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<1>
Accession Number
2013471630
Authors
Mardani D. Bigdelian H.
Institution
(Mardani) Department of Nursing, School of Medicine Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
(Bigdelian) Department of Cardiac Surgery, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Title
The effect of dexamethasone prophylaxis on postoperative delirium after
cardiac surgery: A randomized trial.
Source
Journal of Research in Medical Sciences. 17 (1 SPL.1) (pp S113-S119),
2012. Date of Publication: 2012.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Coronary artery bypass graft is commonly associated with post
cardiac surgery delirium. Proinflammatory processes play an important role
in the pathogenesis of postoperative delirium. Therefore, dexamethasone
might have a beneficial effect on the reduction of this complication.
METHODS: This randomized clinical trial was conducted with the objective
of the evaluation of dexamethasone effects on postoperative delirium and
complications after cardiac surgery. The eligible patients were divided
into 2 groups of dexamethasone with 43 patients and placebo with 50
patients. The dexamethasone group took 8mg dexamethasone before induction
of anesthesia followed by 8mg every 8 hour for 3 days and the other group
received placebo in the same way. RESULTS: all patients were assessed by a
mini mental status questionnaire and psychiatric interviewing with the aim
of diagnosing delirium. Extubation time of the dexamethasone group was
significantly reduced. Our results showed that in the first postoperative
day delirium, extubation time, and intensive care unit length of stay
significantly decreased in the dexamethasone group without increasing
serious complications such as infectious diseases. After administration of
dexamethasone only hyperglycemia as an adverse event was increased in the
dexamethasone group. Other complications of renal, cardiac,
cerebrovascular and respiratory system did not show any significant
differences between the two groups. CONCLUSIONS: postoperative delirium is
in correlation with costly adverse events after cardiac surgery. Our data
suggested that preoperative administration of dexamethasone might safely
protect the brain of patients who undergone cardiac surgery against
postoperative delirium.

<2>
Accession Number
2013471615
Authors
Basati F. Sadeghi M. Kargarfard M. Yazdekhasti S. Golabchi A.
Institution
(Basati) Department of Physical Education, School of Physical Education
and Sport Sciences, University of Isfahan, Isfahan, Iran, Islamic Republic
of
(Sadeghi) Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Kargarfard) Department of Exercise Physiology, School of Physical
Education and Sport Sciences, University of Isfahan, Isfahan, Iran,
Islamic Republic of
(Yazdekhasti) Cardiovascular Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Golabchi) Health Research Center, Baghiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Effects of a cardiac rehabilitation program on systolic function and left
ventricular mass in patients after myocardial infarction and
revascularization.
Source
Journal of Research in Medical Sciences. 17 (1 SPL.1) (pp S28-S32), 2012.
Date of Publication: 2012.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Supervised exercise-based cardiac rehabilitation programs
(CRP) have been suggested to all patients, especially after myocardial
infarction. However, the effects of cardiac rehabilitation on systolic
function are controversial. The aim of this study was to examine the
effects of an 8-week cardiac rehabilitation on left ventricular systolic
function and left ventricular mass in patients with myocardial infarction
(MI) and revascularization. METHODS: This study included 29 men with MI
after reperfusion therapy, i.e. coronary artery bypass grafting (CABG) and
percutaneous coronary intervention (PCI). The patients were randomized
into a training group (n = 15, mean age: 54.2 +/- 9.04 years) and a
control group (n = 14, mean age: 51.71 +/- 6.98 years). The training group
performed 8 weeks of CRP with an intensity of 60-85% of maximum heart
rate, 3 times a week. Each session lasted for 60 minutes. Before and at
the end of the study, all patients underwent 2-dimentional
echocardiography for left ventricular systolic function and left
ventricular mass to be assessed. RESULTS: After 8 weeks of CRP, left
ventricular ejection fraction (LVEF) increased significantly in the
training group (48.53 +/- 10.41 vs. 59.13 +/- 5.90; p < 0.001). Moreover,
the difference in LVEF between the training and control groups were
significant after the course (59.13 +/- 5.90 vs. 55.90 +/- 9.60; p <
0.001). In addition, stroke volume increased significantly (57.22 +/- 7.84
ml vs. 64.03 +/- 12.80 ml; p < 0.001) while left ventricular systolic
volume decreased significantly (42.89 +/- 17.32 ml vs. 31.00 +/- 8.34 ml;
p < 0.001) in the training group. CRP was decreased left ventricular mass
in the training group (229 +/- 42 vs. 196 +/- 34; p < 0.05). CONCLUSIONS:
A 2-month CRP in post-MI patients led to improvements in systolic function
and reductions in left ventricular mass and thus cardiomegaly.

<3>
Accession Number
22829151
Authors
Patron E. Messerotti Benvenuti S. Favretto G. Valfre C. Bonfa C.
Gasparotto R. Palomba D.
Institution
(Patron, Messerotti Benvenuti, Bonfa, Palomba) Department of General
Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy
(Favretto, Valfre, Gasparotto) Department of Preventive and Rehabilitative
Cardiology, Motta di Livenza Hospital, Via Padre Leonardo Bello, 3/c,
31045 Motta di Livenza (TV), Italy
Title
Biofeedback assisted control of respiratory sinus arrhythmia as a
biobehavioral intervention for depressive symptoms in patients after
cardiac surgery: A preliminary study.
Source
Applied Psychophysiology Biofeedback. 38 (1) (pp 1-9), 2013. Date of
Publication: March 2013.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
The current study investigated whether biofeedback training aimed at
increasing respiratory sinus arrhythmia (RSA), a measure of cardiac vagal
modulation, can reduce depressive symptoms in patients after cardiac
surgery. This randomized controlled study enrolled 26 patients after
first-time cardiac surgery. The patients were randomly assigned to an
RSA-biofeedback group (N = 13) or to a treatment as usual group (N = 13).
The biofeedback training consisted of five 45 min sessions designed to
increase RSA. The outcome was assessed as changes in RSA and in the Centre
for Epidemiologic Studies of Depression (CES-D) values from pre- to
post-training. Both groups were comparable for demographic and biomedical
characteristics. RSA increased significantly in patients who underwent
RSA-biofeedback compared to controls. Moreover, the CES-D scores were
reduced significantly from pre- to post-training in the RSA-biofeedback
group compared to the controls. Changes in RSA were inversely related to
changes in CES-D scores from pre- to post-training. These findings extend
the effectiveness of RSA-biofeedback for increasing vagal modulation as
well as for reducing depressive symptoms in post-surgical patients.
Overall, the current study also suggests that this biobehavioral
intervention may add to the efficacy of postoperative risk reduction
programs and rehabilitation protocols in cardiac surgery patients. 2012
Springer Science+Business Media, LLC.

