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Accession Number
2013606060
Authors
Rushani D. Kaufman J.S. Ionescu-Ittu R. Mackie A.S. Pilote L. Therrien J.
Marelli A.J.
Institution
(Rushani, Kaufman, Ionescu-Ittu, Pilote, Marelli) Department of
Epidemiology, Biostatistics and Occupational Health, McGill University,
Montreal, Canada
(Mackie) Division of Cardiology, Stollery Children's Hospital, Edmonton,
Canada
(Pilote) Division of General Internal Medicine, McGill University Health
Center, Montreal, Canada
(Therrien, Marelli) McGill Adult Unit for Congenital Heart Disease, McGill
University Health Center, Department of Medicine, 687 Pine Ave W, H-433,
Montreal, QC H3A 1A1, Canada
Title
Infective endocarditis in children with congenital heart disease:
Cumulative incidence and predictors.
Source
Circulation. 128 (13) (pp 1412-1419), 2013. Date of Publication: 24 Sep
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background - : The American Heart Association guidelines for prevention of
infective endocarditis (IE) in 2007 reduced the groups of congenital heart
disease (CHD) patients for whom antibiotic prophylaxis was indicated. The
evidence base in CHD patients is limited. We sought to determine the risk
of IE in children with CHD. METHODS AND RESULTS - : We performed a
population-based analysis to determine the cumulative incidence and
predictors of IE in children (0-18 years) with CHD by the use of the
Quebec CHD Database from 1988 to 2010. In 47 518 children with CHD
followed for 458 109 patient-years, 185 cases of IE were observed.
Cumulative incidence of IE was estimated in the subset of 34 279 children
with CHD followed since birth, in whom the risk of IE up to 18 years of
age was 6.1/1000 children (95% confidence interval, 5.0-7.5). In a nested
case-control analysis, the following CHD lesions were at highest risk of
IE in comparison with atrial septal defects (adjusted rate ratio, 95%
confidence interval): cyanotic CHD (6.44, 3.95-10.50), endocardial cushion
defects (5.47, 2.89-10.36), and left-sided lesions (1.88, 1.01-3.49).
Cardiac surgery within 6 months (5.34, 2.49-11.43) and an age of <3 years
(3.53, 2.51-4.96; reference, ages 6-18) also conferred an elevated risk of
IE. CONCLUSIONS - : In a large population-based cohort of children with
CHD, we documented the cumulative incidence of IE and associated factors.
These findings help identify groups of patients who are at the highest
risk of developing IE. 2013 American Heart Association, Inc.

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Accession Number
2013565458
Authors
Montalescot G. Bolognese L. Dudek D. Goldstein P. Hamm C. Tanguay J.-F.
Ten Berg J.M. Miller D.L. Costigan T.M. Goedicke J. Silvain J. Angioli P.
Legutko J. Niethammer M. Motovska Z. Jakubowski J.A. Cayla G. Visconti
L.O. Vicaut E. Widimsky P.
Institution
(Montalescot, Silvain) ACTION Study Group, Institut de Cardiologie, Centre
Hospitalier Universitaire Pitie-Salpetriere, 47 Blvd. de l'Hopital, 75013
Paris, France
(Vicaut) Methodology and Statistical Unit, Centre Hospitalier
Universitaire Lariboisiere (ACTION Group, AP-HP, Universite Paris 7),
Paris, France
(Goldstein) Service d'Aide Medicale d'Urgence and Emergency Department,
Lille University Hospital, Lille, France
(Cayla) Service de Cardiologie, Centre Hospitalier Universitaire Nimes
(ACTION Group, Universite Montpellier 1), Montpellier, France
(Bolognese, Angioli) Cardiovascular and Neurological Department, Azienda
Ospedaliera Arezzo, Arezzo, Italy
(Visconti) Division of Cardiology, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
University Hospital, Krakow, Poland
(Legutko) Jagiellonian University Hospital Krakow, Krakow, Poland
(Hamm) Kerckhoff Heart and Thoraxcenter, Bad Nauheim and Medical Clinic I,
University of Giessen, Giessen, Germany
(Goedicke) Eli Lilly Deutschland, Bad Homburg, Germany
(Niethammer) Medizinische Klinik, Universitatsmedizin der Johannes
Gutenberg-Universitat, Mainz, Germany
(Tanguay) Montreal Heart Institute, Montreal, QC, Canada
(Ten Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Miller, Costigan, Jakubowski) Eli Lilly, Indianapolis, IN, United States
(Motovska, Widimsky) Third Medical Faculty of Charles University,
University Hospital Royal Vineyards, Prague, Czech Republic
Title
Pretreatment with prasugrel in non-ST-segment elevation acute coronary
syndromes.
Source
New England Journal of Medicine. 369 (11) (pp 999-1010), 2013. Date of
Publication: 2013.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Although P2Y₁₂ antagonists are effective in
patients with non-ST-segment elevation (NSTE) acute coronary syndromes,
the effect of the timing of administration - before or after coronary
angiography - is not known. We evaluated the effect of administering the
P2Y₁₂ antagonist prasugrel at the time of diagnosis versus
administering it after the coronary angiography if percutaneous coronary
intervention (PCI) was indicated. METHODS: We enrolled 4033 patients with
NSTE acute coronary syndromes and a positive troponin level who were
scheduled to undergo coronary angiography within 2 to 48 hours after
randomization. Patients were randomly assigned to receive prasugrel (a
30-mg loading dose) before the angiography (pretreatment group) or placebo
(control group). When PCI was indicated, an additional 30 mg of prasugrel
was given in the pretreatment group at the time of PCI and 60 mg of
prasugrel was given in the control group. RESULTS: The rate of the primary
efficacy end point, a composite of death from cardiovascular causes,
myocardial infarction, stroke, urgent revascularization, or glycoprotein
IIb/IIIa inhibitor rescue therapy (glycoprotein IIb/IIIa bailout) through
day 7, did not differ significantly between the two groups (hazard ratio
with pretreatment, 1.02; 95% confidence interval [CI], 0.84 to 1.25; P =
0.81). The rate of the key safety end point of all Thrombolysis in
Myocardial Infarction (TIMI) major bleeding episodes, whether related or
not related to coronary-artery bypass grafting (CABG), through day 7 was
increased with pretreatment (hazard ratio, 1.90; 95% CI, 1.19 to 3.02; P =
0.006). The rates of TIMI major bleeding and life-threatening bleeding not
related to CABG were increased by a factor of 3 and 6, respectively.
Pretreatment did not reduce the rate of the primary outcome among patients
undergoing PCI (69% of the patients) but increased the rate of TIMI major
bleeding at 7 days. All the results were confirmed at 30 days and in
prespecified subgroups. CONCLUSIONS: Among patients with NSTE acute
coronary syndromes who were scheduled to undergo catheterization,
pretreatment with prasugrel did not reduce the rate of major ischemic
events up to 30 days but increased the rate of major bleeding
complications. Copyright 2013 Massachusetts Medical Society.

