recently minimalized extracorporeal circulation (MECC) circuits have been
developed with the aim of providing circulatory support while minimizing
the interface between blood and the foreign surfaces of the circuit that
initiates the associated adverse effects of CECC. Recently, some authors
have suggested that MECC may be an alternative to OPCAB in patients
undergoing CABG; the aim of this article is to systematically analyze and
compare the impact of CABG with MECC with that of OPCAB, studying the
adverse outcomes related to CECC. We performed a systematic search to
identify all studies directly comparing OPCAB and MECC. Endpoints were
subcategorized into four key areas of interest: length of stay (LOS),
hemorrhage, cerebrovascular injury, and 30-day mortality. Random effect
modeling techniques were applied to identify differences in outcomes
between the two groups. Six studies fulfilled the inclusion criteria,
incorporating 2,072 patients of whom 930 underwent OPCAB and 1,142
underwent revascularization supported by MECC. We found no statistically
significant difference in hospital or intensive care unit (ICU) LOS, blood
loss, mean number of patients transfused, neurocognitive disturbance, or
30-day mortality between the two groups but a trend toward an increased
number of cerebrovascular events in the MECC group was observed. The
number of studies comparing these alternative techniques for coronary
revascularization is small, and there is a lack of high-quality data.
Currently, there seems little difference between MECC and OPCAB but larger
randomized controlled trials focusing on high-risk patients are required.

<9>
Accession Number
20719724
Authors
Mohd A.R. Ghani M.K. Awang R.R. Su Min J.O. Dimon M.Z.
Institution
(Mohd) Heart and Lung Centre, Universiti Kebangsaan Malaysia Medical
Centre, Kuala Lumpur, Malaysia.
Title
Dermacyn irrigation in reducing infection of a median sternotomy wound.
Source
The heart surgery forum. 13 (4) (pp E228-232), 2010. Date of Publication:
Aug 2010.
Abstract
Sternal wound infection is an infrequent yet potentially devastating
complication following sternotomy. Among the standard practices used as
preventive measures are the use of prophylactic antibiotics and
povidone-iodine as an irrigation agent. A new antiseptic agent, Dermacyn
super-oxidized water (Oculus Innovative Sciences), has recently been used
as a wound-irrigation agent before the closure of sternotomy wounds. This
prospective, randomized clinical trial was conducted to compare the
effectiveness of Dermacyn and povidone-iodine in reducing sternotomy wound
infection in patients undergoing coronary artery bypass graft surgery.
Upon chest closure and after insertion of sternal wires, wounds were
soaked for 15 minutes with either Dermacyn or povidone-iodine.
Subcutaneous tissue and skin were then closed routinely. Patients were
followed up, and any wound infection was analyzed. Of the 178 patients, 88
patients were in the Dermacyn group, and 90 were in the povidone-iodine
group. The mean (+/-SD) age of the patients was 61.1 +/- 7.6 years. The
incidence of sternotomy wound infection was 19 cases (10.7%). Five (5.7%)
of these cases were from the Dermacyn group, and 14 (15.6%) were from the
povidone-iodine group (P = .033). No Dermacyn-related complication was
identified. We found Dermacyn to be safe and more effective as a
wound-irrigation agent than povidone-iodine for preventing sternotomy
wound infection.

<10>
Accession Number
2013415784
Authors
Lakshmi R. James E. Kirthivasan R.
Institution
(Lakshmi, James) Department of Pharmacy Practice, AIMS Health Sciences
Campus, Amrita Vishwa Vidyapeetham University, Kochi-682 041, India
(Kirthivasan) Department of Stroke Medicine, Amrita Institute of Medical
Sciences and Research Centre, Kochi-682 041, India
Title
Study on impact of clinical pharmacist's interventions in the optimal use
of oral anticoagulants in stroke patients.
Source
Indian Journal of Pharmaceutical Sciences. 75 (1) (pp 53-59), 2013. Date
of Publication: January-February 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Anticoagulants are very useful medications but can also lead to
haemorrhagic as well as thromboembolic complications when not used
correctly or without proper medical attention. Anticoagulant's complex
pharmacology and pharmacokinetics contribute to its narrow margin of
safety. Pharmacist's unique knowledge of pharmacology, pharmacokinetics
and interactions makes them well-suited to assist patients in maintaining
safe and effective anticoagulation. Successful anticoagulation therapy
implies fewer incidences of therapeutic failures and bleeding
complications. The anticoagulation management service staffed by clinical
pharmacists is a service established to monitor and manage oral and
parenteral anticoagulants. In this research work, 40 patients each were
included in the intervention and the control groups. In the intervention
group, patient's knowledge score on anticoagulation increased from an
average of 5.6+/-3.2 to 13.8+/-0.94 (P=0.000) after clinical pharmacist's
counselling, whereas in the control group there was no significant
improvement in patient's baseline knowledge over the knowledge score at
the end of the study (8.0+/-1.59 vs. 8.3+/-2.6) (P=0.218). In the
intervention group, 73.45% of the international normalised ratio test
results were within the therapeutic range, 8.45% supratherapeutic and
18.5% subtherapeutic during the 6 months data collection period. The
corresponding data for the control group were 53.2 (P=0.000), 18.4
(P=0.000) and 28.4% (P=0.002), respectively. Forty four adverse drug
reactions (ADRs) related to anticoagulants were identified in the
intervention group as compared to 56 in the control group. These results
revealed that the clinical pharmacist's involvement in the anticoagulation
management improved the therapeutic outcome of patients and demonstrate
the benefits of clinical pharmacist guided anticoagulation clinics in
India.

<11>
Accession Number
2013408321
Authors
Stoppe C. Werker T. Rossaint R. Dollo F. Lue H. Wonisch W. Menon A.
Goetzenich A. Bruells C.S. Coburn M. Kopp R. Bucala R. Bernhagen J. Rex S.
Institution
(Stoppe, Werker, Rossaint, Bruells, Coburn) Department of Anesthesiology,
University Hospital of the RWTH Aachen, Aachen, Germany
(Stoppe, Dollo, Lue, Bernhagen) Institute of Biochemistry and Molecular
Cell Biology, RWTH Aachen, University Hospital, Pauwelsstrase 30, 52074
Aachen, Germany
(Wonisch) Center for Physiological Medicine, Institute of Physiological
Chemistry, Medical University of Graz, Graz, Austria
(Wonisch) Clinical Institute of Medical, Chemical Laboratory Diagnostics,
Medical University of Graz, Graz, Austria
(Menon, Goetzenich) Department of Intensive Care Medicine, Cardiac and
Vascular Surgery, University Hospital, Aachen, Germany
(Kopp) Department of Thoracic, Cardiac and Vascular Surgery, University
Hospital, Aachen, Germany
(Bucala) Department of Medicine, Section of Rheumatology, Yale University
School of Medicine, New Haven, CT, United States
(Rex) Department of Anesthesiology, Department of Cardiovascular Sciences,
University Hospitals Leuven, KU Leuven, Belgium
Title
What Is the significance of perioperative release of macrophage migration
inhibitory factor in cardiac surgery?.
Source
Antioxidants and Redox Signaling. 19 (3) (pp 231-239), 2013. Date of
Publication: 20 Jul 2013.
Publisher
Mary Ann Liebert Inc. (140 Huguenot Street, New Rochelle NY 10801-5215,
United States)
Abstract
Cardiac surgery is associated with release of the pleiotropic cytokine
macrophage migration inhibitory factor (MIF). The trigger for MIF release
has not yet been elucidated. Owing to its intrinsic antioxidative
activity, MIF might reduce oxidative stress and protect from myocardial
ischemia and reperfusion (I/R) injury. In the present study, patients
scheduled for elective cardiac surgery (n=46) were randomized to undergo
coronary artery bypass grafting either conventionally with cardiopulmonary
bypass and cardioplegic arrest-induced I/R (cCABG) or in an off-pump
procedure (OPCAB) with minimized I/R. We report that only patients who
underwent cCABG exhibited a postoperative increase of MIF (p=0.024), while
both groups showed an increase in interleukin-6. MIF release appears to be
primarily mediated by I/R and to a lesser extent by inflammation.
Endogenous peroxidase activity (p=0.021) and serum levels of thioredoxin
(p=0.003) were significantly higher in patients who underwent cCABG after
surgery. Interestingly, perioperative MIF release was associated with an
enhanced antioxidant capacity and a significantly reduced postoperative
incidence of atrial fibrillation (p=0.018) and acute kidney injury
(p=0.048). The present study highlights the role of MIF increase during
cardiac surgery in response to oxidative stress. Based on current
observations, we hypothesize that intraoperative MIF secretion is due to
I/R and enhances the antioxidant capacity in patients during cardiac
surgery. Antioxid. Redox Signal. 19, 231-239. 2013, Mary Ann Liebert,
Inc.

<12>
Accession Number
2013390521
Authors
Hahn R.T. Pibarot P. Stewart W.J. Weissman N.J. Gopalakrishnan D. Keane
M.G. Anwaruddin S. Wang Z. Bilsker M. Lindman B.R. Herrmann H.C. Kodali
S.K. Makkar R. Thourani V.H. Svensson L.G. Akin J.J. Anderson W.N. Leon
M.B. Douglas P.S.
Institution
(Hahn, Kodali, Leon) NYP Columbia Heart Valve Center, Columbia University
Medical Center, New York, NY, United States
(Hahn, Kodali, Leon) Columbia University Medical Center, New York
Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032,
United States
(Pibarot) Department of Medicine, Laval University, Quebec City, QC,
Canada
(Stewart, Svensson) Cleveland Clinic Foundation, Cleveland, OH, United
States
(Weissman, Wang) Medstar Washington Hospital Center, Washington, DC,
United States
(Gopalakrishnan) Medical City Dallas, Dallas, TX, United States
(Keane, Anwaruddin, Herrmann) Hospital of the University of Pennsylvania,
Philadelphia, PA, United States
(Bilsker) University of Miami, Miami, FL, United States
(Lindman) Department of Medicine, Cardiovascular Division, Washington
University in St. Louis School of Medicine, St. Louis, MO, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Akin, Anderson) Edwards Lifesciences, Irvine, CA, United States
(Douglas) Division of Cardiovascular Medicine, Duke University Medical
Center, Duke Clinical Research Institute, Durham, NC, United States
Title
Comparison of transcatheter and surgical aortic valve replacement in
severe aortic stenosis: A longitudinal study of echocardiography
parameters in cohort a of the PARTNER trial (Placement of aortic
transcatheter valves).
Source
Journal of the American College of Cardiology. 61 (25) (pp 2514-2521),
2013. Date of Publication: 25 Jun 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This study sought to compare echocardiographic findings in
patients with critical aortic stenosis following surgical aortic valve
replacement (SAVR) or transcatheter aortic valve replacement (TAVR).
Background The PARTNER (Placement of Aortic Transcatheter Valves) trial
randomized patients 1:1 to SAVR or TAVR. Methods Echocardiograms were
obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years
after the procedure and analyzed in a core laboratory. For the analysis of
post-implantation variables, the first interpretable study (<=6 months)
was used. Results Both groups showed a decrease in aortic valve gradients
and increase in effective orifice area (EOA) (p < 0.0001), which remained
stable over 2 years. Compared with SAVR, TAVR resulted in larger indexed
EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more
total and paravalvular aortic regurgitation (p < 0.0001). Baseline
echocardiographic univariate predictors of death were lower peak
transaortic gradient in TAVR patients, and low left ventricular diastolic
volume, low stroke volume, and greater severity of mitral regurgitation in
SAVR patients. Post-implantation echocardiographic univariate predictors
of death were: larger left ventricular diastolic volume, left ventricular
systolic volume and EOA, decreased ejection fraction, and greater aortic
regurgitation in TAVR patients; and smaller left ventricular systolic and
diastolic volumes, low stroke volume, smaller EOA, and prosthesis-patient
mismatch in SAVR patients. Conclusions Patients randomized to either SAVR
or TAVR experience enduring, significant reductions in transaortic
gradients and increase in EOA. Compared with SAVR, TAVR patients had
higher indexed EOA, lower prosthesis-patient mismatch, and more aortic
regurgitation. Univariate predictors of death for the TAVR and SAVR groups
differed and might allow future refinement in patient selection. (THE
PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial;
NCT00530894). 2013 by the American College of Cardiology Foundation
Published by Elsevier Inc.