<4>
Accession Number
23288176
Authors
Matheus G.B. Dragosavac D. Trevisan P. da Costa C.E. Lopes M.M. Ribeiro
G.C.A.
Institution
(Matheus) Coronary Unit of the Hospital e Maternidade Celso Pierro,
Pontifical Catholic University of Campinas (PUC Campinas), Campinas, SP,
Brazil
(Dragosavac) Department of the Faculty of Medical Sciences at Unicamp (FCM
Unicamp), Campinas, Brazil
(Trevisan) PUC Campinas Hospital, Campinas, SP, Brazil
(da Costa) Caminas Cardiosurgical Clinics, Campinas, SP, Brazil
(Lopes, Ribeiro) FCM Unicamp, Campinas, SP, Brazil
Title
Inspiratory muscle training improves tidal volume and vital capacity after
CABG surgery.
Source
Brazilian Journal of Cardiovascular Surgery. 27 (3) (pp 362-369), 2012.
Date of Publication: July-September 2012.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Objective: To evaluate lung function and respiratory muscle strength in
the postoperative period and investigate the effect of inspiratory muscle
training on measures of respiratory muscle performance in patients
undergoing coronary artery bypass grafting. Methods: A randomized study
with 47 patients undergoing coronary artery bypass grafting with
cardiopulmonary bypass. They were divided into study group (SG) 23
patients and control group (CG) 24 patients, mean age 61.83 +/- 8.61 and
66.33 +/- 10.20 years, EuroSCORE SG 0.71 +/- 0.0018 and CG 0.76 +/-
0.0029, respectively. The study group underwent physical therapy and
inspiratory muscle training with threshold IMT and CG underwent
conventional physiotherapy. We compared the maximal respiratory pressures
(MIP and MEP), tidal volume (TV), vital capacity (VC) and peak expiratory
flow (peak flow) preoperatively (Pre-OP), 1st (PO1) and 3rd (PO3)
postoperative day. Results: There was a significant reduction in all
variables measured on PO1 compared to preoperative values in both groups,
MIP (P <0.0001), MEP (P <0.0001), TV SG (P <0.0004) and CG (P <0.0001) and
VC SG (P <0.0001) and CG (P <0.0001) and peak flow (P <0.0001). At PO3, SG
presented higher value of VC, GE 1230.4 +/- 477.86 ml vs. GC 919.17 +/-
394.47 ml (P=0.0222) and TV SG 608.09 +/- 178.24 ml vs. CG 506.96 +/-
168.31 ml (P= 0.0490). Conclusion: Patients undergoing cardiac surgery
experience reduced ventilatory capacity and respiratory muscle strength
after surgery. Muscle training was performed to retrieve TV and VC in the
PO3, in the trained group.

<5>
Accession Number
2013448297
Authors
Brayton K.M. Patel V.G. Stave C. De Lemos J.A. Kumbhani D.J.
Institution
(Brayton, Stave) Center for Primary Care and Outcomes Research, Stanford
School of Medicine, Stanford University, 117 Encina Commons, Stanford, CA
94305-6019, United States
(Patel, De Lemos, Kumbhani) University of Texas, Southwestern Medical
Center, Dallas, TX, United States
Title
Same-day discharge after percutaneous coronary intervention: A
meta-analysis.
Source
Journal of the American College of Cardiology. 62 (4) (pp 275-285), 2013.
Date of Publication: 23 Jul 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This study sought to assess the safety of same-day discharge in
patients undergoing percutaneous coronary intervention (PCI). Background
The safety of same-day discharge has previously been evaluated primarily
in small, single-center studies. Methods We conducted a meta-analysis of
studies reporting outcomes of patients discharged on the same day as PCI.
Demographic data, procedural characteristics, and adverse outcomes were
collected. Two composite outcomes were pre-specified: 1) death, myocardial
infarction (MI), or target lesion revascularization (TLR); and 2) major
bleeding or vascular complications. Results Data from 12,803 patients in
37 studies were collated, including 7 randomized controlled trials (RCTs)
(n = 2,738) and 30 observational studies (n = 10,065). The majority of
patients in both cohorts underwent PCI for stable angina. The vascular
access site was predominantly transradial in the randomized cohort (60.8%)
and transfemoral in the observational cohort (70.0%). In the RCTs, no
difference was seen between same-day discharge and routine overnight
observation with regard to death/MI/TLR (odds ratio [OR]: 0.90; 95%
confidence interval [CI]: 0.43 to 1.87; p = 0.78) or for major
bleeding/vascular complications (OR: 1.69; 95% CI: 0.84 to 3.40; p =
0.15). In observational studies, the primary outcome of death/MI/TLR
occurred at a pooled rate of 1.00% (95% CI: 0.58% to 1.68%), and major
bleeding/vascular complications occurred at a pooled rate of 0.68% (95%
CI: 0.35% to 1.32%). Conclusions In selected patients undergoing largely
elective PCI, same-day discharge was associated with a low rate of major
complications and appeared to be as safe as routine overnight observation.
2013 by the American College of Cardiology Foundation.

<6>
Accession Number
2013448290
Authors
Mauri L. Foster E. Glower D.D. Apruzzese P. Massaro J.M. Herrmann H.C.
Hermiller J. Gray W. Wang A. Pedersen W.R. Bajwa T. Lasala J. Low R.
Grayburn P. Feldman T.
Institution
(Mauri) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Womens Hospital, 75 Francis Street, Boston, MA 02115, United
States
(Mauri, Apruzzese, Massaro) Harvard Clinical Research Institute, Boston,
MA, United States
(Foster, Wang) University of California, San Francisco, CA, United States
(Glower) Duke University Medical Center, Durham, NC, United States
(Massaro) Boston University, Boston, MA, United States
(Herrmann) University of Pennsylvania, Philadelphia, PA, United States
(Hermiller) St. Vincent Medical Group, Indianapolis, IN, United States
(Gray) Columbia University Medical Center, New York, NY, United States
(Pedersen) Minneapolis Heart Institute, Minneapolis, MN, United States
(Bajwa) Aurora Health Center, Milwaukee, WI, United States
(Lasala) Washington University, St. Louis, MO, United States
(Low) University of California, Davis, CA, United States
(Grayburn) Baylor Heart and Vascular Institute, Dallas, TX, United States
(Feldman) Evanston Hospital, Evanston, IL, United States
Title
4-Year results of a randomized controlled trial of percutaneous repair
versus surgery for mitral regurgitation.
Source
Journal of the American College of Cardiology. 62 (4) (pp 317-328), 2013.
Date of Publication: 23 Jul 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This study sought to evaluate 4-year outcomes of percutaneous
repair versus surgery for mitral regurgitation. Background Transcatheter
therapies are being developed to treat valvular heart disease. In the
EVEREST (Endovascular Valve Edge-to-Edge Repair Study) II trial, treatment
of mitral valve regurgitation (MR) with a novel percutaneous device was
compared with surgery and showed superior safety, but less reduction in MR
at 1 year overall. We report the 4-year outcomes from the EVEREST II
trial. Methods Patients with grade 3+ or 4+ MR were randomly assigned to
percutaneous repair with the MitraClip (Abbott, Menlo Park, California)
device or conventional mitral valve surgery in a 2:1 ratio (184:95).
Patients prospectively consented to 5 years of follow-up. Results At 4
years, the rate of the composite endpoint of freedom from death, surgery,
or 3+ or 4+ MR in the intention-to-treat population was 39.8% versus 53.4%
in the percutaneous repair group and surgical groups, respectively (p =
0.070). Rates of death were 17.4% versus 17.8% (p = 0.914), and 3+ or 4+
MR was present in 21.7% versus 24.7% (p = 0.745) at 4 years of follow-up,
respectively. Surgery for mitral valve dysfunction, however, occurred in
20.4% versus 2.2% (p < 0.001) at 1 year and 24.8% versus 5.5% (p < 0.001)
at 4 years. Conclusions Patients treated with percutaneous repair of the
mitral valve more commonly required surgery to treat residual MR; however,
after the first year of follow-up, there were few surgeries required after
either percutaneous or surgical treatment and no difference in the
prevalence of moderate-severe and severe MR or mortality at 4 years.
(Endovascular Valve Edge-to-Edge Repair Study [EVEREST II]; NCT00209274)
2013 by the American College of Cardiology Foundation.