<3>
Accession Number
2013577406
Authors
Guillon A. Espitalier F. Ehrmann S. Masseret E. Laffon M.
Institution
(Guillon, Ehrmann, Masseret) Service de reanimation medicale, Universite
F.-Rabelais, CHRU de Tours, 2, boulevard Tonnelle, 37044 Tours, France
(Espitalier, Laffon) Departement d'anesthesie-reanimation, Universite
F.-Rabelais, CHRU de Tours, 37000 Tours, France
Title
Influence of pressure- and volume-controlled ventilation on pulse pressure
variations: Randomized study.
Source
Annales Francaises d'Anesthesie et de Reanimation. 32 (9) (pp 548-553),
2013. Date of Publication: September 2013.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Objective: Pulse pressure variation (PP) has been demonstrated to be an
accurate dynamic parameter to predict fluid responsiveness. However, the
impact of different ventilator modes on this parameter is unknown. We
compared PP values calculated alternatively during pressure- and
volume-controlled ventilation. Study design: Double-blind randomized
study, cross-over design. Patients: Patients in intensive care unit after
a cardiac surgery. Method: Patients were ventilated alternatively in both
ventilator modes (according to the randomization): volume-controlled
ventilation (VVC) and pressure-controlled ventilation (VPC). Other
parameters of ventilation were identical. PP values were calculated for
each patient in both ventilator modes. Results: Among the 26patients
analyzed, mean PP value was de 14.0. +/-. 7.3% in VVC and 11.8. +/-. 6.2%
in VPC ( P<. 0,0001). On Bland-Altman representation, mean bias was +2.2.
+/-. 2.3% and inferior and superior limits of agreement were respectively
-2.3 and 6.7%. Arterial blood pressure and central venous pressure were
not modified. Conclusion: PP values obtained with both ventilator modes
were not interchangeable. On average, PP decreases by more than two points
in the passage VVC to VPC for a given patient, all others things being
equal. 2013 Societe francaise d'anesthesie et de reanimation (Sfar).