<13>
Accession Number
23167223
Authors
von Oppell U.O. Segadal L. Busund R. Johnston G.G. Dimitrakakis G. Masani
N. Lung T.H.
Institution
(von Oppell) University Hospital of Wales, Cardiff, UK.
Title
Aortic annulus diameter and valve design each determine the valve size
implanted.
Source
The Journal of heart valve disease. 21 (5) (pp 591-598), 2012. Date of
Publication: Sep 2012.
Abstract
The study aim was to compare the sizing characteristics and hemodynamics
of the Medtronic Mosaic Ultra porcine and Carpentier-Edwards PERIMOUNT
Magna bovine pericardial bioprosthetic stented aortic valves in relation
to the patient's true aortic annulus size. In this prospective multicenter
randomized study, data acquired perioperatively and at six months
postoperatively were collected. Following aortic valve excision and
debridement, the annulus was measured by blinded sizers prior to the
randomization of 141 patients (Ultra, n=72; Magna, n=69). The median
patient age was 75 years, and 89% of the patients had aortic stenosis. A
good left ventricular function was present in 75% of patients, and the
EuroSCORE-predicted mortality was 9%. Concomitant procedures (coronary
artery bypass grafting, mitral/tricuspid repair, septal myectomy, modified
Maze) were performed in 61% of patients. The in-hospital mortality was 3%,
and at six months postoperatively 96% of the patients were NYHA class I or
II, with no intergroup differences. The mean 'true aortic annulus' size
was 23.0 +/- 1.4 mm for the Ultra valve, and 22.6 +/- 1.8 mm for the Magna
valve (p = NS). The implanted labeled valve size was > or = 23 mm for 83%
of Ultra valves, and for 52% of Magna valves (p < 0.01), and smaller than
the measured true aortic diameter (44% Magna versus 33% Ultra). The mean
echo gradients were lower with Magna valves (11 +/- 6 mmHg) than with
Ultra (17 +/- 6 mmHg; p < 0.01), while the effective orifice area (EOA)
was higher with Magna than with Ultra (1.6 +/- 0.4 versus 1.4 +/- 0.4 ; p
< 0.01). Both groups showed a similar left ventricular mass regression
(Ultra -48 +/- 83 g; Magna -42 +/- 70 g). Trivial to moderate
regurgitation was noted in 24% of Ultra valves compared to 48% of Magna
valves (p < 0.01). Selection of the Ultra bioprosthetic valve allowed the
implantation of larger valve sizes. However, when compared to the 'true
aortic annulus', the Magna was associated with lower transprosthetic
gradients and larger EOAs. The longer term significance of these
observations remains inconclusive in terms of bioprosthesis selection,
however.

<14>
Accession Number
21563145
Authors
Dieleman J.M. van Paassen J. van Dijk D. Arbous M.S. Kalkman C.J.
Vandenbroucke J.P. van der Heijden G.J. Dekkers O.M.
Institution
(Dieleman) Division of Anesthesiology, Intensive Care and Emergency
Medicine, University Medical Center Utrecht, PO Box 85500, mailstop:
Q04.2.313, Utrecht, Netherlands, 3508 GA.
Title
Prophylactic corticosteroids for cardiopulmonary bypass in adults.
Source
Cochrane database of systematic reviews (Online). 5 (pp CD005566), 2011.
Date of Publication: 2011.
Abstract
High-dose prophylactic corticosteroids are often administered during
cardiac surgery. Their use, however, remains controversial, as no trials
are available that have been sufficiently powered to draw conclusions on
their effect on major clinical outcomes. The objective of this
meta-analysis was to estimate the effect of prophylactic corticosteroids
in cardiac surgery on mortality, cardiac and pulmonary complications.
Major medical databases (CENTRAL, MEDLINE, EMBASE, CINAHL and Web of
Science) were systematically searched for randomised studies assessing the
effect of corticosteroids in adult cardiac surgery. Database were searched
for the full period covered, up to December 2009. No language restrictions
were applied. Randomised controlled trials comparing corticosteroid
treatment to either placebo treatment or no treatment in adult cardiac
surgery were selected. There were no restrictions with respect to length
of the follow-up period. All selected studies qualified for pooling of
results for one or more end-points. The processes of searching and
selection for inclusion eligibility were performed independently by two
authors. Also, quality assessment and data-extraction of selected studies
were independently performed by two authors. The primary endpoints were
mortality, cardiac and pulmonary complications. The main effect measure
was the Peto odds ratio comparing corticosteroids to no treatment/placebo.
Fifty-four randomised studies, mostly of limited quality, were included.
Altogether, 3615 patients were included in these studies. The pooled odds
ratio for mortality was 1.12 (95% CI 0.65 to 1.92), showing no mortality
reduction in patients treated with corticosteroids. The odds ratios for
myocardial and pulmonary complications were 0.95, (95% CI 0.57 to 1.60)
and 0.83 (95% CI 0.49 to 1.40), respectively. The use of a random effects
model did not substantially influence study results. Analyses of secondary
endpoints showed a reduction of atrial fibrillation and an increase in
gastrointestinal bleeding in the corticosteroids group. This meta-analysis
showed no beneficial effect of corticosteroid use on mortality, cardiac
and pulmonary complications in cardiac surgery patients.

<15>
Accession Number
20943717
Authors
Mameletzi D. Kouidi E. Koutlianos N. Deligiannis A.
Institution
(Mameletzi) Laboratory of Sports Medicine, Department of Physical
Education and Sports Science, Aristotle University of Thessaloniki,
Thessaloniki, Greece.
Title
Effects of long-term exercise training on cardiac baroreflex sensitivity
in patients with coronary artery disease: a randomized controlled trial.
Source
Clinical rehabilitation. 25 (3) (pp 217-227), 2011. Date of Publication:
Mar 2011.
Abstract
To investigate whether a structured long-term exercise training programme
in patients with coronary artery disease affects baroreflex function and
cardiorespiratory efficiency. Twenty-five elderly male patients with
coronary artery disease. The patients were randomized into exercise (group
A) or control group (group B). Group A followed a seven-month supervised
exercise programme, consisting of three sessions of aerobic interval
training weekly at moderate intensity. Twenty patients completed the study
(group A: 10 patients and group B: 10 patients). At the beginning and end
of the study, all subjects underwent a tilt test for the baroreflex
sensitivity assessment and a graded exercise treadmill test with
spiroergometry for the evaluation of their cardiorespiratory efficiency.
There were no differences between the two groups for any baseline
variable. After training in group A, peak oxygen consumption, maximal
treadmill tolerance time and anaerobic threshold were significantly
increased by 21.9% (P < 0.001), 19.8% (P < 0.001) and 18.6% (P < 0.05),
respectively. There were also significant increases in baroreflex
sensitivity by 21.2% (P < 0.01), in baroreflex effectiveness index by
23.9% (P < 0.01), in event count by 45.1% (P < 0.01) and in ramp count by
13.2% (P < 0.05). Moreover, significant correlations were observed between
the autonomic and cardiorespiratory parameters in group A at the end. The
results suggest that long-term exercise training leads to beneficial
effects on baroreflex activity and cardiorespiratory performance in
coronary patients, and thus could constitute an efficient
nonpharmacological intervention in this population.

<16>
Accession Number
21505219
Authors
Bolland M.J. Grey A. Avenell A. Gamble G.D. Reid I.R.
Institution
(Bolland) Department of Medicine, University of Auckland, Private Bag 92
019, Auckland 1142, New Zealand.
Title
Calcium supplements with or without vitamin D and risk of cardiovascular
events: reanalysis of the Women's Health Initiative limited access dataset
and meta-analysis.
Source
BMJ (Clinical research ed.). 342 (pp d2040), 2011. Date of Publication:
2011.
Abstract
To investigate the effects of personal calcium supplement use on
cardiovascular risk in the Women's Health Initiative Calcium/Vitamin D
Supplementation Study (WHI CaD Study), using the WHI dataset, and to
update the recent meta-analysis of calcium supplements and cardiovascular
risk. Reanalysis of WHI CaD Study limited access dataset and incorporation
in meta-analysis with eight other studies. Data source WHI CaD Study, a
seven year, randomised, placebo controlled trial of calcium and vitamin D
(1g calcium and 400 IU vitamin D daily) in 36,282 community dwelling
postmenopausal women. Main outcome measures Incidence of four
cardiovascular events and their combinations (myocardial infarction,
coronary revascularisation, death from coronary heart disease, and stroke)
assessed with patient-level data and trial-level data. In the WHI CaD
Study there was an interaction between personal use of calcium supplements
and allocated calcium and vitamin D for cardiovascular events. In the
16,718 women (46%) who were not taking personal calcium supplements at
randomisation the hazard ratios for cardiovascular events with calcium and
vitamin D ranged from 1.13 to 1.22 (P = 0.05 for clinical myocardial
infarction or stroke, P = 0.04 for clinical myocardial infarction or
revascularisation), whereas in the women taking personal calcium
supplements cardiovascular risk did not alter with allocation to calcium
and vitamin D. In meta-analyses of three placebo controlled trials,
calcium and vitamin D increased the risk of myocardial infarction
(relative risk 1.21 (95% confidence interval 1.01 to 1.44), P = 0.04),
stroke (1.20 (1.00 to 1.43), P = 0.05), and the composite of myocardial
infarction or stroke (1.16 (1.02 to 1.32), P = 0.02). In meta-analyses of
placebo controlled trials of calcium or calcium and vitamin D, complete
trial-level data were available for 28,072 participants from eight trials
of calcium supplements and the WHI CaD participants not taking personal
calcium supplements. In total 1384 individuals had an incident myocardial
infarction or stroke. Calcium or calcium and vitamin D increased the risk
of myocardial infarction (relative risk 1.24 (1.07 to 1.45), P = 0.004)
and the composite of myocardial infarction or stroke (1.15 (1.03 to 1.27),
P = 0.009). Calcium supplements with or without vitamin D modestly
increase the risk of cardiovascular events, especially myocardial
infarction, a finding obscured in the WHI CaD Study by the widespread use
of personal calcium supplements. A reassessment of the role of calcium
supplements in osteoporosis management is warranted.