<7>
Accession Number
2013468766
Authors
Beer L. Szerafin T. Mitterbauer A. Debreceni T. Maros T. Dworschak M. Roth
G.A. Ankersmit H.J.
Institution
(Beer, Mitterbauer, Ankersmit) Department of Thoracic Surgery, Medical
University Vienna, Wahringer Gurtel 18-20, A-1090 Vienna, Austria
(Beer, Mitterbauer, Ankersmit) Christian Doppler Laboratory for Cardiac
and Thoracic Diagnosis and Regeneration, Vienna, Austria
(Szerafin, Debreceni, Maros) Department of Cardiac Surgery, Institute of
Cardiology, Medical and Health Science Centre, University of Debrecen,
Debrecen, Hungary
(Dworschak, Roth) Department of Anesthesiology, General Intensive Care and
Pain Medicine, Medical University of Vienna, Vienna, Austria
Title
Continued mechanical ventilation during coronary artery bypass graft
operation attenuates the systemic immune response.
Source
European Journal of Cardio-thoracic Surgery. 44 (2) (pp 282-287), 2013.
Date of Publication: July 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: Cardiopulmonary bypass (CPB) is known to induce a short
pro-and long-lasting anti-inflammatory immune response. The
anti-inflammatory protein soluble ST2 (sST2) may be involved in the
pathogenesis of postoperative immune dysfunction. We investigated whether
continued mechanical ventilation during CPB has an impact on postoperative
serum sST2 and cytokine release. Methods: Thirty patients undergoing
conventional coronary artery bypass graft (CABG) operation were randomized
into a ventilated on CPB (VG; n = 15) and non-ventilated on CPB group
(NVG; n = 15). Blood samples were drawn at the beginning and at the end of
surgery, and at the 5 consecutive days. sST2, IL-4, IL-10, IgM, IgG, IL-6
and endotoxin were measured by ELISA. Data are given as mean standard
deviation (SD). A Mann-Whitney U-test was used for statistical analysis.
Results: Serum levels of sST2 and IL-10 were significantly higher in the
NVG when compared with the VG at the first postoperative day (POD-1) [sST2
pg/ml: 1366.4 (433) (VG) vs 2296.3 (1795.5) (NVG) P = 0.029; IL-10 pg/ml:
10.7 (4.0) (VG) vs 15.4 (6.8) (NVG) P = 0.038]. In addition, the secretion
of proinflammatory IL-6 was slightly reduced in the VG at POD-1 [IL-6
pg/ml: 83.1 (52.5) (VG) vs 110.2 (42.3) (NVG) P = 0.033]. IL-4, endotoxin,
IgM and IgG showed no differences between groups. Conclusion: These data
suggest that continued mechanical ventilation during CABG attenuates
inflammatory and anti-inflammatory immune responses after CPB. Continued
mechanical ventilation may have beneficial effects in the attenuation of
the CPB-induced immune activation. The Author 2013. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<8>
Accession Number
2013468760
Authors
Palade E. Passlick B. Osei-Agyemang T. Gunter J. Wiesemann S.
Institution
(Palade, Passlick, Osei-Agyemang, Gunter, Wiesemann) Department of
Thoracic Surgery, Medical Center Freiburg, Hugstetterstr. 55, Freiburg,
Germany
Title
Video-assisted vs open mediastinal lymphadenectomy for Stage I
non-small-cell lung cancer: Results of a prospective randomized trial.
Source
European Journal of Cardio-thoracic Surgery. 44 (2) (pp 244-249), 2013.
Date of Publication: July 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: Since the introduction of video-assisted lobectomy for
non-small-cell lung cancer (NSCLC) into clinical practice, it has been
discussed controversially whether mediastinal lymphadenectomy can be
performed as effectively as an open procedure via thoracotomy. Therefore,
we address this issue in a prospective randomized trial conducted in our
institution. Methods: In total, 66 patients with completely staged
clinical Stage I NSCLC were included and randomized either into a
videoassisted group (n = 34) or into the conventional lobectomy group (n =
32). The video-assisted thoracoscopic (VATS) lobectomy was performed by
using a 4- to 5-cm utility incision in the fourth or fifth intercostal
space and two additional 10-mm ports without rib spreading. The
conventional lobectomy was done via an anterolateral thoracotomy. Lymph
nodes were classified according to the International Association for the
Study of Lung Cancer classification; for right-sided tumours, lymph nodes
number 2R, 4R, 7, 8, 9, 10, 11 and 12 were dissected, and for left-sided
tumours, lymph nodes number 5, 6, 7, 8, 9, 10, 11 and 12. For the
subsequent analyses, lymph nodes were grouped into different zones
consisting of Zone 1 (2R and 4R), Zone 2 (7), Zone 3 (8R and 9R), Zone 4
(10R, 11R and 12R), Zone 5 (4L), Zone 6 (5 and 6), Zone 7 (8L and 9L) and
Zone 8 (10L, 11L and 12L). Results: Both groups were comparable with
respect to different clinical pathological parameters (age, tumour size
and comorbidity). In the video-assisted group, 2 patients were excluded
due to conversion to an open thoracotomy. The number of mediastinal lymph
nodes removed was as follows: VATS (right side) 24.0 lymph nodes/patient,
open right-sided 25.2 lymph nodes/patient, VATS (left side) 25.1 lymph
nodes/patient and open left-sided 21.1 lymph nodes/patient. With respect
to the zones mentioned above, we found the following results: VATS vs open
(mean number of lymph nodes/patient): Zone 1: 9 vs 8.5; Zone 2: 6.3 vs
5.6; Zone 3: 2.4 vs 3.2; Zone 4: 6.5 vs 6.9; Zone 5: 0 vs 0.5; Zone 6: 3.2
vs 3.7; Zone 7: 4.6 vs 3.2 and Zone 8: 10.5 vs 8.9. There were no
statistically significant differences between the procedures, either with
respect to the overall number of lymph nodes or with respect to the number
of lymph nodes in each zone. Conclusions: Mediastinal lymph node
dissection can be performed as effectively by the video-assisted approach
as by the open thoracotomy approach. Furthermore, the video-assisted
approach allows a better visualization of different lymph node zones. The
Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<9>
Accession Number
2013465045
Authors
Binder R.K. Webb J.G. Willson A.B. Urena M. Hansson N.C. Norgaard B.L.
Pibarot P. Barbanti M. Larose E. Freeman M. Dumont E. Thompson C. Wheeler
M. Moss R.R. Yang T.-H. Pasian S. Hague C.J. Nguyen G. Raju R. Toggweiler
S. Min J.K. Wood D.A. Rodes-Cabau J. Leipsic J.
Institution
(Binder, Webb, Willson, Barbanti, Freeman, Thompson, Wheeler, Moss, Yang,
Hague, Nguyen, Raju, Toggweiler, Leipsic) St. Paul's Hospital, University
of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
(Urena, Pibarot, Larose, Dumont, Pasian, Rodes-Cabau) Quebec Heart and
Lung Institute, Laval University, Quebec City, QC, Canada
(Hansson, Norgaard) Aarhus University Hospital Skejby, Aarhus, Denmark
(Min) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Wood) Vancouver General Hospital, University of British Columbia,
Vancouver, BC, United States
Title
The impact of integration of a multidetector computed tomography annulus
area sizing algorithm on outcomes of transcatheter aortic valve
replacement: A prospective, multicenter, controlled trial.
Source
Journal of the American College of Cardiology. 62 (5) (pp 431-438), 2013.
Date of Publication: 30 Jul 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This study prospectively investigated the impact of integration
of a multidetector computed tomography (MDCT) annular area sizing
algorithm on transcatheter aortic valve replacement (TAVR) outcomes.
Background Appreciation of the 3-dimensional, noncircular geometry of the
aortic annulus is important for transcatheter heart valve (THV) sizing.
Methods Patients being evaluated for TAVR in 4 centers underwent
pre-procedural MDCT. Recommendations for balloon-expandable THV size
selection were based on an MDCT sizing algorithm with an optimal goal of
modest annulus area oversizing (5% to 10%). Consecutive patients who
underwent TAVR with the algorithm (MDCT group) were compared with
consecutive patients without the algorithm (control group). The primary
endpoint was the incidence of more than mild paravalvular regurgitation
(PAR), and the secondary endpoint was the composite of in-hospital death,
aortic annulus rupture, and severe PAR. Results Of 266 patients, 133
consecutive patients underwent TAVR (SAPIEN XT THV) in the MDCT group and
133 consecutive patients were in the control group. More than mild PAR was
present in 5.3% (7 of 133) of the MDCT group and in 12.8% (17 of 133) in
the control group (p = 0.032). The combined secondary endpoint occurred in
3.8% (5 of 133) of the MDCT group and in 11.3% (15 of 133) of the control
group (p = 0.02), driven by the difference of severe PAR. Conclusions The
implementation of an MDCT annulus area sizing algorithm for TAVR reduces
PAR. Three-dimensional aortic annular assessment and annular area sizing
should be considered for TAVR.