<4>
Accession Number
2013570605
Authors
Carrasco-Chinchilla F. Munoz-Garcia A.J. Dominguez-Franco A.
Millan-Vazquez G. Guerrero-Molina A. Ortiz-Garcia C. Enguix-Armada A.
Alonso-Briales J.H. Hernandez-Garcia J.M. De Teresa-Galvan E.
Jimenez-Navarro M.F.
Institution
(Carrasco-Chinchilla, Munoz-Garcia, Dominguez-Franco, Millan-Vazquez,
Guerrero-Molina, Ortiz-Garcia, Enguix-Armada, Alonso-Briales,
Hernandez-Garcia, De Teresa-Galvan, Jimenez-Navarro) Area Del Corazon Del
Hospital Clinico Universitario Virgen de la Victoria, Fundacion IMABIS,
RECAVA, Malaga, Spain
(De Teresa-Galvan, Jimenez-Navarro) Facultad de Medicina, Universidad de
Malaga, Campus Universitario Teatinos S/n, Malaga 29010, Spain
Title
Remote ischaemic postconditioning: Does it protect against ischaemic
damage in percutaneous coronary revascularisation? Randomised
placebo-controlled clinical trial.
Source
Heart. 99 (19) (pp 1431-1437), 2013. Date of Publication: Octoberber 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective Determine whether remote ischaemic postconditioning (RIP)
protects against percutaneous coronary intervention-related myocardial
infarction (PCI-MI). Design Single-centre, randomised, blinded to the
researchers, clinical trial. ClinicalTrials.gov (NCT 01113008). Setting
Tertiary hospital centre. Patients 232 patients underwent elective PCI for
stable or unstable angina. Interventions Patients were randomised to RIP
(induction of three 5-min cycles of ischaemia in the arm after the PCI)
versus placebo. Main outcome measures The primary outcome measure was the
peak 24-h troponin I level. PCI-MI was defined by an elevation of troponin
values >3 or >5 of the 99th percentile according to the classical or the
new definition. The secondary outcome measure was hospital admission, PCI
for stable angina or acute coronary syndrome and mortality after 1 year of
follow-up. The use of RIP in diabetic patients was specifically studied.
Results The mean age was 64.6 years, and 42% were diabetic. The peak
troponin in the RIP patients was 0.476 vs 0.478 ng/mL ( p=0.99). PCI-MI
occurred in 36% of the RIP patients versus 30.8% in the placebo group (
p=0.378). Diabetic RIP patients had more PCI-MI (new definition): OR 2.7;
95% CI 1.10 to 6.92; p=0.027. The secondary outcome measure was seen in
11.7% of the RIP patients versus 10.8% in the placebo group ( p=0.907).
Conclusions RIP did not reduce the damage associated with elective PCI or
cardiovascular events during the follow-up. The diabetic population who
underwent RIP had more PCI-MI.

<5>
Accession Number
2013568594
Authors
Pagnotta P. Briguori C. Ferrante G. Visconti G. Focaccio A. Belli G.
Presbitero P.
Institution
(Pagnotta, Ferrante, Belli, Presbitero) Laboratory of Interventional
Cardiology, Department of Cardiology, IRCCS Humanitas, Milan, Italy
(Briguori, Visconti, Focaccio) Laboratory of Interventional Cardiology,
Department of Cardiology, Clinica Mediterranea, Via Orazio 2, 80121
Naples, Italy
Title
Tornus catheter and rotational atherectomy in resistant chronic total
occlusions.
Source
International Journal of Cardiology. 167 (6) (pp 2653-2656), 2013. Date of
Publication: 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Although the inability to cross the chronic total occlusion
(CTO) with a guidewire is the most common reason for failure, one of the
most frustrating situations that may occur during a recanalization
procedure is when a guidewire crosses successfully but it is impossible to
advance any device over the wire through the occluded segment. We assessed
the application of the Tornus catheter and/or rotational atherectomy to
improve the success rate of percutaneous recanalization of CTO. Methods:
From October 2009 to May 2011, 55 consecutive patients with CTO resistant
to recanalization by conventional techniques were treated by the following
step-by-step approach: 1) Tornus catheter and 2) eventual high speed
rotational atherectomy. Results: Twenty-four lesions were successfully
crossed by the Tornus catheter (43.5%). Rotational atherectomy was used in
31 patients (one with Tornus success and 30 with Tornus failure). A final
angiographic success was obtained in 50/55 patients (91%) whereas in 5
patients both bail-out strategies failed (9%). As compared to the 24 CTO
successfully treated by the Tornus catheter (Tornus-success group), the 31
patients in the Tornus-failure group were treated more often with the 2.1
F Tornus catheter and had more severely calcified lesions. By
multivariable regression analysis the single independent predictor of
Tornus failure was the presence of severely calcified lesions.
Conclusions: The Tornus catheter is a safe and effective device allowing
us to overcome the inability to cross a CTO with a balloon catheter in
approximately 45% of cases. In severely calcified CTO rotational
atherectomy should be performed first. 2012 Elsevier Ireland Ltd.