<17>
Accession Number
20974511
Authors
Venugopal V. Laing C.M. Ludman A. Yellon D.M. Hausenloy D.
Institution
(Venugopal) The Hatter Cardiovascular Institute, University College London
Hospital, London, UK.
Title
Effect of remote ischemic preconditioning on acute kidney injury in
nondiabetic patients undergoing coronary artery bypass graft surgery: a
secondary analysis of 2 small randomized trials.
Source
American journal of kidney diseases : the official journal of the National
Kidney Foundation. 56 (6) (pp 1043-1049), 2010. Date of Publication: Dec
2010.
Abstract
Novel treatment strategies are required to reduce the development of acute
kidney injury (AKI) in patients undergoing cardiac surgery. In this
respect, remote ischemic preconditioning (RIPC), a phenomenon in which
transient nonlethal ischemia applied to an organ or tissue protects
another organ or tissue from subsequent lethal ischemic injury, is a
potential renoprotective strategy. Secondary analysis of 2 randomized
trials. 78 consenting selected nondiabetic patients in a university
teaching hospital undergoing elective coronary artery bypass graft (CABG)
surgery recruited to 2 previously reported randomized studies. RIPC
consisted of three 5-minute cycles of right forearm ischemia, induced by
inflating a blood pressure cuff on the upper arm to 200 mm Hg, with an
intervening 5 minutes of reperfusion, during which time the cuff was
deflated. The control consisted of placing an uninflated cuff on the arm
for 30 minutes. AKI measured using Acute Kidney Injury Network (AKIN)
criteria, duration of hospital stay, in-hospital and 30-day mortality.
Numbers of participants with AKI stages 1, 2, and 3 were 1 (3%), 3 (8%),
and 0 in the intervention group compared with 10 (25%), 0, and 0 in the
control group, respectively (P = 0.005). The decrease in AKI was
independent of the effect of concomitant aortic valve replacement and
cross-clamp times, which were distributed unevenly between the 2 groups.
Retrospective analysis of data. More patients in the RIPC group underwent
concomitant aortic valve replacement with CABG; although we have corrected
statistically for this imbalance, it remains an important confounding
variable. RIPC induced using transient forearm ischemia decreased the
incidence of AKI in nondiabetic patients undergoing elective CABG surgery
in this retrospective analysis. A large prospective clinical trial is
required to study this effect and clinical outcomes in patients undergoing
cardiac surgery. Copyright 2010 National Kidney Foundation, Inc.
Published by Elsevier Inc. All rights reserved.

<18>
Accession Number
2013390916
Authors
Fisher S.A. Doree C. Brunskill S.J. Mathur A. Martin-Rendon E.
Institution
(Fisher, Doree, Brunskill) Systematic Review Initiative, NHS Blood and
Transplant, John Radcliffe Hospital, Oxford, United Kingdom
(Fisher, Doree, Brunskill, Martin-Rendon) Nuffield Division of Clinical
Laboratory Sciences, Radcliffe Department of Medicine, University of
Oxford, Oxford, United Kingdom
(Mathur) Queen Mary University of London CV Biomedical Research Unit,
Barts and The London School of Medicine and Dentistry, London, United
Kingdom
(Martin-Rendon) Stem Cell Research Laboratory, NHS Blood and Transplant,
John Radcliffe Hospital, Oxford, United Kingdom
Title
Bone Marrow Stem Cell Treatment for Ischemic Heart Disease in Patients
with No Option of Revascularization: A Systematic Review and
Meta-Analysis.
Source
PLoS ONE. 8 (6) , 2013. Article Number: e64669. Date of Publication: 19
Jun 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Objective:To evaluate bone marrow stem cell treatment (BMSC) in patients
with ischemic heart disease (IHD) and no option of
revascularization.Background:Autologous BMSC therapy has emerged as a
novel approach to treat patients with acute myocardial infarction or
chronic ischemia and heart failure following percutaneous or surgical
revascularization, respectively. However, the effect of the treatment has
not been systematic evaluated in patients who are not eligible for
revascularization.Methods:MEDLINE (1950-2012), EMBASE (1980-2012), CENTRAL
(The Cochrane Library 2012, Issue 8) and ongoing trial databases were
searched for relevant randomized controlled trials. Trials where
participants were diagnosed with IHD, with no option for revascularization
and who received any dose of stem cells by any delivery route were
selected for inclusion. Study and participant characteristics, details of
the intervention and comparator, and outcomes measured were recorded by
two reviewers independently. Primary outcome measures were defined as
mortality and measures of angina; secondary outcomes were heart failure,
quality of life measures, exercise/performance and left ventricular
ejection fraction (LVEF).Results:Nine trials were eligible for inclusion.
BMSC treatment significantly reduced the risk of mortality (Relative Risk
0.33; 95% Confidence Interval 0.17 to 0.65; P = 0.001). Patients who
received BMSC showed a significantly greater improvement in CCS angina
class (Mean Difference -0.55; 95% Confidence Interval -1.00 to -0.10; P =
0.02) and significantly fewer angina episodes per week at the end of the
trial (Mean Difference -5.21; 95% Confidence Interval -7.35 to -3.07;
P<0.00001) than those who received no BMSC. In addition, the treatment
significantly improved quality of life, exercise/performance and LVEF in
these patients.Conclusions:BMSC treatment has significant clinical benefit
as stand-alone treatment in patients with IHD and no other treatment
option. These results require confirmation in large well-powered trials
with long-term follow-up to fully evaluate the clinical efficacy of this
treatment. 2013 Fisher et al.

<19>
Accession Number
2013390544
Authors
Schweizer M. Perencevich E. McDanel J. Carson J. Formanek M. Hafner J.
Braun B. Herwaldt L.
Institution
(Schweizer, Perencevich, Carson, Herwaldt) University of Iowa, Carver
College of Medicine, Iowa City, IA, United States
(Schweizer, Perencevich, McDanel, Formanek, Herwaldt) University of Iowa,
College of Public Health, Iowa City, IA, United States
(Schweizer, Perencevich, Formanek) Iowa City VA Health Care System,
Mailstop 152, 601 Hwy 6 West, Iowa City, IA 52246, United States
(Perencevich, Herwaldt) Office of Clinical Quality, Safety, and
Performance Improvement, Department of Medicine, University of Iowa
Hospitals and Clinics, Iowa City, IA, United States
(Hafner, Braun) Joint Commission, Oakbrook Terrace, IL, United States
Title
Effectiveness of a bundled intervention of decolonization and prophylaxis
to decrease Gram positive surgical site infections after cardiac or
orthopedic surgery: Systematic review and meta-analysis.
Source
BMJ (Online). 346 (7912) , 2013. Article Number: f2743. Date of
Publication: 20 Jun 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective To evaluate studies assessing the effectiveness of a bundle of
nasal decolonization and glycopeptide prophylaxis for preventing surgical
site infections caused by Gram positive bacteria among patients undergoing
cardiac operations or total joint replacement procedures. Design
Systematic review and meta-analysis. Data sources PubMed (1995 to 2011),
the Cochrane database of systematic reviews, CINAHL, Embase, and
clinicaltrials.gov were searched to identify relevant studies. Pertinent
journals and conference abstracts were hand searched. Study authors were
contacted if more data were needed. Eligibility criteria Randomized
controlled trials, quasi-experimental studies, and cohort studies that
assessed nasal decolonization or glycopeptide prophylaxis, or both, for
preventing Gram positive surgical site infections compared with standard
care. Participants Patients undergoing cardiac operations or total joint
replacement procedures. Data extraction and study appraisal Two authors
independently extracted data from each paper and a random effects model
was used to obtain summary estimates. Risk of bias was assessed using the
Downs and Black or the Cochrane scales. Heterogeneity was assessed using
the Cochran Q and I² statistics. Results 39 studies were
included. Pooled effects of 17 studies showed that nasal decolonization
had a significantly protective effect against surgical site infections
associated with Staphylococcus aureus (pooled relative risk 0.39, 95%
confidence interval 0.31 to 0.50) when all patients underwent
decolonization (0.40, 0.29 to 0.55) and when only S aureus carriers
underwent decolonization (0.36, 0.22 to 0.57). Pooled effects of 15
prophylaxis studies showed that glycopeptide prophylaxis was significantly
protective against surgical site infections related to methicillin
(meticillin) resistant S aureus (MRSA) compared with prophylaxis using
beta lactam antibiotics (0.40, 0.20 to 0.80), and a non-significant risk
factor for methicillin susceptible S aureus infections (1.47, 0.91 to
2.38). Seven studies assessed a bundle including decolonization and
glycopeptide prophylaxis for only patients colonized with MRSA and found a
significantly protective effect against surgical site infections with Gram
positive bacteria (0.41, 0.30 to 0.56). Conclusions Surgical programs that
implement a bundled intervention including both nasal decolonization and
glycopeptide prophylaxis for MRSA carriers may decrease rates of surgical
site infections caused by S aureus or other Gram positive bacteria.

<20>
Accession Number
2013387143
Authors
Acipayam M. Sunar H. Canbaz S. Huseyinova G. Erbas H. Erten O. Duran E.
Institution
(Acipayam) Department of Cardiovascular Surgery, Mustafa Kemal University,
Hatay, Turkey
(Sunar) Clinic of Cardiovascular Surgery, Kartal Kosuyolu Yuksek Ihtisas
Training and Research Hospital, Istanbul, Turkey
(Canbaz, Duran) Department of Cardiovascular Surgery, Trakya University,
Edirne, Turkey
(Huseyinova) Department of Pathology, Trakya University, Edirne, Turkey
(Erbas) Department of Biochemistry, Trakya University, Edirne, Turkey
(Erten) Clinic of Biochemistry, Uzunkopru State Hospital, Trabzon, Turkey
Title
The efficacy of vitamin E in the prevention of lung ischemia-reperfusion
injury after cardiopulmonary bypass in open heart surgery.
Source
Turkiye Klinikleri Journal of Medical Sciences. 33 (3) (pp 777-784), 2013.
Date of Publication: 2013.
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Objective: The purpose of the study was to investigate the effects of
vitamin E in the protection of the lung from potential
ischemia-reperfusion injury during elective coronary artery bypass graft
surgery. Material and Methods: This controlled randomized single-center
study included patients who underwent elective coronary bypass grafting
(CABG) operation. Forty-nine patients were randomly divided into 2 groups.
Water soluble Vitamin E (100 mg) in tepid saline (n=25) or tepid saline
alone (n=24) was administered via the jugular vein before the aortic cross
clamping. Serum total antioxidant capacity (TAC) levels and serum
malonedialdehyde levels (MDA) were measured. Pulmonary biopsies were
obtained before the aortic cross clamping and 60 minutes after removing
the cross clamp. Biopsies were examined histopathologically under electron
microscopy. Results: Serum MDA levels at T1 (15 minutes after removal of
the cross clamp) and T2 (30 minutes after removal of the cross clamp) were
higher in the control group compared to the Vitamin group. Serum TAC
levels at T1, T2 and T3 (60 minutes after removal of the cross clamp) were
higher in the Vitamin E group compared to the control group.
Histopathologic injury grade was lower in the Vitamin E group than in the
control group. Conclusion: Vitamin E was found to be protective against
reperfusion induced oxidative injury in the early operative period. 2013
by Turkiye Klinikleri.