<10>
Accession Number
2013469432
Authors
Vatankulu M.A. Bacaksiz A. Sonmez O. Alihanoglu Y. Koc F. Demir K. Gul
E.E. Turfan M. Tasal A. Kayrak M. Yazici M. Ozdemir K.
Institution
(Vatankulu, Bacaksiz, Sonmez, Turfan, Tasal) Cardiology Department,
Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
(Alihanoglu) Cardiology Department, Faculty of Medicine, Pamukkale
University, Denizli, Turkey
(Koc) Cardiology Department, Faculty of Medicine, Gaziosmanpasa
University, Tokat, Turkey
(Demir, Gul, Kayrak, Yazici, Ozdemir) Cardiology Department, Faculty of
Medicine, Selcuk University, Konya, Turkey
Title
Does spironolactone have a dose-dependent effect on left ventricular
remodeling in patients with preserved left ventricular function after an
acute myocardial infarction?.
Source
Cardiovascular Therapeutics. 31 (4) (pp 224-229), 2013. Date of
Publication: August 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Aims: The aim of this study was to investigate the effects of
spironolactone on left ventricular (LV) remodeling in patients with
preserved LV function following acute myocardial infarction (AMI). Methods
and Results: Successfully revascularized patients (n = 186) with acute ST
elevation MI (STEMI) were included in the study. Patients were randomly
divided into three groups, each of which was administered a different dose
of spironolactone (12.5, 25 mg, or none). Echocardiography was performed
within the first 3 days and at 6 months after MI. Echocardiography control
was performed on 160 patients at a 6-month follow-up. The median left
ventricular ejection fraction (LVEF) increased significantly in all
groups, but no significant difference was observed between groups (P =
0.13). At the end of the sixth month, the myocardial performance index
(MPI) had improved in each of the three groups, but no significant
difference was found between groups (F = 2.00, P = 0.15). The mean LV peak
systolic velocities (S_m) increased only in the control group
during the follow-up period, but there is no significant difference
between groups (F = 1.79, P = 0.18). The left ventricular end-systolic
volume index (LVESVI) and the left ventricular end-diastolic volume index
(LVEDVI) did not change significantly compared with the basal values
between groups (F = 0.05, P = 0.81 and F = 1.03, P = 0.31, respectively).
Conclusion: In conclusion, spironolactone dosages of up to 25 mg do not
augment optimal medical treatment for LV remodeling in patients with
preserved cardiac functions after AMI. 2012 John Wiley & Sons Ltd.