<6>
Accession Number
2013568621
Authors
Planer D. Witzenbichler B. Guagliumi G. Peruga J.Z. Brodie B.R. Xu K. Fahy
M. Mehran R. Stone G.W.
Institution
(Planer, Xu, Fahy, Stone) Columbia University Medical Center,
Cardiovascular Research Foundation, 111 E. 59th St., New York, NY 10022,
United States
(Planer) Hadassah - Hebrew University Medical Center, Jerusalem, Israel
(Witzenbichler) Charite Campus Benjamin Franklin, Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Peruga) Medical University, Lodz, Poland
(Brodie) LeBauer Cardiovascular Research Foundation, Moses Cone Hospital,
Greensboro NC, United States
(Mehran) Mount Sinai Medical Center, Cardiovascular Research Foundation,
New York NY, United States
Title
Impact of hyperglycemia in patients with ST-segment elevation myocardial
infarction undergoing percutaneous coronary intervention: The HORIZONS-AMI
trial.
Source
International Journal of Cardiology. 167 (6) (pp 2572-2579), 2013. Date of
Publication: 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Few studies have examined the association between
hyperglycemia and adverse outcomes in patients with ST-segment elevation
myocardial infarction (STEMI) treated with primary percutaneous coronary
intervention (PCI). We therefore evaluated the prognostic utility of
admission hyperglycemia in the HORIZONS-AMI trial. Methods and results:
Admission glucose levels were available in 3405 of 3602 (94.5%) enrolled
patients, of which 566 patients (16.6%) were known to have diabetes.
Outcomes were assessed at 30 days and 3 years, stratified by baseline
glucose level and diabetes status. Median [IQR] admission glucose level in
the entire study cohort was 138.0 [115.4, 171.0] mg/dl. Multivariable
adjusted 30-day mortality was significantly increased in all patients with
admission glucose in the highest glucose tertile vs. The lower two-thirds
(HR [95%CI] = 3.53 [1.89, 6.60], p < 0.0001); in patients with diabetes
(4.40 [2.04, 9.50], p = 0.0002); and in patients without diabetes (3.33
[1.16, 9.55], p = 0.03). By ROC analysis, the best cut-off values for
30-day mortality were 169 mg/dl for all patients (AUC = 0.76), 149 mg/dl
for patients without diabetes (AUC = 0.77), and 231 mg/dl for patients
with diabetes (AUC = 0.69). Baseline hyperglycemia was also an independent
predictor of 3-year mortality in all patients (HR [95%CI] = 1.93 [1.35,
2.76], P = 0.0003), patients with diabetes (2.65 [1.28, 5.47], P = 0.008),
and patients without diabetes (1.58 [1.05, 2.36], P = 0.03). Conclusions:
In patients with STEMI undergoing primary PCI, admission hyperglycemia is
an independent predictor of early and late mortality in both patients with
and without known diabetes. 2012 Elsevier Ireland Ltd.

<7>
Accession Number
2013599180
Authors
Argulian E. Messerli F.
Institution
(Argulian, Messerli) Department of Medicine, St. Luke's-Roosevelt Hospital
Center, Columbia University College of Physicians and Surgeons, 1111
Amsterdam Avenue, New York, NY 10025, United States
Title
Misconceptions and facts about pericardial effusion and tamponade.
Source
American Journal of Medicine. 126 (10) (pp 858-861), 2013. Date of
Publication: October 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Several common misconceptions can make the clinical diagnosis of subacute
pericardial tamponade challenging. Widely known physical findings of
pericardial tamponade lack sensitivity and specificity. Interpretation of
echocardiographic signs requires good understanding of pathophysiology.
Over-reliance on echocardiography may result in over-utilization of
pericardial drainage procedures. Awareness of these misconceptions with an
integrative approach to both clinical and imaging data will help
clinicians to assess the hemodynamic impact of pericardial effusion and
the need for drainage.

<8>
Accession Number
2013562252
Authors
Guerrero Orriach J.L. Galan Ortega M. Ramirez Aliaga M. Iglesias P. Rubio
Navarro M. Cruz Manas J.
Institution
(Guerrero Orriach, Galan Ortega, Ramirez Aliaga, Iglesias, Rubio Navarro,
Cruz Manas) Department of Anaesthesia, Hospital Virgen de la Victoria,
Malaga, Spain
Title
Prolonged sevoflurane administration in the off-pump coronary artery
bypass graft surgery: Beneficial effects.
Source
Journal of Critical Care. 28 (5) (pp 879.e13-879.e18), 2013. Date of
Publication: October 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Purpose: The benefits of intraoperative administration of halogenated
agents in patients undergoing cardiac surgery have been shown by numerous
studies. The mechanisms of preconditioning and postconditioning appear to
be the cause of these benefits. The possibility of maintaining the early
postoperative sedation with halogenated agents, after its intraoperative
administration, can increase their benefits. Patients and methods: This is
a prospective trial with 60 patients undergoing coronary artery bypass
graft surgery divided into 3 groups according to the administration of
hypnotic drugs in the intraoperative and postoperative periods
(sevoflurane, sevoflurane: SS, sevoflurane-propofol: SP,
propofol-propofol: PP). For the first 48 hours, hemodynamic parameters,
the need for inotropic drugs, N-terminal pro-brain natriuretic peptide,
and troponin I plasmatic concentrations were obtained. Results: There were
significant differences between group SS and the other 2 groups in the
levels of N-terminal pro-brain natriuretic peptide (SS [501 +/- 280 pg/mL]
compared with SP [1270 +/- 498 pg/mL] and PP [1775 +/- 527 pg/mL] [. P <
.05]) and troponin I (SS [0.5 +/- 0.4 ng/mL] compared with SP [1.61 +/-
1.30 ng/mL] and PP [2.27 +/- 1.5 ng/mL] [. P < .05]) and a lower number of
inotropic drugs. Conclusion: Sevoflurane administration in patients
undergoing off-pump coronary artery bypass graft, in the operating room
and the intensive care unit, decreases myocardial injury markers compared
with patients who only received sevoflurane in the intraoperative period,
but both were a better option to decrease levels of myocardial markers
when compared with the propofol group. 2013 Elsevier Inc.