<21>
Accession Number
2013405688
Authors
Dingemann C. Ure B.
Institution
(Dingemann, Ure) Department of Pediatric Surgery, Hannover Medical School,
Bult Children's Hospital, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Title
Minimally invasive repair of esophageal atresia: An update.
Source
European Journal of Pediatric Surgery. 23 (3) (pp 198-203), 2013. Date of
Publication: 2013.
Publisher
Georg Thieme Verlag (Rudigerstrasse 14, Stuttgart D-70469, Germany)
Abstract
We reviewed the available literature on the role of minimally invasive
techniques for esophageal atresia (EA)/tracheoesophageal fistula (TEF)
repair. No prospective studies have been published to date. According to
the recent classification of the Oxford Centre for Evidence based
Medicine, the best available evidence for studies comparing the minimally
invasive versus open approach for EA/TEF repair is Level 3 (a, b). Similar
postoperative results of the thoracoscopic versus conventional repair are
confirmed in four retrospective comparative studies and one meta-analysis.
However, the available data on complications and postoperative esophageal
function are derived from series operated by experienced surgeons in
specialized centers. More data on the impact of the learning curve are
mandatory before a recommendation on a widespread use can be made. Patient
selection and a low threshold for conversion may further improve results.
2013 Georg Thieme Verlag KG Stuttgart New York.

<22>
Accession Number
2013404455
Authors
Klitsie L.M. Hazekamp M.G. Roest A.A.W. Van Der Hulst A.E. Gesink-Van Der
Veer B.J. Kuipers I.M. Blom N.A. Ten Harkel A.D.J.
Institution
(Klitsie, Roest, Van Der Hulst, Blom, Ten Harkel) Department of Pediatric
Cardiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC
Leiden, Netherlands
(Hazekamp) Department of Cardiothoracic Surgery, Leiden University Medical
Center, Leiden, Netherlands
(Gesink-Van Der Veer) Department of Intensive Care, Leiden University
Medical Center, Leiden, Netherlands
(Kuipers) Department of Pediatric Cardiology, Academic Medical Center,
Amsterdam, Netherlands
Title
Tissue Doppler imaging detects impaired biventricular performance shortly
after congenital heart defect surgery.
Source
Pediatric Cardiology. 34 (3) (pp 630-638), 2013. Date of Publication:
March 2013.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Cardiac surgery with cardiopulmonary bypass is associated with the
development of a systemic inflammatory response, which can lead to
myocardial damage. However, knowledge concerning the time course of
ventricular performance deterioration and restoration after correction of
a congenital heart defect (CHD) in pediatric patients is sparse.
Therefore, the authors perioperatively quantified left ventricular (LV)
and right ventricular (RV) performance using echocardiography. Their study
included 141 patients (ages 0-18 years) undergoing CHD correction and 40
control subjects. The study assessed LV systolic performance (fractional
shortening) and diastolic performance (mitral Doppler flow) in combination
with RV systolic performance [tricuspid annular plane systolic excursion
(TAPSE)] and diastolic performance (tricuspid Doppler flow). Additionally,
systolic (S') and diastolic (E', A', E/E') tissue Doppler imaging (TDI)
measurements were obtained at the LV lateral wall, the interventricular
septum, and the RV free wall. Echocardiographic studies were performed
preoperatively, 1 day postoperatively, and at hospital discharge after 9
+/- 5 days. Although all LV echocardiographic measurements showed a
deterioration 1 day after surgery, only LV TDI measurements were impaired
in patients at discharge versus control subjects (S': 5.7 +/- 2.0 vs 7.1
+/- 2.7 cm/s; E': 9.8 +/- 3.9 vs 13.7 +/- 5.1 cm/s; E/E': 12.2 +/- 6.4 vs
8.8 +/- 4.3; p < 0.05). In the RV, TAPSE and RV TDI velocities also were
impaired in patients at discharge versus control subjects (TAPSE: 9 +/- 3
vs 17 +/- 5 mm; S': 5.2 +/- 1.7 vs 11.4 +/- 3.4 cm/s; E': 7.3 +/- 2.5 vs
16.3 +/- 5.2 cm/s; E/E': 12.5 +/- 6.8 vs 4.8 +/- 1.9; p < 0.05).
Furthermore, longer aortic cross-clamp times were associated with more
impaired postoperative LV and RV performance (p < 0.05). In conclusion,
both systolic and diastolic biventricular performances were impaired
shortly after CHD correction. This impairment was detected only by TDI
parameters and TAPSE. Furthermore, a longer-lasting negative influence of
cardiopulmonary bypass on myocardial performance was suggested. 2012
Springer Science+Business Media, LLC.

<23>
[Use Link to view the full text]
Accession Number
2013408200
Authors
Zaugg M. Lucchinetti E.
Institution
(Zaugg, Lucchinetti) Department of Anesthesiology and Pain Medicine,
University of Alberta, AB, Canada
Title
Letter by Zaugg and Lucchinetti regarding article, "randomized comparison
of sevoflurane versus propofol to reduce perioperative myocardial ischemia
in patients undergoing noncardiac surgery".
Source
Circulation. 127 (25) (pp e875), 2013. Date of Publication: 25 Jun 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<24>
Accession Number
2013406156
Authors
Plosker G.L.
Institution
(Plosker) Adis, 41 Centorian Drive North Shore, 0754 Auckland, New Zealand
Title
Landiolol: A review of its use in intraoperative and postoperative
tachyarrhythmias.
Source
Drugs. 73 (9) (pp 959-977), 2013. Date of Publication: June 2013.
Publisher
Springer International Publishing AG (Gewerbestrasse 11, Cham (ZG) 6330,
Switzerland)
Abstract
Landiolol (Onoact) is an intravenously administered, ultra
short-acting beta₁-blocker with an elimination half-life of 3-4
min and 8-fold greater cardioselectivity than esmolol in vitro. It is
approved in Japan for the treatment of intraoperative and postoperative
tachyarrhythmias, but in clinical practice is also used to prevent
postoperative tachyarrhythmias, such as atrial fibrillation after coronary
artery bypass grafting. Randomized controlled trials in patients
undergoing open-heart surgery demonstrated that various dosages of
landiolol (0.0005-0.04 mg/kg/min) [0.5-40 mug/kg/min] were more effective
than diltiazem in converting postoperative atrial fibrillation to normal
sinus rhythm during the first 8 h after surgery, and were more effective
than placebo (or no landiolol) in preventing the development of atrial
fibrillation during the first week after surgery (primary efficacy
endpoints). In patients undergoing surgical procedures, landiolol 0.125
mg/kg/min for 1 min followed by 0.04 mg/kg/min for 10 min was superior to
placebo in improving intraoperative tachycardia in randomized double-blind
trials. The beneficial effects of landiolol in attenuating adverse
haemodynamic or other changes that can occur during surgery or invasive
procedures (e.g. percutaneous coronary intervention) have been
demonstrated in a large number of randomized controlled trials. For
example, several studies showed that landiolol attenuated the increase in
heart rate associated with tracheal intubation, without adversely
affecting blood pressure or other haemodynamic parameters. Landiolol was
generally well tolerated in clinical trials, with a relatively low risk of
hypotension and bradycardia, although routine monitoring of cardiac
function during landiolol administration is important. In general, adverse
events such as reduced blood pressure resolve quickly after
discontinuation of landiolol. Thus, as an ultra short-acting
beta₁-blocker with a rapid onset of action and readily
titratable and rapidly reversible effects, landiolol represents an
important agent for the management of intraoperative and postoperative
tachyarrhythmias. 2013 Springer International Publishing Switzerland.

<25>
Accession Number
23076900
Authors
Khan S.N. Stansby G.
Institution
(Khan) Quaid-i-Azam International Hospital, Rawalpindi, Pakistan.
Title
Cerebrospinal fluid drainage for thoracic and thoracoabdominal aortic
aneurysm surgery.
Source
Cochrane database of systematic reviews (Online). 10 (pp CD003635), 2012.
Date of Publication: 2012.
Abstract
During aortic aneurysm surgery, cross-clamping can lead to inadequate
blood supply to the spinal cord resulting in neurological deficit.
Cerebrospinal fluid drainage (CSFD) may increase the perfusion pressure to
the spinal cord and hence reduce the risk of ischaemic spinal cord injury.
To determine the effect of CSFD during thoracic and thoracoabdominal
aortic aneurysm (TAAA) surgery on the risk of developing spinal cord
injury. For this update the Cochrane Peripheral Vascular Diseases Group
Trials Search Co-ordinator searched the Specialised Register (last
searched May 31 2012) and CENTRAL (2012, Issue 5) for publications
describing randomised controlled trials of cerebrospinal fluid drainage
for thoracic and thoracoabdominal aortic aneurysm surgery. Reference lists
of relevant articles were checked. Randomised trials involving CSFD during
thoracic and TAAA surgery. Both authors assessed the quality of trials
independently. SNK extracted data and GS verified the data. Three trials
with a total of 287 participants operated on for Type I or II TAAA were
included.In the first trial of 98 participants, neurological deficits in
the lower extremities occurred in 14 (30%) of CSFD group and 17 (33%)
controls. The deficit was observed within 24 hours of the operation in 21
(68%), and from three to 22 days in 10 (32%) participants. CSFD did not
have a significant benefit in preventing ischaemic injury to the spinal
cord.The second trial of 33 participants used a combination of CSFD and
intrathecal papaverine. It showed a statistically significant reduction in
the rate of postoperative neurological deficit (P = 0.039), compared to
controls. Analysis was undertaken after only one third of the estimated
sample size had entered the trial.In the third trial TAAA repair was
performed on 145 participants. CSFD was initiated during the operation and
continued for 48 hours after surgery. Paraplegia or paraparesis occurred
in 9 of 74 participants (12.2%) in the control group versus 2 of 82
participants (2.7%) receiving CSFD (P = 0.03). Overall, CSFD resulted in
an 80% reduction in the relative risk of postoperative deficits.
Meta-analysis showed an odds ratio (OR) of 0.48 (95 % confidence interval
(CI) 0.25 to 0.92). For CSFD-only trials, OR was 0.57 (95% CI 0.28 to
1.17) and for intention-to-treat analysis in CSFD-only studies, the OR
remained unchanged. There are limited data supporting the role of CSFD in
thoracic and thoracoabdominal aneurysm surgery for prevention of
neurological injury. Further clinical and experimental studies are
indicated.