<11>
Accession Number
2013447904
Authors
Mirhosseini S.J. Forouzannia S.K. Nasirian M. Ali-Hassan-Sayegh S.
Institution
(Mirhosseini, Forouzannia) Department of Cardiac Surgery, Yazd
Cardiovascular Researches Center, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Nasirian) Ali Ben Abitaleb Medical College, Islamic Azad University,
Yazd, Iran, Islamic Republic of
(Ali-Hassan-Sayegh) Yazd Cardiovascular Researches Center, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
Title
N-acetylcysteine instead of theophylline in patients with COPD who are
candidates for elective off-pump CABG surgery: Is it possible in
cardiovascular surgery unit?.
Source
Saudi Journal of Anaesthesia. 7 (2) (pp 151-154), 2013. Date of
Publication: April-June 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Forced expiratory volume in one second (FEV1) is a good
predictor of chronic obstructive pulmonary disease (COPD). COPD is
characterized by a chronic limitation of airflow. This study was designed
to compare the effects and complications of theophylline alone,
N-acetylcysteine (NAC) alone, and a combination of the two drugs on the
rates of FEV1 in patients with COPD who were candidates for off-pump
coronary artery bypass graft (CABG) surgery. Methods: This clinical trial
was performed on 100 patients who had a smoking history of 27 pack years
with a range of 20 to 40 pack years but were not heavy smokers and were
candidates for elective off-pump CABG surgery in Afshar Cardiovascular
Hospital, Yazd, Iran. The patients with a history of asthma and
bronchospasm and non-COPD respiratory disorders were excluded. There were
three groups, that is, the theophylline group (n=33) that received
theophylline 10 mg/kg TDS after consumption of food, NAC group (n=33) who
received NAC 10-15 mg/kg BD after consumption of food, and the combined
group (n=32) who received theophylline and NAC together. Data were
analyzed by analysis of variance (ANOVA), Chi-square, and exact test for
quantitative and qualitative variables. Results: One hundred patients with
COPD enrolled in this study as possible candidates for CABG surgery.
Average age of the patients was 60.36+/-10.21 years. Of the participants,
83 (83.3%) were male and 17 (17%) were female. Rate of postoperative FEV1
to basal FEV1 was 0.76+/-0.32, 0.66+/-0.22, and 0.69+/-0.24 in the
treatments with theophylline, NAC, and the combination, respectively.
Theophylline, NAC, and a combination of these drugs can decrease the rate
of postoperative FEV1 compared to basal FEV1 significantly. (P=0.0001)
Conclusion: Theophylline alone, NAC alone, and a combination of these
drugs improve pulmonary function, and there are no significant differences
between these protocols. Stomach discomfort and cardiac complications in
treatment with theophylline alone is significantly higher than NAC alone
and the combination.

<12>
Accession Number
2013443934
Authors
Fteropoulli T. Stygall J. Cullen S. Deanfield J. Newman S.P.
Institution
(Fteropoulli, Stygall, Newman) Centre for Health Services Research, School
of Health Sciences, City University London, London EC1 V 0HB, United
Kingdom
(Cullen, Deanfield) GUCH Unit, Heart Hospital, University College of
London Hospitals NHS Foundation Trust, London, United Kingdom
Title
Quality of life of adult congenital heart disease patients: A systematic
review of the literature.
Source
Cardiology in the Young. 23 (4) (pp 473-485), 2013. Date of Publication:
August 2013.
Publisher
Cambridge University Press (Shaftesbury Road, Cambridge CB2 2RU, United
Kingdom)
Abstract
Abstract Aims This review explores the quality of life of adult congenital
heart disease patients and the relationship between disease severity and
quality of life. Methods We searched seven electronic databases and the
bibliography of articles. The 31 selected studies fulfilled the following
criteria: adult population; quantitative; assessment of quality of life
and/or impact of disease severity on quality of life using validated
measures; English language. Data extraction forms were used to summarise
the results. Results There are evident methodological limitations within
the reviewed studies such as heterogeneous populations, designs, and
quality of life conceptualisations and measurements. Despite these
problems, findings suggest that the quality of life of adult congenital
heart disease patients is compromised in the physical domain compared with
their healthy counterparts, whereas no differences were found in relation
to the psychosocial and environmental/occupational domain. Some severity
variables appear to be significant correlates of quality of life and could
be considered in a future standardised classification of disease severity.
Conclusion The methodological limitations of past research in relation to
the definition and measurement of quality of life, the study designs, and
disease severity classifications need to be addressed in future studies in
order to provide robust evidence and valid conclusions in this area of
study. This will enable the development of targeted interventions for the
improvement of quality of life in the adult population of congenital heart
disease patients. Copyright 2013 Cambridge University Press.

<13>
Accession Number
2013463897
Authors
Abdelmalak B.B. Bonilla A. Mascha E.J. Maheshwari A. Wilson Tang W.H. You
J. Ramachandran M. Kirkova Y. Clair D. Walsh R.M. Kurz A. Sessler D.I.
Institution
(Abdelmalak, Ramachandran) Department of General Anaesthesiology, General
Anaesthesiology/E-31, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH
44195, United States
(Abdelmalak, Bonilla, Mascha, You, Kurz, Sessler) Department of Outcomes
Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44102,
United States
(Mascha, You) Department of Quantitative Health Sciences, Cleveland
Clinic, 9500 Euclid Avenue, Cleveland, OH 44102, United States
(Maheshwari, Kirkova) Anaesthesiology Institute, Cleveland Clinic, 9500
Euclid Avenue, Cleveland, OH 44102, United States
(Wilson Tang) Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid
Avenue, Cleveland, OH 44102, United States
(Clair) Department of Vascular Surgery, Cleveland Clinic, 9500 Euclid
Avenue, Cleveland, OH 44102, United States
(Walsh) Department of General Surgery, Cleveland Clinic, 9500 Euclid
Avenue, Cleveland, OH 44102, United States
(Bonilla) Northside Medical Centre, 500 Gypsy Lane, Youngstown, OH 44501,
United States
(Kirkova) Department of Internal Medicine, Cleveland Clinic, 9500 Euclid
Avenue, Cleveland, OH 44102, United States
Title
Dexamethasone, light anaesthesia, and tight glucose control (DeLiT)
randomized controlled trial.
Source
British Journal of Anaesthesia. 111 (2) (pp 209-221), 2013. Date of
Publication: August 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundThe inflammatory response to surgical tissue injury is
associated with perioperative morbidity and mortality. We tested the
primary hypotheses that major perioperative morbidity is reduced by three
potential anti-inflammatory interventions: (i) low-dose dexamethasone,
(ii) intensive intraoperative glucose control, and (iii) lighter
anaesthesia.MethodsWe enrolled patients having major non-cardiac surgery
who were >=40 yr old and had an ASA physical status <=IV. In a three-way
factorial design, patients were randomized to perioperative i.v.
dexamethasone (a total of 14 mg tapered over 3 days) vs placebo, intensive
vs conventional glucose control 80-110 vs 180-200 mg dl^-1, and
lighter vs deeper anaesthesia (bispectral index target of 55 vs 35). The
primary outcome was a collapsed composite of 15 major complications and 30
day mortality. Plasma high-sensitivity (hs) C-reactive protein (CRP)
concentration was measured before operation and on the first and second
postoperative days.ResultsThe overall incidence of the primary outcome was
about 20%. The trial was stopped after the second interim analysis with
381 patients, at which all three interventions crossed the futility
boundary for the primary outcome. No three-way (P=0.70) or two-way (all
P>0.52) interactions among the interventions were found. There was a
significantly smaller increase in hsCRP in patients given dexamethasone
than placebo [maximum 108 (64) vs 155 (69) mg litre^-1,
P<0.001], but none of the other two interventions differentially
influenced the hsCRP response to surgery.ConclusionsAmong our three
interventions, dexamethasone alone reduced inflammation. However, no
intervention reduced the risk of major morbidity or 1 yr mortality.Trial
Registration IdentifierNCT00433251 at www.clinicaltrials.gov. The Author
[2013]. Published by Oxford University Press on behalf of the British
Journal of Anaesthesia. All rights reserved.