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Accession Number
2013596439
Authors
Kitsios G.D. Thaler D.E. Kent D.M.
Institution
(Kitsios, Kent) Institute for Clinical Research and Health Policy Studies,
Tufts Medical Center, Box 63, 800 Washington St, Boston, MA 02111, United
States
(Thaler, Kent) Department of Neurology, Tufts Medical Center, Boston, MA,
United States
(Kitsios) Department of Internal Medicine, Lahey Hospital and Medical
Center, Burlington, MA, United States
Title
Potentially large yet uncertain benefits: A meta-analysis of patent
foramen ovale closure trials.
Source
Stroke. 44 (9) (pp 2640-2643), 2013. Date of Publication: September 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)

<10>
Accession Number
2013599430
Authors
Atalan N. Efe Sevim M. Akgun S. Fazliogullari O. Basaran C.
Institution
(Atalan) Department of Anesthesiology and Intensive Care, Medicana
Hospitals Bahcelievler, Istanbul, Turkey
(Efe Sevim) Department of Psychiatry, Bakirkoy Mental Hospital, Istanbul,
Turkey
(Akgun, Fazliogullari, Basaran) Department of Cardivascular Surgery,
Medicana Hospitals Bahcelievler, Istanbul, Turkey
Title
Morphine is a reasonable alternative to haloperidol in the treatment of
postoperative hyperactive-type delirium after cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (5) (pp 933-938),
2013. Date of Publication: October 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: Patients who undergo cardiac surgery have an increased risk of
delirium. Currently, there are few choices of treatment for postoperative
hyperactive delirium in cardiac surgical patients. The aim of this study
was to assess the effect of morphine compared with a haloperidol-based
regimen in hyperactive-type delirium in patients after cardiac surgery.
Design: A prospective, randomized clinical study. Setting: A single
community hospital. Participants: Fifty-three consecutive, adult,
delirious patients. Interventions: Patients were randomized into 2 groups;
in group 1, patients received 5 mg of haloperidol intramuscularly and in
group 2, patients received 5 mg of morphine sulfate intramuscularly to
control delirium symptoms. Measurements and Main Results: During the
second and third hour of the morphine treatment, statistically low
Richmond Agitation and Sedation Scale scores were found and the target
Richmond Agitation and Sedation Scale scores percentages were
statistically higher than those of the haloperidol group (p = 0.042 and p
= 0.028, respectively). The number of patients requiring additive
sedatives was significantly more in the haloperidol group when compared
with the morphine group (p = 0.011). Conclusion: During the treatment of
patients, it was determined that the patients who were receiving morphine
treatment responded more quickly compared with the patients receiving
haloperidol treatment. Morphine was found to be a reasonable alternative
to haloperidol in the treatment of postoperative hyperactive delirious
patients after cardiac surgery. 2013 Elsevier Inc. All rights reserved.

<11>
Accession Number
2013599432
Authors
Anastasiadis K. Asteriou C. Antonitsis P. Argiriadou H. Grosomanidis V.
Kyparissa M. Deliopoulos A. Konstantinou D. Tossios P.
Institution
(Anastasiadis, Asteriou, Antonitsis, Argiriadou, Grosomanidis, Kyparissa,
Deliopoulos, Konstantinou, Tossios) Cardiothoracic Department, AHEPA
University Hospital, Sakellaridi 25, 542 48, Thessaloniki, Greece
Title
Enhanced recovery after elective coronary revascularization surgery with
minimal versus conventional extracorporeal circulation: A prospective
randomized study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (5) (pp 859-864),
2013. Date of Publication: October 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: A minimal extracorporeal circulation (MECC) circuit integrates
the advances in cardiopulmonary bypass (CPB) technology into a single
circuit and is associated with improved short-term outcome. The aim of
this study was to prospectively evaluate MECC compared with conventional
CPB in facilitating fast-track recovery after elective coronary
revascularization procedures. Design: Prospective randomized study.
Setting: All patients scheduled for elective coronary artery surgery were
evaluated, excluding those considered particularly high risk for
fast-track failure. The fast-track protocol included careful preoperative
patient selection, a fast-track anesthetic technique based on minimal
administration of fentanyl, surgery at normothermia, early postoperative
extubation in the cardiac recovery unit, and admission to the
cardiothoracic ward within the first 24 hours postoperatively.
Participants: One hundred twenty patients were assigned randomly into 2
groups (60 in each group). Interventions: Group A included patients who
were operated on using the MECC circuit, whereas patients in Group B
underwent surgery on conventional CPB. Measurements and Main Results:
Incidence of fast-track recovery was significantly higher in patients
undergoing MECC (25% v 6.7%, p = 0.006). MECC also was recognized as a
strong independent predictor of early recovery, with an odds ratio of 3.8
(p = 0.011). Duration of mechanical ventilation and cardiac recovery unit
stay were significantly lower in patients undergoing MECC together with
the need for blood transfusion, duration of inotropic support, need for an
intra-aortic balloon pump, and development of postoperative atrial
fibrillation and renal failure. Conclusions: MECC promotes successful
early recovery after elective coronary revascularization procedures, even
in a nondedicated cardiac intensive care unit setting. 2013 Elsevier Inc.
All rights reserved.