<26>
Accession Number
23076899
Authors
Zhu F. Lee A. Chee Y.E.
Institution
(Zhu) Department of Anaesthesia and Intensive Care, The Chinese University
of Hong Kong, Shatin, Hong Kong.
Title
Fast-track cardiac care for adult cardiac surgical patients.
Source
Cochrane database of systematic reviews (Online). 10 (pp CD003587), 2012.
Date of Publication: 2012.
Abstract
Fast-track cardiac care is a complex intervention involving several
components of care during cardiac anaesthesia and in the postoperative
period, all with the ultimate aim of early extubation after surgery, to
reduce the length of stay in the intensive care unit and in the hospital.
Safe and effective fast-track cardiac care may reduce hospital costs. This
is an update of a Cochrane review published in 2003. To update the
evidence on the safety and effectiveness of fast-track cardiac care
compared to conventional (not fast-track) care in adult patients
undergoing cardiac surgery. We searched the Cochrane Central Register of
Controlled Trials (CENTRAL) (2012, Issue 3), MEDLINE (January 1966 to
April 2012), EMBASE (January 1980 to April 2012), CINAHL (January 1982 to
April 2012), and ISI Web of Science (January 2003 to April 2012). We
searched reference lists of articles and contacted experts in the field.
All randomized controlled trials of adult cardiac surgical patients
(coronary artery bypass grafts, aortic valve replacement, mitral valve
replacement) that compared fast-track cardiac care and conventional (not
fast-track) care groups were included. We focused on the following
fast-track interventions that were designed for early extubation after
surgery, administration of low-dose opioid based general anaesthesia
during cardiac surgery and the use of a time-directed extubation protocol
after surgery. The primary outcome was the risk of mortality. Secondary
outcomes included postoperative complications, reintubation within 24
hours of surgery, time to extubation, length of stay in the intensive care
unit and in the hospital, quality of life after surgery and hospital
costs. Two review authors independently assessed trial quality and
extracted the data. Study authors were contacted for additional
information. We used a random-effects model and reported relative risk
(RR), mean difference (MD) and 95% confidence intervals (95% CI).
Twenty-five trials involving 4118 patients were included in the review.
There were two studies with a low risk of bias and nine studies with a
high risk of bias. There were no differences in the risk of mortality
within the first year after surgery between low-dose versus high-dose
opioid based general anaesthesia groups (RR 0.58, 95% CI 0.28 to 1.18) and
between early extubation protocol versus usual care groups (RR 0.84, 95%
CI 0.40 to 1.75).There were no significant differences between low-dose
versus high-dose opioid based anaesthesia groups for postoperative
complications: myocardial infarction (RR 0.98, 95% CI 0.48 to 1.99),
reintubation (RR 1.77, 95% CI 0.38 to 8.27), acute renal failure (RR 1.19,
95% CI 0.33 to 4.33), major bleeding (RR 0.48, 95% CI 0.16 to 1.44), and
stroke (RR 1.17, 95% CI 0.36 to 3.78). Compared to the usual care, there
were no significant differences in the risk of postoperative complications
associated with early extubation: myocardial infarction (RR 0.94, 95% CI
0.55 to 1.60), reintubation (RR 1.91, 95% CI 0.90 to 4.07), acute renal
failure (RR 0.77, 95% CI 0.19 to 3.10), major bleeding (RR 0.80, 95% CI
0.45 to 1.44), stroke (RR 0.87, 95% CI 0.31 to 2.46), major sepsis (RR
1.25, 95% CI 0.08 to 19.75) and wound infection (RR 0.67, 95% CI 0.25 to
1.83).Although there were high levels of heterogeneity, both low-dose
opioid anaesthesia and the use of time-directed extubation protocols were
associated with reductions in the time to extubation (3.0 to 10.5 hours)
and in the length of stay in the intensive care unit (0.4 to 8.7 hours).
However, these fast-track care interventions were not associated with
reductions in the total length of stay in hospital. One high quality
cost-effectiveness analysis included in a randomized controlled trial
showed that early extubation was likely to be cost-effective. The use of
low-dose opioid based general anaesthesia and time-directed protocols for
fast-track interventions have similar risks of mortality and major
postoperative complications to conventional (not fast-track) care, and
therefore appear to be safe in patients considered to be at low to
moderate risk. These fast-track interventions reduced the time to
extubation and shortened the length of stay in the intensive care unit,
but did not reduce the length of stay in the hospital.

<27>
Accession Number
21450567
Authors
Stoylen A. Conraads V. Halle M. Linke A. Prescott E. Ellingsen O.
Institution
(Stoylen) St. Olavs Hospital, Trondheim, Norway.
Title
Controlled study of myocardial recovery after interval training in heart
failure: SMARTEX-HF--rationale and design.
Source
European journal of preventive cardiology. 19 (4) (pp 813-821), 2012. Date
of Publication: Aug 2012.
Abstract
BACKGROUND: The large randomized controlled multicentre clinical trial,
HF-ACTION, recently demonstrated that a programme of recommendation of
regular exercise training at moderate intensity is safe, improves quality
of life, and reduces the combined endpoint of all-cause death and
hospitalization in patients with chronic heart failure. However, the size
of beneficial effects was modest compared to results published in smaller
single studies and meta-analyses. OBJECTIVE: Based on results of a pilot
study, the objective of the present investigation is to test the
hypothesis that a programme comprising interval training at high relative
intensity would yield significantly larger effects in terms of left
ventricular remodelling compared to moderate continuous exercise training.
STUDY DESIGN: In a three-armed randomized multicentre study of stable
heart failure patients with left ventricular ejection fraction <=35%, the
effects of a 12-week programme of high-intensity interval training (HIT;
85-90% of peak oxygen uptake, VO(2peak)) will be compared to actual
practice in Europe, represented by either an isocaloric programme of
moderate continuous training (MCT; 50-60% of VO(2peak)) and a
recommendation of regular exercise (RE) of the individual patients' own
preference based on clinical practice at the local centre. The primary
endpoint is reverse remodelling, defined as change in left ventricular
end-diastolic diameter assessed by echocardiography. Secondary endpoints
include peak oxygen uptake (VO(2peak)), biomarkers, quality of life, and
level of physical activity assessed by questionnaires. In addition,
long-term maintenance of effects after the supervised training period will
be determined. Assessments will be made at baseline, after the 12-week
intervention programme, and at 1-year follow up. A total number of 200
patients on treatment per protocol, randomized to the three groups in a 1
: 1 : 1 manner, is estimated to detect clinically relevant differences in
effect with HIT vs. MCT and RE (p < 0.05; statistical power 0.90) for the
primary endpoint. Inclusion of patients started May 2009 and will run
until total number has been reached.

<28>
Accession Number
22290884
Authors
Kolcz J. Skladzien T. Kordon Z. Rudzinski A. Skalski J.
Institution
(Kolcz) Department of Pediatric Cardiac Surgery, Polish-American
Children's Hospital, Krakow, Poland.
Title
Impact of right ventricle-pulmonary artery conduit placement on pulmonary
artery development after the Norwood procedure in hypoplastic left heart
syndrome.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 42 (2) (pp 218-223;
discussion 223-224), 2012. Date of Publication: Aug 2012.
Abstract
The right ventricle-to-pulmonary artery (RV-PA) shunt in the Norwood
procedure (NP) for children with hypoplastic left heart syndrome (HLHS)
provides stable haemodynamics and improves interstage survival. The aim of
the study was to find the effect of RV-PA placement on pulmonary artery
development after the NP. A prospective, randomized study of 60 children
with HLHS was carried out between 2008 and 2010. All children underwent
the NP in the neonatal period and survivors underwent the hemi-Fontan
operation (at a mean age of 4.78 +/- 2.8 months). RV-PA was left side to
the neo-aorta in 32 children (the first group) and right side to the
neo-aorta in 28 children (the second group). Echocardiography and
angiograms were used to asses the pulmonary artery size. There was a
significant difference between right pulmonary artery (RPA) and left
pulmonary artery (LPA) diameters in both groups before the NP (first: 4.94
+/- 0.27 vs. 4.26 +/- 0.22, P = 0.04; second: 4.97 +/- 0.23 vs. 4.14 +/-
0.17, P = 0.003). This difference was not significant when z-scores were
taken into account. The dynamics of the pulmonary artery development was
similar in both groups comparing pre-Norwood and pre-hemi-Fontan periods.
A slight increase in the LPA and the RPA diameter with a significant
decrease in the z-scores was noted. At the pre-hemi-Fontan stage, there
was no significant difference in the diameter and the z-score between LPA
and RPA in the second group, whereas in the first group, the z-score for
LPA was significantly lower compared with RPA (-1.34 +/- 1.6 vs. -0.86 +/-
1.4, P = 0.016). Placement of the RV-PA conduit on the right side to the
neo-aorta ensures more equal distribution of the blood to the pulmonary
arteries and better development of the LPA.

<29>
Accession Number
21053666
Authors
MacCune S.
Institution
(MacCune) St Stephens College of Nursing, St Stephens Hospital, Delhi.
Title
Effect of back massage on sleep among post-operative CABG and valve
replacement patients.
Source
The Nursing journal of India. 101 (4) (pp 86-88), 2010. Date of
Publication: Apr 2010.

<30>
Accession Number
2013399255
Authors
Ning M. Lo E.H. Ning P.-C. Xu S.-Y. McMullin D. Demirjian Z. Inglessis I.
Dec G.W. Palacios I. Buonanno F.S.
Institution
(Ning, Lo, Ning, Xu, McMullin, Demirjian, Inglessis, Palacios, Buonanno)
Cardio-Neurology Clinic, Massachusetts General Hospital, Harvard Medical
School, United States
(Ning, Lo, Ning, Xu, McMullin, Buonanno) Clinical Proteomics Research
Center, Massachusetts General Hospital, Harvard Medical School, United
States
(Ning, Lo) Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, United States
(Demirjian) Department of Hematology, Massachusetts General Hospital,
Harvard Medical School, United States
(Inglessis, Dec) Department of Cardiology, Massachusetts General Hospital,
Harvard Medical School, United States
Title
The brain's heart - Therapeutic opportunities for patent foramen ovale
(PFO) and neurovascular disease.
Source
Pharmacology and Therapeutics. 139 (2) (pp 111-123), 2013. Date of
Publication: August 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Patent foramen ovale (PFO), a common congenital cardiac abnormality, is a
connection between the right and left atria in the heart. As a "back door
to the brain", PFO can serve as a conduit for paradoxical embolism,
allowing venous thrombi to enter the arterial circulation, avoiding
filtration by the lungs, and causing ischemic stroke. PFO-related strokes
affect more than 150,000 people per year in the US, and PFO is present in
up to 60% of migraine patients with aura, and in one out of four normal
individuals. So, in such a highly prevalent condition, what are the best
treatment and prevention strategies? Emerging studies show PFO-related
neurovascular disease to be a multi-organ condition with varying
individual risk factors that may require individualized therapeutic
approaches - opening the field for new pharmacologic and therapeutic
targets. The anatomy of PFO suggests that, in addition to thrombi, it can
also allow harmful circulatory factors to travel directly from the venous
to the arterial circulation, a concept important in finding novel
therapeutic targets for PFO-related neurovascular injury. Here, we: 1)
review emerging data on PFO-related injuries and clinical trials; 2)
discuss potential mechanisms of PFO-related neurovascular disease in the
context of multi-organ interaction and heart-brain signaling; and 3)
discuss novel therapeutic targets and research frontiers. Clinical studies
and molecular mapping of the circulatory landscape of this multi-organ
disease will both be necessary in order to better individualize clinical
treatment for a condition affecting more than a quarter of the world's
population. 2013 Elsevier Inc.