<14>
Accession Number
2013438125
Authors
Laiq N. Khan R.A. Mailk A. Ahmad H.
Institution
(Laiq) Department of Cardiothoracic Anaesthesia, Postgraduate Medical
Institute, Lady Reading Hospital, Peshawar, Pakistan
(Khan, Mailk, Ahmad) Department of Cardiovascular Postgraduate Medical
Institute, Lady Reading Hospital, Peshawar, Pakistan
Title
Intravenous magnesium prevents atrial fibrillation after valvular heart
surgery.
Source
Journal of Medical Sciences (Peshawar). 21 (2) (pp 77-80), 2013. Date of
Publication: April 2013.
Publisher
Khyber Medical College (PeshawarPakistan)
Abstract
Objective: To evaluate the effectiveness of prophylactic magnesium sulfate
in the prophylaxis of atrial fibrillation. Materials and Methods: It was a
prospective randomized placebo-controlled trial in 100 consecutive
patients who were scheduled to undergo elective cardiac valvular surgery
and had provided informed written consent, were studied from January 2007
to January 2009 at Cardiothoracic Anaesthesia Department of Post Graduate
Medical Institute, Lady Reading Hospital, Peshawar. Operations and
management of atrial fibrillations were performed by the same surgical
team. Results: In the treatment group (n = 50) 32 (64%) of the patients
were women and 18 (36%) were men, the average age was 36 +/- 12.9 years
(range 20-60 years). The control group consisted of 20 (40%) men and 30
(60%) women, mean age 40 +/- 11.35 SD years, age (range 20-60 years). Data
collected were the number of patients, preoperative patient
characteristics, magnesium sulphate level and length of stay (LOS) in ICU
and in the hospital. LOS in ICU as well as in the ward were significantly
long in our control group compared to treatment group i-e 20% in magnesium
group and 40% in control group. The rest of data were significantly not
different in both of our studied groups. Blood magnesium sulfate levels in
both groups were not significantly different in Preoperative,
perioperative, and postoperative patients. Frequency of atrial
fibrillation (AF) in the treatment group was significantly lower (P =
0.05) compare to control group. No mortality was recorded in our studied
groups. Conclusion: Magnesium provides good pre,intra and postoperative
control of arrythmias, without any significant adverse effects,therefore
it should be encouraged in open heart surgeries.

<15>
Accession Number
2013457198
Authors
Aykut K. Albayrak G. Guzeloglu M. Hazan E. Tufekci M. Erdogan I.
Institution
(Aykut, Albayrak, Guzeloglu, Hazan) Department of Cardiovascular Surgery,
Faculty of Medicine, Izmir University, Yeni Girne Bulvari, 1825 Sok, No:
12 Karsiyaka, Izmir 35000, Turkey
(Tufekci, Erdogan) Department of Psychology, Faculty of Medicine, Izmir
University, Izmir 35000, Turkey
Title
Pulsatile versus non-pulsatile flow to reduce cognitive decline after
coronary artery bypass surgery: A randomized prospective clinical trial.
Source
Journal of Cardiovascular Disease Research. 4 (2) (pp 127-129), 2013. Date
of Publication: June 2013.
Publisher
Reed Elsevier India Pvt. Ltd. (India)
Abstract
Background: In this prospective study, we aimed to compare the effect of
pulsatile and non-pulsatile flow on the cognitive functions in patients
undergoing coronary artery bypass surgery. Methods Patients scheduled for
their first coronary artery bypass surgery (n = 148) were randomly
assigned to the pulsatile flow group (Group A, n = 75) or non-pulsatil
group (Group B, n = 73). Cognitive performance was assessed with (MoCA)
montreal cognitive assessment test performed by psychologists before
coronary artery bypass surgery and 1 month after the operation. Results:
Mild cognitive impairment was seen in 12 (16%) patients and serious
cognitive impairment was seen in 1 (1.33%) patient in the pulsatile flow
group. In the other group, mild cognitive impairment was detected in 23
(31.50%) patients and serious cognitive decline was found in 3 (4.10%)
patients. Mean MoCA scores were 25.86 +/- 2.62 in group A and 22.12 +/-
2.20 in group B. The difference between two groups was statistically
significant (P = 0.041). Conclusions: We suggest that pulsatile flow has
beneficial effects to decrease cognitive dysfunction in patients
undergoing on-pump coronary artery bypass surgery. 2013, SciBioIMed.Org,
Published by Reed Elsevier India Pvt. Ltd. All rights reserved.

<16>
Accession Number
2013461863
Authors
McGuinness S.P. Parke R.L. Bellomo R. Van Haren F.M.P. Bailey M.
Institution
(McGuinness, Parke) Cardiothoracic and Vascular Intensive Care Unit,
Auckland City Hospital, Auckland, New Zealand
(Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Bellomo, Bailey) Australian and New Zealand Intensive Care Research
Centre, Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Van Haren) Department of Intensive Care, Canberra Hospital, Canberra,
Australia
Title
Sodium bicarbonate infusion to reduce cardiac surgery-associated acute
kidney injury: A phase II Multicenter double-blind randomized controlled
trial.
Source
Critical Care Medicine. 41 (7) (pp 1599-1607), 2013. Date of Publication:
July 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVES:: Cardiac surgery-associated acute kidney injury occurs in up
to 50% of patients and is associated with increased mortality and
morbidity. This study aimed to discover if perioperative urinary
alkalinization with sodium bicarbonate infusion reduces the prevalence of
cardiac surgery-associated acute kidney injury. DESIGN:: This study was a
phase IIb multicenter double-blind randomized controlled trial. SETTING::
This study was conducted in three tertiary hospitals in New Zealand and
Australia. PATIENTS:: A total of 427 patients scheduled to undergo
elective cardiac surgery, who were at increased risk of development of
cardiac surgery-associated acute kidney injury using recognized risk
factors. MEASUREMENTS AND MAIN RESULTS:: Patients were randomly allocated
to receive either sodium bicarbonate (n = 215) or sodium chloride (n =
212) infusion, commencing at the start of anesthesia, in a dose of 0.5
mEq/kg/hr for the first hour and then 0.2 mmol/kg/hr for 23 hours. The
primary outcome measure was the number of patients with development of
cardiac surgery-associated acute kidney injury, defined as an increase in
creatinine greater than 25% or 0.5 mg/dL (44 mumol/L) from baseline to
peak value within the first five postoperative days. Significant
differences among the groups in both plasma and urinary biochemistry were
achieved 6 hours after commencement of the infusion, and these changes
persisted for more than 24 hours. A total of 100 out of 215 patients (47%
[95% CI, 40%-53%]) in the sodium bicarbonate group and 93 of 212 patients
(44% [95% CI, 37%-51%]) in the sodium chloride group with development of
acute kidney injury within the first five postoperative days (p = 0.58).
There were also no significant differences in ventilation hours, ICU or
hospital length of stay, or mortality. CONCLUSIONS:: Perioperative
alkalinization of blood and urine using an infusion of sodium bicarbonate
did not result in a decrease in the prevalence of acute kidney injury in
patients following cardiac surgery. Copyright 2013 by the Society of
Critical Care Medicine and Lippincott.