<12>
Accession Number
2013599434
Authors
Zhou G. Feng Z. Xiong H. Duan W. Jin Z.
Institution
(Zhou, Duan, Jin) Department of Cardiovascular Surgery, Xijing Hospital,
127 Changle West RD, Xi'an 710032, China
(Zhou, Feng) Department of Cardiac Surgery, Affiliated Bayi Children's
Hospital, General Hospital of Beijing Military Region, Beijing, China
(Xiong) Department of Cardiovascular Surgery, Central Hospital of xi'An,
Xi'an, China
Title
A combined ultrafiltration strategy during pediatric cardiac surgery: A
prospective, randomized, controlled study with clinical outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (5) (pp 897-902),
2013. Date of Publication: October 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To investigate the clinical effects of a combined
ultrafiltration strategy on the surgical treatment of pediatric patients
with congenital heart diseases. Design: A prospective, randomized,
controlled study. Setting: A single-institution study in an affiliated
hospital of a university. Participants: Sixty-five pediatric patients who
underwent open heart surgery with cardiopulmonary bypass (CPB) to treat
congenital heart disease were enrolled. The participants were randomized
into 2 groups: conventional + modified ultrafiltration (MUF) (CM) group
and prime + zero-balanced + MUF (PZM) group. Interventions: In the CM
group (n = 33), conventional ultrafiltration was performed after removal
of the aortic clamp, and MUF was performed after the completion of CPB. In
the PZM group (n = 32), ultrafiltration was performed for the circuit
prime solution, zero-balance ultrafiltration was performed after removal
of the aortic clamp, and MUF was performed after the completion of CPB.
Measurements and Main Results: The blood gas parameters and tumor necrosis
factor alpha content in the priming solution and perioperative blood
samples were analyzed. Postoperative parameters, including mechanical
ventilation time, respiratory indices, intensive care unit time, and
hospital time, also were recorded. One hospital death occurred in each
group. No severe complications occurred in either group. The lactic acid,
glucose, and tumor necrosis factor alpha contents in the priming solution
and perioperative blood samples were significantly lower in the PZM group
compared with the CM group. The respiratory indices were statistically
significantly better in the PZM group compared with the CM group in the
early postoperative period. No significant differences were found between
the 2 groups regarding the postoperative ventilation time, inotropic
support, homologous blood transfusion, drainage, intensive care unit time,
or postoperative hospital time. Conclusion: The combined use of
ultrafiltration of prime solution, zero-balance ultrafiltration, and MUF
strategy is associated with a modest improvement in pulmonary function
compared with the combination of conventional and MUF strategies in the
early postoperative period, but the principal clinical outcomes are
similar. 2013 Elsevier Inc. All rights reserved.

<13>
Accession Number
2013599436
Authors
Neto C.N. Arnoni R. Rida B.S. Landoni G. Tardelli M.A.
Institution
(Neto, Arnoni, Rida) Dante Pazzanese Institute OfCardiology, Federal
University of Sao Paulo (UNIFESP), Rua Martinianode Carvalho, No 864-6a
andar, Cj. 603/604-Bela-Vista, Sao Paulo-SP, Brazil
(Landoni) Anesthesia and Intensive Care Department, San Raffaele
Scientific Institute, Italy
(Landoni) Maieutics Foundation, Milan, Italy
(Tardelli) Anesthesia and Intensive Care Department, Federal University of
Sao Paulo, Brazil
Title
Randomized trial on the effect of sevoflurane on polypropylene membrane
oxygenator performance.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (5) (pp 903-907),
2013. Date of Publication: October 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: Volatile anesthetics have cardioprotective properties that
improve clinically relevant outcomes in cardiac surgery, and can be used
during cardiopulmonary bypass (CPB) through adapted calibrated vaporizers
together with air and oxygen (O₂). The effect of volatile
agents on the membrane oxygenator is unknown. The aim of this study was to
evaluate, for the first time, the performance of semiporous polypropylene
membrane oxygenators after the use of sevoflurane vaporized during CPB in
cardiac surgery. Design: A prospective, randomized, controlled trial.
Setting: Teaching hospital. Participants: Thirty-two consecutive patients
scheduled to undergo coronary artery bypass graft with CPB. Interventions:
Patients were allocated randomly to receive either a volatile anesthetic
(sevoflurane 1%-3%, 16 patients) or an intravenous hypnotic (midazolam, 16
patients) during CPB. After surgery, the membrane oxygenators used during
CPB were tested with regard to O₂ transfer, carbon dioxide
transfer, and pressure drop. Measurements and Main Results: The authors
observed no protocol deviation or crossover. The performance of the
membrane oxygenator was similar between the 2 groups, as documented by
O₂ transfer (55+/-6.4 mL/min/L in the sevoflurane group versus
57+/-4.7 mL/min/L in the midazolam group, p = 0.4), carbon dioxide
transfer, and pressure drop. Conclusions: The use of sevoflurane during
CPB in cardiac surgery does not affect membrane oxygenator performance.
2013 Elsevier Inc. All rights reserved.