<31>
Accession Number
2013398245
Authors
Asteriou C. Antonitsis P. Argiriadou H. Deliopoulos A. Konstantinou D.
Foroulis C. Papakonstantinou C. Anastasiadis K.
Institution
(Asteriou, Antonitsis, Argiriadou, Deliopoulos, Konstantinou, Foroulis,
Papakonstantinou, Anastasiadis) Department of Cardiothoracic Surgery,
AHEPA University Hospital, Sakellaridi 25, 542 48, Thessaloniki, Greece
Title
Minimal extracorporeal circulation reduces the incidence of postoperative
major adverse events after elective coronary artery bypass grafting in
high-risk patients. A single-institutional prospective randomized study.
Source
Perfusion (United Kingdom). 28 (4) (pp 350-356), 2013. Date of
Publication: July 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Coronary artery bypass grafting (CABG) using minimal extracorporeal
circulation (MECC) has been associated with an improved short-term
clinical outcome compared to conventional extracorporeal circulation
(CECC). The aim of this study was to evaluate the impact of MECC compared
to CECC on postoperative major adverse events in high-risk patients
undergoing elective coronary revascularization procedures. Two hundred
patients undergoing elective CABG were randomized into two groups. In
Group A (n=100), MECC was used while Group B (n=100) included patients who
were operated on CECC. The incidence of postoperative major adverse events
(myocardial infarction, renal failure, stroke, death) was the primary
end-point of the study. MECC was associated with a 77% relative risk
reduction in the incidence of major adverse events compared to CECC
(p=0.004). The rate of major adverse events occurring in the high-risk
patient subgroup (preoperative left ventricular ejection fraction <=40%,
age >65 years, EuroSCORE II >5) operated on with MECC was significantly
lower in comparison to their CECC counterparts. Based on our results,
cardiac centres should be encouraged to use MECC as the standard circuit
when performing elective coronary procedures, even in a high-risk
population. The Author(s) 2013.

<32>
Accession Number
2013398238
Authors
Sepehripour A.H. Saso S. Harling L. Punjabi P. Ashrafian H. Athanasiou T.
Institution
(Sepehripour, Saso, Harling, Punjabi, Ashrafian, Athanasiou) Department of
Surgery and Cancer, St Mary's Hospital, Imperial College London, London W2
1NY, United Kingdom
Title
Does off-pump coronary revascularization reduce mortality in re-operative
coronary artery surgery? A meta-analysis of observational studies.
Source
Perfusion (United Kingdom). 28 (4) (pp 340-349), 2013. Date of
Publication: July 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background: Re-operative coronary artery bypass grafting (CABG) is a
challenging operation that is often performed in a high-risk patient
group. Avoiding cardiopulmonary bypass (CPB) in these patients is
hypothesised to be advantageous due to the reduced invasiveness and
physiological stress of off-pump coronary artery bypass grafting (OPCAB).
The aims of this study were to assess whether OPCAB may improve outcomes
in patients undergoing re-operative CABG. Methods: Twelve studies,
incorporating 3471 patients, were identified by systematic literature
review. These were meta-analysed using random-effects modelling. Primary
endpoints were 30-day and mid-term mortality. Secondary endpoints were
completeness of revascularization, mean number of grafts per patient and
the effect of intra-operative conversion on mortality. Results: A
significantly lower rate of 30-day mortality was observed with OPCAB (OR
0.51, 95% CI [0.35, 0.74]), however, no difference was demonstrated in
mid-term mortality. Significantly less complete revascularization and mean
number of grafts per patient were observed in the OPCAB group.
Meta-regression revealed no change in 30-day mortality when the effect of
conversion from one technique to the other was assessed. Conclusions:
Off-pump techniques may reduce early mortality in selected patients
undergoing re-operative CABG; however, this does not persist into mid-term
follow-up. OPCAB may also lead to intra-operative conversion and, although
this did not affect outcomes in this study, these results are constrained
by the limited data available. Furthermore, OPCAB may increase target
vessel revascularization and, consequently, incomplete revascularization
which, whilst not reflected in the short-term outcomes, requires
longer-term follow-up in order to be fully assessed. The Author(s) 2013.

<33>
Accession Number
2011097343
Authors
Imazio M.
Institution
(Imazio) Humanitas Gavazzeni, Bergamo, Italy
Title
Adding colchicine to standard therapy after cardiac surgery reduced risk
for the postpericardiotomy syndrome.
Source
Annals of Internal Medicine. 154 (4) (pp JC2-10), 2011. Date of
Publication: February 15, 2011.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<34>
Accession Number
21336736
Authors
Zhang Z. Ma P. Xu Y. Zhan M. Zhang Y. Yao S. Zhang S.
Institution
(Zhang, Ma, Xu, Zhan, Yao, Zhang) Department of Anesthesiology, Union
Hospital, Huazhong University of Science and Technology, Wuhan 430022,
China
(Zhang) Department of Neurology and Psychology, Union Hospital, Huazhong
University of Science and Technology, Wuhan 430022, China
Title
Preventive effect of gastrodin on cognitive decline after cardiac surgery
with cardiopulmonary bypass: A double-blind, randomized controlled study.
Source
Journal of Huazhong University of Science and Technology - Medical
Science. 31 (1) (pp 120-127), 2011. Date of Publication: February 2011.
Publisher
Tongji Medical University (1, Wuhan, Hubei Province 430030, China)
Abstract
Cognitive decline is a common complication after cardiac surgery with
cardiopulmonary bypass (CPB), but as such no pharmacological therapy has
been shown to be efficacious in preventing the decline. However, gastrodin
has been shown to have multi-pharmacological effects on neurological
functions. We undertook this study to test the hypothesis that gastrodin
would potentially prevent CPB-associated neurocognitive decline. We
randomly assigned 200 patients undergoing mitral valve replacement surgery
to receive either gastrodin (40 mg/kg) or saline after the induction of
anesthesia and subsequently evaluated cognitive function before surgery,
at discharge, and at 3rd month after surgery by using a battery of five
neurocognitive tests, or adverse effects of gastrodin postoperatively.
Neurocognitive decline in postoperative function was defined as a drop of
1 SD or more in the scores on tests of any one of the four domains of
cognitive function. Cognitive decline occurred in 9% of the patients in
the gastrodin group in contrast to 42% in the control group (P<0.01) at
discharge. Cognitive outcome could be determined at 3rd month in 87
patients in the gastrodin group and 89 in the control group. Cognitive
decline was detected in 6% in the gastrodin group and 31% in the control
group (P<0.01). The incidences of possible adverse effects were similar
between two groups. These results indicate that gastrodin is an effective
and a safe drug for the prevention of neurocognitive decline in patients
undergoing mitral valve replacement surgery with CPB. 2011 Huazhong
University of Science and Technology and Springer-Verlag Berlin
Heidelberg.

<35>
Accession Number
2011076348
Authors
Matchar D.B.
Institution
(Matchar) North Pavilion, Durham, NC, United States
Title
Weekly INR self-testing did not reduce stroke, major bleeding, or death
more than monthly clinic testing.
Source
Annals of Internal Medicine. 154 (2) (pp JC1-13), 2011. Date of
Publication: January 18, 2011.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<36>
Accession Number
20562080
Authors
From A.M. Al Badarin F.J. Cha S.S. Rihal C.S.
Institution
(From) The Division of Cardiovascular Diseases, Mayo Clinic College of
Medicine and Mayo Foundation, Rochester, MN, USA.
Title
Percutaneous coronary intervention with drug-eluting stents versus
coronary artery bypass surgery for multivessel coronary artery disease: a
meta-analysis of data from the ARTS II, CARDia, ERACI III, and SYNTAX
studies and systematic review of observational data.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
6 (2) (pp 269-276), 2010. Date of Publication: Jun 2010.
Abstract
The aim of this study was to systematically analyse the available data
from trials comparing revascularisation by drug-eluting stent (DES)
placement versus coronary artery bypass grafting (CABG) in patients with
multivessel coronary artery disease (CAD). We searched PubMed, Medline and
several internet sources for randomised controlled trials comparing DES
placement to CABG in patients with multivessel coronary artery disease.
There were no restrictions on journal type or population studied. Prior to
data collection we chose to analyse the prospectively performed trials
separately from data obtained retrospectively. Four prospective trials
were identified which enrolled a total of 3,895 patients: 1,914 in the DES
arm and 1,981 patients in the CABG arm. Pooled analysis of data from these
four studies showed that in patients treated DES compared to CABG there
was a similar risk of the combined endpoints of death, myocardial
infarction and stroke (10.2% versus 10.8%, respectively; RR=0.94 [95%
CI=0.77-1.116]; p=0.56), but a significantly higher risk of target vessel
revascularisation (TVR) (14.6% versus 6.8%, respectively; RR=2.09 [95%
CI=1.72-2.55]; <0.001) and, therefore, a significantly higher risk of
MACCE (21.2% versus 16.3%, respectively; RR=1.27 [95% CI=1.09-1.48];
p=0.002). Interestingly, when MACCE rates at one year are used for these
trials the risk is equivalent between DES and CABG (14.4% versus 12.5%,
respectively; RR=1.05 [95% CI=0.70-1.57]; p=0.83). Analysis of
observational data revealed similar findings. Overall, PCI with DES
placement was safe in patients with multivessel disease compared to CABG,
but is associated with a significantly higher risk of TVR.

<37>
Accession Number
2013382583
Authors
Blacher J. Czernichow S. Paillard F. Ducimetiere P. Hercberg S. Galan P.
Institution
(Blacher) Universite Paris Descartes, Assistance Publique-Hopitaux de
Paris, Hotel-Dieu, Place du Parvis Notre-Dame, 75004 Paris, France
(Blacher, Hercberg, Galan) UMR U557 Inserm, Universite Paris 13, CRNH IdF,
F-93017 Bobigny, France
(Hercberg) Universite Paris 13, Departement de Sante Publique, Hopital
Avicenne, 93017, F-Bobigny, France
(Paillard) Centre de Prevention Cardiovasculaire, CHU Pontchaillou, 35033,
Rennes Cedex 09, France
(Ducimetiere) INSERM U780-IFR69, Recherche en Epidemiologie et en
Biostatistiques, Villejuif, France
(Czernichow) Unite de Nutrition, Hopital A. Pare (AP-HP), Universite
Versailles St-Quentin, Boulogne, France
Title
Cardiovascular effects of B-vitamins and/or N-3 fatty acids: The
Su.Fol.Om3 trial.
Source
International Journal of Cardiology. 167 (2) (pp 508-513), 2013. Date of
Publication: 31 Jul 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Mechanisms involved in coronary stenosis evolution are
different than those involved in clinical events. Because of differential
vascular effects, N-3 polyunsatured fatty acids (PUFA) and B vitamins
could have differential effects on different types of cardiovascular
clinical events in high-risk patients. Methods: We analyzed the effects of
n-3 PUFA and of B vitamins on both coronary revascularization and on hard
coronary events risks in a subgroup of the SU.FOL.OM3 trial, a randomized,
double-blind, placebo-controlled secondary prevention trial. Data were
analyzed according to the intention-to-treat principle, with the use of
Cox proportional-hazards models. Results: After a mean follow-up of 4.2
+/- 1.0 years among the 1,863 participants with coronary heart disease,
163 coronary revascularizations were performed, and 95 patients
experienced a hard coronary event. Neither treatment with n-3 PUFA, nor
treatment with B vitamins was associated with any significant effect on
the occurrence of hard coronary events. Allocation to n-3 PUFA was not
associated with any significant effect on coronary revascularization.
However, treatment with B vitamins was associated with a statistically
significant 52% increase in the risk of coronary revascularization
(multivariate HR: 1.52; 95% CI: [1.11-2.10]; p = 0.01). Conclusions:
Neither n-3 PUFA, nor B vitamins reduced the rates of hard coronary events
and of coronary revascularization. Furthermore, B vitamins significantly
increased the rate of coronary revascularization. Consistent with the
findings of previous trials, our results do not support the routine use of
dietary supplements containing n-3 PUFA and argue against using dietary
supplements containing B-vitamins in coronary patients in secondary
cardiovascular prevention. 2013 Elsevier Ireland Ltd. All rights
reserved.