<17>
Accession Number
2013461906
Authors
Preau S. Montaigne D. Modine T. Fayad G. Koussa M. Tardivel M. Durocher A.
Saulnier F. Marechal X. Neviere R.
Institution
(Preau, Montaigne, Marechal, Neviere) Departement de Physiologie (EA
4484), Faculte de Medecine, Universite Lille, IFR 114 (IMPRT), Lille,
France
(Preau, Durocher, Saulnier) Reanimation Medicale, Hopital Calmette, CHRU
Lille, boulevard du Pr Leclercq, 59037 Lille Cedex, France
(Modine, Fayad, Koussa) Departement de Chirurgie Cardiovasculaire, Hopital
Cardiologique, CHRU Lille, boulevard du Pr Leclercq, 59037 Lille Cedex,
France
(Tardivel) BioImaging Center Lille, Faculte de Medecine, Universite Lille,
IFR 114 (IMPRT), Lille, France
Title
Macrophage migration inhibitory factor induces contractile and
mitochondria dysfunction by altering cytoskeleton network in the human
heart.
Source
Critical Care Medicine. 41 (7) (pp e125-e133), 2013. Date of Publication:
July 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVES:: Macrophage migration inhibitory factor (MIF) has been
recognized as a potent proinflammatory mediator that may induce myocardial
dysfunction. Mechanisms by which MIF affects cardiac function are not
completely elucidated; yet, some macrophage migration inhibitory effects
have been related to changes in cytoskeleton architecture. We hypothesized
that MIF-induced myocardial dysfunction and mitochondrial respiration
deficit could be related to cardiac cell microtubule dynamics alterations.
DESIGN:: Prospective, randomized study. SETTING:: Experimental
Cardiovascular Laboratory, University Hospital. SUBJECTS:: Human
myocardial (atrial) trabeculae. INTERVENTIONS:: Atrial trabeculae were
obtained at the time of cardiac surgery. Isometrically contracting
isolated human right atrial trabeculae were exposed to MIF (100 ng/mL) for
60 minutes, in the presence or not of pretreatment with colchicine (10
muM), a microtubule-depolymerizing agent, or paclitaxel (10 muM) a
microtubule-stabilizing agent. MEASUREMENTS AND MAIN RESULTS:: Maximal
active isometric tension curve and developed isometric force were studied.
Trabeculae were then permeabilized for mitochondrial respiration studies
using high-resolution oxygraphy. Heart fiber electron microscopy and
visualization of betaIV tubulin and polymerized actin by confocal
microscopy were used to evaluate sarcomere and microtubule disarray.
Compared with controls, MIF elicited cardiac contractile and mitochondrial
dysfunction, which were largely prevented by pretreatment with colchicine,
but not by paclitaxel. Pretreatment with colchicine prevented MIF-induced
microtubule network disorganization, excessive tubulin polymerization, and
mitochondrial fragmentation. Compound-C, an inhibitor of AMP-activated
protein kinase (AMPK), partially prevented contractile dysfunction,
suggesting that cardiac deleterious effects of MIF were related to AMPK
activation. CONCLUSIONS:: MIF depresses human myocardial contractile
function and impairs mitochondrial respiration. Changes in microtubule
network likely promote MIF-induced cardiac dysfunction by 1) altering with
mitochondrial tubular assembly and outer membrane permeability for adenine
nucleotides leading to energy deficit, 2) excessive tubulin polymerization
that may impede cardiomyocyte viscosity and motion, and 3) interfering
with AMPK pathway. Copyright 2013 by the Society of Critical Care
Medicine and Lippincott.

<18>
[Use Link to view the full text]
Accession Number
2013438970
Authors
Didsbury M. McGee R.G. Tong A. Craig J.C. Chapman J.R. Chadban S. Wong G.
Institution
(Didsbury, McGee, Tong, Craig, Wong) Sydney School of Public Health,
University of Sydney, Sydney, NSW 2006, Australia
(McGee, Tong, Craig, Wong) Centre for Kidney Research, Children's Hospital
at Westmead, Westmead, NSW, Australia
(Chapman, Wong) Centre for Transplant and Renal Research, Westmead
Hospital, Westmead, NSW, Australia
(Chadban) Central Clinical School, Faculty of Medicine, University of
Sydney, Sydney, NSW, Australia
Title
Exercise training in solid organ transplant recipients: A systematic
review and meta-analysis.
Source
Transplantation. 95 (5) (pp 679-687), 2013. Date of Publication: 15 Mar
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background. Exercise training is effective in improving the cardiovascular
risk profiles of nontransplanted patients, but the health benefits and
potential harms of routine exercise training after solid organ
transplantation are unclear. This study aims to assess the health benefits
and harms of supervised exercise training programs in solid organ
recipients. Methods. We systematically reviewed all randomized controlled
trials (RCTs) comparing the outcomes of exercise training programs in
solid organ recipients against standard care. MEDLINE, EMBASE, the
Transplant Library from the Centre for Evidence in Transplantation, and
the Cochrane Central Register of Controlled Trials were searched to June
2012. Results. In total, 15 eligible RCTs involving 643 patients (9
cardiac transplants [n=250 patients], 2 kidney transplants [n=164
patients], 3 lung transplants [n=110 patients], and 1 liver transplant
[n=119 patients]) were included. Cardiac transplant recipients who engaged
in an exercise program after transplantation showed significant
improvement in maximal oxygen uptake (standardized mean difference, 0.77;
95% confidence interval, 0.10Y1.45) but no improvement in the overall
serum lipid profile, blood pressure, and glycemic control compared with
standard care. Among other solid organ transplant recipients, no
significant improvements in exercise capacity or cardiovascular risk
factors such as incidence of new-onset diabetes after transplantation were
observed, but all effect estimates were very imprecise. Conclusions.
Exercise training is a promising but unproven intervention for improving
the cardiovascular outcomes of solid organ transplant recipients. Existing
trials are small, of relatively short duration, and focused on surrogate
outcomes. Large-scale RCTs are urgently required if resources are to be
directed toward exercise programs. Copyright 2013 by Lippincott Williams
& Wilkins.