<14>
Accession Number
2013599442
Authors
Pagel P.S.
Institution
(Pagel) Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical
Center, 5000 W. National Avenue, Milwaukee, WI 53295, United States
Title
Myocardial protection by volatile anesthetics in patients undergoing
cardiac surgery: A critical review of the laboratory and clinical
evidence.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (5) (pp 972-982),
2013. Date of Publication: October 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)

<15>
Accession Number
2013599427
Authors
Fechner J. Ihmsen H. Schuttler J. Jeleazcov C.
Institution
(Fechner, Ihmsen, Schuttler, Jeleazcov) Department of Anesthesiology,
University of Erlangen-Nuremberg, Krankenhaus-strasse 12, 91054 Erlangen,
Germany
Title
A randomized open-label phase i pilot study of the safety and efficacy of
total intravenous anesthesia with fospropofol for coronary artery bypass
graft surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (5) (pp 908-915),
2013. Date of Publication: October 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To determine safety and efficacy of the water-soluble prodrug
fospropofol for anesthesia in cardiac surgery and to compare the
pharmacodynamic profiles of fospropofol and propofol. Design: Pilot study
and a prospective, phase I, open-label, single-center, randomized clinical
trial. Setting: University hospital; single institution. Participants:
Sixteen patients undergoing elective first-time coronary artery bypass
surgery. Interventions: Patients were randomized to receive total
intravenous anesthesia with fospropofol (n = 8) or propofol (n = 8)
combined with alfentanil as total intravenous anesthesia. Bispectral
index, arterial blood pressure, and heart rate were recorded continuously,
and pulmonary artery catheter measurements were obtained. Plasma
concentrations of formate, phosphate, and Ca²⁺ were monitored
closely. Safety and tolerability were assessed by adverse events,
neurologic examinations, clinical laboratory tests, and vital signs.
Measurements and Main Results: The total doses of fospropofol and propofol
during anesthesia were 11.3+/-2.5 and 4.4+/-1.0 mg/kg/h, respectively.
According to the achieved bispectral index (BIS) values, fospropofol was
as effective as propofol in providing general anesthesia and sedation.
There were no clinical signs of formate toxicity in the fospropofol group.
The only treatment-related adverse event after administration of
fospropofol was a transient burning sensation in the perineal and perianal
region during induction of sedation or anesthesia. Conclusions:
Fospropofol could be used to provide general anesthesia in patients
undergoing coronary artery bypass graft surgery. Further larger studies
are needed to prove the safety of fospropofol when given to provide
general anesthesia for major cardiac surgical procedures. 2013 Elsevier
Inc. All rights reserved.

<16>
[Use Link to view the full text]
Accession Number
2013598155
Authors
Pokushalov E. Romanov A. De Melis M. Artyomenko S. Baranova V. Losik D.
Bairamova S. Karaskov A. Mittal S. Steinberg J.S.
Institution
(Pokushalov, Romanov, Artyomenko, Baranova, Losik, Bairamova, Karaskov)
State Research Institute of Circulation Pathology, Rechkunovskaya 15,
630055 Novosibirsk 55, Russian Federation
(De Melis) Medtronic Bakken Research Center, Maastricht, Netherlands
(Mittal, Steinberg) Valley Health System, Columbia University College of
Physicians and Surgeons, New York, NY, United States
Title
Progression of atrial fibrillation after a failed initial ablation
procedure in patients with paroxysmal atrial fibrillation: A randomized
comparison of drug therapy versus reablation.
Source
Circulation: Arrhythmia and Electrophysiology. 6 (4) (pp 754-760), 2013.
Date of Publication: August 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-The aim of this prospective randomized study was to assess
whether an early reablation was superior to antiarrhythmic drug (AAD)
therapy in patients with previous failed pulmonary vein isolation. Methods
and Results-Patients with paroxysmal atrial fibrillation (AF) eligible for
AAD therapy or reablation after a previously failed initial pulmonary vein
isolation procedure were eligible for this study and were followed up for
3 years to assess rhythm by means of an implanted cardiac monitor. After
the blanking period postablation, 154 patients had symptomatic AF
recurrences and were randomized to AAD (n=77) or repulmonary vein
isolation (n=77). At the end of follow-up, 61 (79%) patients in the AAD
group and 19 (25%) patients in the reablation group demonstrated AF%
progression (P<0.01). The AF% at 36 months was significantly greater in
the AAD group compared with patients in the reablation group (18.8+/-11.4%
versus 5.6+/-9.5%, respectively; P<0.01). In addition, 18 (23%) patients
in the AAD group and 3 (4%) patients in the reablation group progressed to
persistent AF (P<0.01). Furthermore, 45 (58%) of the 77 reablation group
patients were free of AF/atrial tachycardia on no AADs; in contrast, in
the AAD group, only 9 (12%) of the 77 patients were free of AF/atrial
tachycardia (P<0.01) throughout follow-up. Conclusions-Redo AF ablation
was substantially more effective than AAD in reducing the progression and
prevalence of AF after the failure of an initial ablation. 2013 American
Heart Association, Inc.