<38>
Accession Number
2013382579
Authors
Chan M.Y. Sun J.-L. Newby L.K. Lokhnygina Y. White H.D. Moliterno D.J.
Theroux P. Ohman E.M. Simoons M.L. Mahaffey K.W. Pieper K.S. Giugliano
R.P. Armstrong P.W. Califf R.M. Van De Werf F. Harrington R.A.
Institution
(Chan) National University Heart Center, 5 Lower Kent Ridge Road,
Singapore, Singapore
(Sun, Newby, Lokhnygina, Ohman, Mahaffey, Pieper, Harrington) Duke
Clinical Research Institute, Durham, NC, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Moliterno) University of Kentucky, Lexington, KY, United States
(Theroux) Montreal Heart Institute, Montreal, QC, Canada
(Simoons) Erasmus University Medical Center, Rotterdam, Netherlands
(Giugliano) Brigham and Women's Hospital, Boston, MA, United States
(Armstrong) University of Alberta, Edmonton, AB, Canada
(Califf) Duke Translational Medicine Institute, Durham, NC, United States
(Van De Werf) University of Leuven, Leuven, Belgium
Title
Trends in clinical trials of non-ST-segment elevation acute coronary
syndromes over 15 years.
Source
International Journal of Cardiology. 167 (2) (pp 548-554), 2013. Date of
Publication: 31 Jul 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Data are limited on whether clinical trials have randomized
higher-risk patients over time and how trends in risk profiles and
evidence-based pharmacotherapies have influenced trial outcomes. We
quantified changes in baseline risk, treatment, and outcomes of patients
with non-ST-segment elevation acute coronary syndromes (NSTE ACS)
randomized in 9 phase 3 clinical trials of antithrombotic therapy over 15
years. Methods: We studied 58,771 patients in GUSTO IIb, PURSUIT,
PARAGON-A, PARAGON-B, PRISM, PRISM-PLUS, GUSTO IV-ACS, SYNERGY, and EARLY
ACS. Patient-level data were mapped to 3 pre-specified 5-year
randomization periods. Temporal trends in GRACE score-predicted mortality
were compared with trends in observed mortality. Results: Over time,
in-hospital and discharge use of thienopyridines (p = 0.001), statins (p <
0.0001), and angiotensin-converting enzyme inhibitors (p < 0.0001)
increased, and hospital length-of-stay decreased (p = 0.024). Blood
transfusion use increased (8.3% [1994-98], 10.7% [1999-2003], 13%
[2004-08], p = 0.0002) despite stable rates of severe bleeding (0.9%
[1994-98], 1.4% [1999-2003] and 1.1% [2004-08], p = 0.127) and coronary
artery bypass grafting (12.4% [1994-98], 13.7% [1999-2003] 13.1%
[2004-08], p = 0.880). Although predicted 6-month mortality increased
(6.9% [1994-98], 9.0% [1999-2003], 7.9% [2004-08], p = 0.017), observed
6-month mortality decreased (6.7% [1994-98], 5.8% [1999-2003], 5.1%
[2004-08], p = 0.025). Thirty-day myocardial infarction rates remained
stable (9.2% [1994-98], 9.3% [1999-2003], 10% [2004-08], p = 0.539).
Conclusions: Despite enrolling higher-risk patients into these NSTE ACS
trials, with better treatment, observed mortality declined over the past
15 years. The appropriateness of increased blood transfusion despite
unchanged bleeding rates deserves further study. 2013 Elsevier Ireland
Ltd. All rights reserved.

<39>
Accession Number
2013383032
Authors
Wessel D.L. Berger F. Li J.S. Dahnert I. Rakhit A. Fontecave S. Newburger
J.W.
Institution
(Wessel) Children's National Medical Center, 111 Michigan Ave. NW,
Washington, DC 20010, United States
(Berger) German Heart Institute Berlin and Charite, Berlin, Germany
(Dahnert) Department of Pediatric Cardiology, Heart Center, University of
Leipzig, Leipzig, Germany
(Li) Duke Clinical Research Institute, Durham, NC, United States
(Rakhit) Bristol-Myers Squibb, Princeton, NJ, United States
(Fontecave) Sanofi Research and Development, Chilly-Mazarin, France
(Newburger) Department of Cardiology, Boston Children's Hospital, Boston,
United States
(Newburger) Department of Pediatrics, Harvard Medical School, Boston,
United States
Title
Clopidogrel in infants with systemic-to-pulmonary-artery shunts.
Source
New England Journal of Medicine. 368 (25) (pp 2377-2384), 2013. Date of
Publication: 2013.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Infants with cyanotic congenital heart disease palliated with
placement of a systemic-to-pulmonary-artery shunt are at risk for shunt
thrombosis and death. We investigated whether the addition of clopidogrel
to conventional therapy reduces mortality from any cause and morbidity
related to the shunt. METHODS: In a multicenter, double-blind,
event-driven trial, we randomly assigned infants 92 days of age or younger
with cyanotic congenital heart disease and a systemic-to-pul-monary-artery
shunt to receive clopidogrel at a dose of 0.2 mg per kilogram of body
weight per day (467 infants) or placebo (439 infants), in addition to
conventional therapy (including aspirin in 87.9% of infants). The primary
efficacy end point was a composite of death or heart transplantation,
shunt thrombosis, or performance of a cardiac procedure due to an event
considered to be thrombotic in nature before 120 days of age. RESULTS: The
rate of the composite primary end point did not differ significantly
between the clopidogrel group (19.1%) and the placebo group (20.5%)
(absolute risk difference, 1.4 percentage points; relative risk reduction
with clopidogrel, 11.1%; 95% confidence interval, -19.2 to 33.6; P =
0.43), nor did the rates of the three components of the composite primary
end point. There was no significant benefit of clopidogrel treatment in
any subgroup, including subgroups defined by shunt type. Clopidogrel
recipients and placebo recipients had similar rates of overall bleeding
(18.8% and 20.2%, respectively) and severe bleeding (4.1% and 3.4%,
respectively). CONCLUSIONS: Clopidogrel therapy in infants with cyanotic
congenital heart disease palliated with a systemic-to-pulmonary-artery
shunt, most of whom received concomitant aspirin therapy, did not reduce
either mortality from any cause or shunt-related morbidity. (Funded by
Sanofi-Aventis and Bristol-Myers Squibb; ClinicalTrials.gov number,
NCT00396877.) Copyright 2013 Massachusetts Medical Society.

<40>
Accession Number
2013373264
Authors
Geske J.B. McKie P.M. Ommen S.R. Sorajja P.
Institution
(Geske, McKie, Ommen, Sorajja) Department of Internal Medicine, Mayo
Clinic, College of Medicine, 200 First Street SW, Rochester, MN 55905,
United States
Title
B-type natriuretic peptide and survival in hypertrophic cardiomyopathy.
Source
Journal of the American College of Cardiology. 61 (24) (pp 2456-2460),
2013. Date of Publication: 18 Jun 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives The aim of this study was to determine the relationship between
B-type natriuretic peptide (BNP) and survival in patients with
hypertrophic cardiomyopathy. Background Natriuretic peptides are released
in response to neurohormonal activation, myocardial stretch, and wall
tension and therefore reflect hemodynamic derangements. Methods A total of
772 patients with hypertrophic cardiomyopathy had BNP obtained in
conjunction with echocardiography and clinical evaluation, inclusive of
cardiopulmonary exercise evaluation in 429 patients (56%). Results
Survival free of all-cause mortality was lower across increasing levels of
BNP (log-rank test, p = 0.002). Three-year survival by tertile was 99.2%
(95% confidence interval: 94.3% to 99.9%; BNP level <=98 pg/ml), 94.8%
(95% confidence interval: 88.2% to 97.8%; BNP level, >98 to <298 pg/ml),
and 89.9% (95% confidence interval: 82.0% to 94.5%; BNP level >=298
pg/ml). Compared with patients in the first tertile, the hazard ratios for
death in the second and third tertiles were 4.88 (p = 0.006) and 6.98 (p =
0.0003), respectively. This relationship persisted in patients without
resting obstructive physiology (n = 497, p = 0.01). BNP levels were
related to New York Heart Association functional status (p < 0.0001) and
the subsequent need for septal reduction therapy in follow-up (p = 0.04).
Conclusions In this large cohort of patients with hypertrophic
cardiomyopathy, BNP was an independent predictor of morbidity and
mortality. 2013 by the American College of Cardiology Foundation.
Published by Elsevier Inc.

<41>
Accession Number
2013373259
Authors
Tandjung K. Sen H. Lam M.K. Basalus M.W.Z. Louwerenburg J.W. Stoel M.G.
Van Houwelingen K.G. De Man F.H.A.F. Linssen G.C.M. Said S.A.M. Nienhuis
M.B. Lowik M.M. Verhorst P.M.J. Van Der Palen J. Von Birgelen C.
Institution
(Tandjung, Sen, Lam, Basalus, Louwerenburg, Stoel, Van Houwelingen, De
Man, Lowik, Verhorst, Von Birgelen) Department of Cardiology,
Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55,
7513ER Enschede, Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo,
Netherlands
(Said) Department of Cardiology, Ziekenhuisgroep Twente, Hengelo,
Netherlands
(Nienhuis) Department of Cardiology, Streekziekenhuis Koningin Beatrix,
Winterswijk, Netherlands
(Van Der Palen) Department of Epidemiology, Medisch Spectrum Twente,
Enschede, Netherlands
(Van Der Palen) Department of Research Methodology, Measurement and Data
Analysis, University of Twente, Enschede, Netherlands
(Von Birgelen) Department of Health Technology and Services Research,
MIRA-Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, Netherlands
Title
Clinical outcome following stringent discontinuation of dual antiplatelet
therapy after 12 months in real-world patients treated with
second-generation zotarolimus-eluting resolute and everolimus-eluting
xience v stents: 2-year follow-up of the randomized TWENTE trial.
Source
Journal of the American College of Cardiology. 61 (24) (pp 2406-2416),
2013. Date of Publication: 18 Jun 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives The aim of this study was to assess the safety and efficacy of
the implantation of Resolute zotarolimus-eluting stents (ZES) (Medtronic
Inc., Santa Rosa, California) and Xience V everolimus-eluting stents (EES)
(Abbott Vascular, Santa Clara, California) following strict
discontinuation of dual antiplatelet therapy (DAPT) after 12 months.
Background Only limited long-term follow-up data are available from
head-to-head comparisons of second-generation drug-eluting stents. Methods
The randomized TWENTE (The Real-World Endeavor Resolute Versus Xience V
Drug-Eluting Stent Study in Twente) trial is an investigator-initiated
study performed in a population with many complex patients and lesions and
only limited exclusion criteria. Patients were randomly assigned 1:1 to
ZES (n = 697) or EES (n = 694). Results Two-year follow-up information was
available on all patients. The rate of continuation of DAPT beyond 12
months was very low (5.4%). The primary endpoint of target vessel failure,
a composite of cardiac death, target vessel-related myocardial infarction,
and target vessel revascularization, did not differ between ZES and EES
(10.8% vs. 11.6, p = 0.65), despite fewer target lesion revascularizations
in patients with EES (2.6% vs. 4.9%, p = 0.03). The patient-oriented
composite endpoint was similar (16.4% vs. 17.1%, p = 0.75). Two-year rates
of definite or probable stent thrombosis were 1.2% and 1.4%, respectively
(p = 0.63). Very late definite or probable stent thrombosis occurred only
in 2 patients in each study arm (0.3% vs. 0.3%, p = 1.00). Conclusions
After 2 years of follow-up and stringent discontinuation of DAPT beyond 12
months, Resolute ZES and Xience V EES showed similar results in terms of
safety and efficacy for treating patients with a majority of complex
lesions and off-label indications for drug-eluting stents. (The Real-World
Endeavor Resolute Versus Xience V Drug-Eluting Stent Study in Twente
[TWENTE]; NCT01066650). 2013 by the American College of Cardiology
Foundation. Published by Elsevier Inc.