<19>
Accession Number
2013350976
Authors
Yao D.-K. Chen H. Ma L.-L. Ma Z.-S. Wang L.-X.
Institution
(Yao, Chen) Department of Cardiology, Beijing Friendship Hospital, Capital
Medical University, Beijing, China
(Ma, Wang) Department of Cardiology, Liaocheng People's Hopsital,
Shandong, China
(Ma) Department of Cardiac Surgery, Liaocheng People's Hospital, Shandong,
China
(Ma, Ma, Wang) School of Biomedical Sciences, Centre for Inland Health,
Charles Sturt University, Wagga Wagga, NSW 2678, Australia
Title
Totally endoscopic atrial septal repair with or without robotic
assistance: A systematic review and meta-analysis of case series.
Source
Heart Lung and Circulation. 22 (6) (pp 433-440), 2013. Date of
Publication: June 2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Objective: To evaluate the safety and efficacy of totally endoscopic
repair of atrial septal defect (ASD). Methods: A review of the literature
was conducted. Studies were obtained from the following sources: MEDLINE,
EMBASE, Web of Science and CENTRAL Library. Inclusion criteria were: (1)
randomised controlled trials, non-randomised trials, observational
studies, case series, and full text conference proceedings; (2) use of
totally endoscopy closure of ASD; and (3) outcomes reported as clinical
efficacy. When available, we also quantified the complication rates from
each included study. Meta-analysis was performed on outcomes with a
random-effects model. Results: Six studies met all inclusion criteria. The
pooled average success rate of totally endoscopic ASD repair was 94.8%
from a total of 114 cases (95% CI, 88.0% to 97.8%), with a minimal
heterogeneity in the group of studies (Q value x²=1.807,
I²=0.000). In the studies with no robotic assistance, an
average success rate of totally endoscopic ASD repair was 96.9% (95% CI,
85.9-99.4%), with a minimal heterogeneity in the two studies (Q value
x²=0.683, I²=0.000). There were few complications
for totally endoscopic ASD repair in the studies with and without robotic
assistance. There were no statistically significant differences in success
rates between robotically and non-robotically assisted totally endoscopic
repairs (p>0.05). Conclusions: Totally endoscopic ASD repair was
associated with a high success rate and a low complication rate. There is
a need for prospective controlled clinical trials comparing totally
endoscopic and conventional surgical repair of ASD. 2013 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ).

<20>
Accession Number
71126298
Authors
Brims F.J.H. Maskell N.
Institution
(Brims) University College London, London, United Kingdom
(Maskell) University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom
Title
Ambulatory treatment for pneumothorax: A systematic review of the
literature and case for outpatient orientated care?.
Source
Thorax. Conference: British Thoracic Society Winter Meeting 2012 London
United Kingdom. Conference Start: 20121205 Conference End: 20121207.
Conference Publication: (var.pagings). 67 (pp A114), 2012. Date of
Publication: December 2012.
Publisher
BMJ Publishing Group
Abstract
Introduction Spontaneous pneumothorax (SP) is broken down into primary
(PSP: no known underlying lung disease), secondary (SSP: known lung
disease) and non-spontaneous from trauma or iatrogenic pneumothorax (IP).
PSP carries a very low mortality. Current recognised treatments include a
conservative approach, needle aspiration, intercostal chest tube (ICT) and
surgery. A Heimlich valve (HV) is a lightweight one-way valve specifically
designed for the ambulatory treatment of pneumothorax when used with an
intercostal catheter. This systematic review was designed to examine the
evidence for the use of HV in the management of adults with SP or IP.
Methods A systematic review was undertaken across nine electronic
databases for studies reporting the use of HV for SP or IP. Randomised
trials, case control studies and case series were included, unrestricted
by year of publication. Post-thoracic surgery and traumatic pneumothorax
reports were excluded. All publications were independently scored by two
reviewers (FB & NM). Measures of interest included: the use of a HV alone
to manage SP or IP, successful treatment as outpatient (OP), complications
and financial data. Results Eighteen studies were included reporting on
the use of HV in 1235 patients, comprising 992 SP (of which 413 were
reported as PSP) and 243 IP. The overall quality of the reports was low
with only 2 RCTs (n=80 patients), 1 consecutive case series and 14 case
reports. Table 1 presents a summary of the outcome measures. In some
reports it was not possible to distinguish outcomes between pneumothorax
type. There were highly variable protocols and treatment practise across
the studies. No deaths were reported, complications included four
haemothoraces and one chest wall haematoma. Three studies presented data
with cost analysis, with OP HV vs. inpatient ICT cost ratios ranging from
1:3 to 1:5. Conclusions High quality data to support the use of HV for
ambulatory treatment of pneumothorax is sparse. There are, however, data
on >1100 patients from case reports suggesting that the use of HV for SP
and IP is safe, effective and may facilitate outpatient orientated
treatment of pneumothorax. There is need for a carefully designed RCT to
examine this further. (Table presented).

<21>
Accession Number
71126058
Authors
Hooper C.E. Edey A.J. Wallis A.J. Clive A.O. Morley A.J. Darby M. Zahan N.
Harvey J.E. Medford A.R. Maskell N.A.
Institution
(Hooper, Edey, Wallis, Morley, Darby, Zahan, Harvey, Medford) North
Bristol NHS Trust, Bristol, United Kingdom
(Clive, Maskell) University of Bristol, Bristol, United Kingdom
Title
Pleural irrigation trial (PIT): Standard care versus pleural irrigation, a
randomised controlled trial in patients with pleural infection.
Source
Thorax. Conference: British Thoracic Society Winter Meeting 2012 London
United Kingdom. Conference Start: 20121205 Conference End: 20121207.
Conference Publication: (var.pagings). 67 (pp A11), 2012. Date of
Publication: December 2012.
Publisher
BMJ Publishing Group
Abstract
Background Pleural infection remains common with an increasing incidence.
It is associated with a high morbidity and mortality. Despite chest tube
drainage and antibiotic therapy up to 30% of patients will die or require
surgery. Case reports suggest that irrigation of the pleural space with
saline may be beneficial but this has never been the tested in the form of
a randomised controlled trial. Method Randomised controlled pilot study
comparing saline irrigation (250ml normal saline intra-pleurally over one
hour, 3 times a day for 3 days) plus best standard care, with best
standard care alone, in patients with pleural infection (microbiology
positive or pH<7.2 or purulent pleural fluid and clinical infection)
requiring chest tube drainage, who had a residual pleural collection on
baseline CT thorax. Primary outcome was percentage change in CT pleural
volume from day 0 to day 3. Secondary outcomes included referral for
surgery, hospital stay and adverse events. Results 47 patients approached,
38 randomised, 3 excluded (drain fell out/no residual fluid on CT/removal
of consent). Saline irrigation results in significant reduction in CT
pleural collection volume compared to standard care - Irrigation group
29.15% reduction (95% CI 16.2-62) vs Standard care 13.9% (95% CI
-4.1-26.3) p<0.04. There was also a significant reduction in the need for
thoracic surgery in the irrigation group 9/17 vs 2/18 p=0.01 (OR 9.0, 95%
CI 1.56-51.9). No differences were seen in length of hospital stay or fall
in inflammatory markers (CPR, WCC and procalcitinin). The safety profile
of saline irrigation was good with no serious complications and adverse
events did not differ between groups. Conclusion Saline irrigation
improves fluid drainage in pleural infection (as measured by volumetric
CT), leading to reduction in referral for surgery. No change in hospital
stay was noted. This study now needs to be repeated as a large multicentre
RCT powered to look at mortality and length of hospital stay.