<42>
Accession Number
2013373253
Authors
Porter T.R. Smith L.M. Wu J. Thomas D. Haas J.T. Mathers D.H. Williams E.
Olson J. Nalty K. Hess R. Therrien S. Xie F.
Institution
(Porter, Wu, Thomas, Haas, Mathers, Williams, Olson, Nalty, Hess,
Therrien, Xie) Department of Cardiology, University of Nebraska Medical
Center, 982265 Nebraska Medical Center, Omaha, NE 68198, United States
(Smith) College of Public Health Biostatistics, University of Nebraska
Medical Center, Omaha, NE, United States
Title
Patient outcome following 2 different stress imaging approaches: A
prospective randomized comparison.
Source
Journal of the American College of Cardiology. 61 (24) (pp 2446-2455),
2013. Date of Publication: 18 Jun 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives The study sought to prospectively compare patient outcome after
stress real-time myocardial contrast echocardiography (RTMCE) versus
conventional stress echo (CSE), where contrast is used to optimize wall
motion (WM) analysis. Background Myocardial perfusion imaging with RTMCE
may improve the detection of coronary artery disease (CAD), and predict
patient outcome. Methods Patients with intermediate to high pre-test
probability referred for dobutamine or exercise stress echocardiography
were prospectively randomized to either RTMCE or CSE. Definity contrast
was used for CSE only when endocardial border delineation was inadequate
(63% of studies). Studies were interpreted by either an experienced
contrast reviewer (R1; n = 1257), or 4 Level 3 echocardiographers (R2)
with basic contrast training (n = 806). Death, nonfatal myocardial
infarction (MI), and revascularizations were recorded at follow-up.
Results Follow-up was available in 2,014 patients (median 2.6 years). Mean
age was 59 +/- 13 years (53% women). An abnormal RTMCE was more frequently
observed than an abnormal CSE (p < 0.001), and more frequently resulted in
revascularization (p = 0.004). Resting WM abnormalities were also more
frequently seen with RTMCE (p < 0.01), and were an independent predictor
of death/nonfatal MI (p = 0.005) for RTMCE, but not CSE. The predictive
value of a positive study, whether with CSE or RTMCE, was significant for
both R1 and R2 reviewers in predicting the combined endpoint, but R1 was
better than R2 at predicting patients at risk for death or nonfatal MI.
Conclusions Perfusion imaging with RTMCE improves the detection of CAD
during stress echocardiography, and identifies those more likely to
undergo revascularization following an abnormal study. 2013 by the
American College of Cardiology Foundation. Published by Elsevier Inc.

<43>
Accession Number
21243280
Authors
Nerbass F.B. Feltrim M.I.Z. de Souza S.A. Ykeda D.S. Lorenzi-Filho G.
Institution
(Nerbass, Lorenzi-Filho) Sleep Laboratory, Pulmonary Division, Instituto
do Coracao, Hospital das Clinicas, Faculdade de Medicina, Universidade de
Sao Paulo, Sao Paulo, Brazil
(Nerbass, Feltrim, de Souza, Ykeda) Physiotherapy Division, Instituto do
Coracao, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, Brazil
Title
Effects of massage therapy on sleep quality after coronary artery bypass
graft surgery.
Source
Clinics. 65 (11) (pp 1105-1110), 2010. Date of Publication: 2010.
Publisher
Universidade de Sao Paulo (Av.Dr.Arnaldo 455-Cerqueira Cesar, Sao Paulo
01246903, Brazil)
Abstract
INTRODUCTION: Poor sleep quality is common among patients following
cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and
poor sleep quality may be improved by massage therapy. OBJECTIVE: This
study evaluated whether massage therapy is an effective technique for
improving sleep quality in patients following cardiopulmonary artery
bypass graft surgery. METHOD: Participants included cardiopulmonary artery
bypass graft surgery patients who were randomized into a control group and
a massage therapy group following discharge from the intensive care unit
(Day 0), during the postoperative period. The control group and the
massage therapy group comprised participants who were subjected to three
nights without massage and three nights with massage therapy,
respectively. The patients were evaluated on the following mornings (i.e.,
Day 1 to Day 3) using a visual analogue scale for pain in the chest, back
and shoulders, in addition to fatigue and sleep. Participants kept a sleep
diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery
bypass graft surgery patients were enrolled in the study during the
preoperative period, 17 of whom were excluded due to postoperative
complications. The remaining 40 participants (male: 67.5%, age: 61.9 years
8.9 years, body mass index: 27.2 kg/m² 3.7 kg/m²)
were randomized into control (n = 20) and massage therapy (n = 20) groups.
Pain in the chest, shoulders, and back decreased significantly in both
groups from Day 1 to Day 3. The participants in the massage therapy group
had fewer complaints of fatigue on Day 1 (p = 0.006) and Day 2 (p = 0.028)
in addition, they reported a more effective sleep during all three days (p
= 0.019) when compared with the participants in the control group.
CONCLUSION: Massage therapy is an effective technique for improving
patient recovery from cardiopulmonary artery bypass graft surgery because
it reduces fatigue and improves sleep. 2010 CLINICS.

<44>
Accession Number
2013396903
Authors
Shi J. Ji H. Ren F. Wang G. Xu M. Xue Y. Chen M. Qi J. Li L.
Institution
(Shi, Ji, Li) State Key Laboratory of Cardiovascular Disease, Peking Union
Medical College, Fuwai Hospital, China
(Ren) Capital Medical University, China
(Wang) General Hospital of Chinese People's Liberation Army, China
(Xu) Shanghai Jiaotong University, Beijing, Shanghai, China
(Xue) TEDA International Cardiovascular Hospital, Tianjin, China
(Chen) Fourth Military Medical University, Xi'an, Shaanxi, China
(Qi) Fujian Provincial Hospital, Fuzhou, Fujian, China
Title
Protective effects of tranexamic acid on clopidogrel before coronary
artery bypass grafting: A multicenter randomized trial.
Source
JAMA Surgery. 148 (6) (pp 538-547), 2013. Date of Publication: June 2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Importance: Excessive bleeding and transfusion increase morbidity and
mortality in patients receiving coronary artery bypass grafting (CABG),
especially in those exposed to antiplatelet agents. Objective: To evaluate
the influence and interaction of clopidogrel bisulfate and tranexamic acid
on bleeding and transfusion outcomes. Design: A multicenter randomized and
blinded trial. Setting: Seven medical centers across China. Participants:
Patients eligible for randomization were 1173 men and women aged 18 to 85
years undergoing primary and isolated on-pump CABG; 570 adults were
randomized and 552 were analyzed. Patients were recruited and stratified
into 3 levels according to preoperative clopidogrel exposure (clopidogrel
ingestion -7 days, clopidogrel discontinuation -7 days, and nonexposure).
Intervention: Patients were randomized to receive tranexamic acid
(10-mg/kg^-1 bolus and 10-mg/kg^-1/h^-1
maintenance dose) or placebo. Main Outcome Measure: The primary outcomes
included blood loss, major bleeding, and red blood cell (RBC) transfusion
volume and exposure. Results: As compared with controls, clopidogrel
increased blood loss (mean difference [MD], 270 mL; 95% CI, 135 to 404
mL), major bleeding (risk difference [RD], 18.5; 95% CI, 7.85 to 29.2),
volume of RBCs transfused (MD, 2.97 U; 95% CI, 1.51 to 4.43 U), and RBC
transfusion exposure (RD, 17.9; 95% CI, 8.51 to 27.2). As compared with
placebo, tranexamic acid reduced blood loss (MD, -278 mL; 95% CI, -380 mL
to -176 mL), major bleeding (RD, -19.5; 95% CI, -27.7 to -11.4), volume of
RBCs transfused (MD, -2.58 U; 95% CI -3.61 U to -1.55 U), and RBC
transfusion exposure (RD, -18.9; 95% CI, -26.4 to -11.4). Subgroup
analysis demonstrated a significantly enhanced effect of tranexamic acid
especially in patients with impaired platelet function. Conclusions and
Relevance: Preoperative clopidogrel exposure increased bleeding and
transfusion requirements in patients receiving on-pump CABG. Tranexamic
acid reduced this risk and provided extra protection selectively in the
patients with persistent clopidogrel exposure within 7 days before
surgery. 2013 American Medical Association. All rights reserved.

<45>
Accession Number
2013380539
Authors
Inoue N. Oka N. Kitamura T. Shibata K. Itatani K. Tomoyasu T. Miyaji K.
Institution
(Inoue, Oka, Kitamura, Shibata, Itatani, Tomoyasu, Miyaji) Department of
Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa,
Japan
Title
Neutrophil elastase inhibitor sivelestat attenuates perioperative
inflammatory response in pediatric heart surgery with cardiopulmonary
bypass: A prospective randomized study.
Source
International Heart Journal. 54 (3) (pp 149-153), 2013. Date of
Publication: 2013.
Publisher
International Heart Journal Association (7-3-1 Hongo, Bunkyo-ku, Tokyo
113-8655, Japan)
Abstract
Cardiopulmonary bypass (CPB) evokes activation of a systemic inflammatory
response. Sivelestat has been used clinically to treat acute lung injury
associated with systemic inflammatory response syndrome. This prospective,
double-blind, randomized study was designed to evaluate the effects of
sivelestat in the perioperative period of elective pediatric open-heart
surgery with CPB. Twenty-six consecutive pediatric patients weighing
between 5 and 10 kg and undergoing open-heart surgery with CPB were
divided into a sivelestat group (n = 13) and a control group (n = 13). The
patients in the sivelestat group were administered a continuous
intravenous infusion of 0.2 mg/kg/hour of sivelestat, and the patients in
the control group were administered the same volume of 0.9% saline from
the initiation of CPB to 24 hours after surgery. Blood samples were drawn
for the measurement of cytokines, polymorphonuclear elastase (PMN-E),
white blood cell count (WBC), neutrophil count (NC), and C-reactive
protein (CRP). There were no significant differences in cytokine data
between the two groups. The peak PMN-E and WBC levels were significantly
increased in the control group (P = 0.049, P = 0.039). The WBC and NC
levels immediately after surgery in the control group were significantly
greater than those in the sivelestat group (P = 0.049, P = 0.044). The
peak CRP level in the control group was significantly greater than the
sivelestat group (P = 0.04), and the CRP level on postoperative day 4 in
the control group was significantly greater than in the sivelestat group
(P = 0.014). This study showed that sivelestat attenuates the
perioperative inflammatory response in pediatric heart surgery with CPB.