<17>
[Use Link to view the full text]
Accession Number
2013596678
Authors
Arnold S.V. Spertus J.A. Lei Y. Green P. Kirtane A.J. Kapadia S. Thourani
V.H. Herrmann H.C. Beohar N. Zajarias A. Mack M.J. Leon M.B. Cohen D.J.
Institution
(Arnold, Spertus, Lei, Cohen) Saint Luke's Mid America Heart Institute,
4401 Wornall Rd, Kansas City, MO 64111, United States
(Green, Kirtane, Leon) Columbia-Presbyterian Hospital, New York, NY,
United States
(Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Beohar) Columbia Division of Cardiology, Mount Sinai Medical Center,
Miami Beach, FL, United States
(Zajarias) Washington University, St. Louis, MO, United States
(Mack) Medical City Dallas, Dallas, TX, United States
Title
How to define a poor outcome after transcatheter aortic valve replacement
: Conceptual framework and empirical observations from the placement of
Aortic Transcatheter Valve (PARTNER) trial.
Source
Circulation: Cardiovascular Quality and Outcomes. 6 (5) (pp 591-597),
2013. Date of Publication: September 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Transcatheter aortic valve replacement (TAVR) has emerged as a
less invasive option for valve replacement of patients with severe aortic
stenosis. Although it has been recommended that TAVR should not be offered
to patients who will not improve functionally or derive meaningful
survival benefit from the procedure, no guidance exists on how best to
identify such patients. The first step in this process is to define a poor
outcome that can then be used as a foundation for subsequent case
identification. We sought to evaluate potential definitions of a poor
outcome after TAVR that combine both mortality and quality of life
components. Methods and Results-Using data from 463 patients who underwent
TAVR as part of the Placement of AoRTic TraNscathetER Valve (PARTNER)
trial, we evaluated 6-month mortality and quality of life outcomes using
the Kansas City Cardiomyopathy Questionnaire to explore potential
definitions of a poor outcome. We then compared the strengths and
weaknesses of each potential definition by examining the relationship
between baseline and 6-month Kansas City Cardiomyopathy Questionnaire
scores for each patient. Based on these analyses, we argue that the most
appropriate definition of a poor outcome after TAVR is (1) death, (2)
Kansas City Cardiomyopathy Questionnaire overall summary score <45, or (3)
Kansas City Cardiomyopathy Questionnaire decrease of >=10 points, which
best reflects a failure to achieve the therapeutic goals of TAVR.
Conclusions-Using empirical data on a large number of patients enrolled in
the PARTNER trial, we propose a definition for poor outcome after TAVR
that combines both mortality and quality of life measures into a single
composite end point. Use of this end point (or other similar end points)
in future studies can facilitate development of predictive models that may
be useful to identify patients who are poor candidates for TAVR and to
provide such patients and their families with appropriate expectations of
functional recovery after TAVR. 2013 American Heart Association, Inc.

<18>
[Use Link to view the full text]
Accession Number
2013596659
Authors
Hajduk A.M. Kiefe C.I. Person S.D. Gore J.G. Saczynski J.S.
Institution
(Hajduk, Kiefe, Person, Gore, Saczynski) Departments of Quantitative
Health Sciences, University of Massachusetts Medical School (UMMS), 55
Lake Ave N, AS7-1065J, Worcester, MA 01655, United States
(Gore, Saczynski) Departments of Medicine, University of Massachusetts
Medical School (UMMS), Worcester, United States
(Hajduk, Saczynski) Meyers Primary Care Institute, University of
Massachusetts Medical School (UMMS), Worcester, United States
Title
Cognitive change in heart failure : A systematic review.
Source
Circulation: Cardiovascular Quality and Outcomes. 6 (4) (pp 451-460),
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
Background-Cognitive impairment, highly prevalent in patients with heart
failure (HF), increases risk for hospitalization and mortality. However,
the course of cognitive change in HF is not well characterized. The
purpose of this systematic review was to examine the available evidence
longitudinal changes in cognitive function in patients with HF. Methods
and Results-A literature search of several electronic databases was
performed. Studies published from January 1, 1980, to September 30, 2012,
that used validated measures to diagnose HF and assess cognitive function
>=2x in adults with HF were eligible for inclusion. Change in cognitive
function was examined in the context of HF treatments applied (eg,
medication initiation, left ventricular assist device implantation),
length of follow-up, and comparison group. Fifteen studies met eligibility
criteria. Significant decline in cognitive function was noted among
patients with HF followed up for >1 year. Improvements in cognition were
observed among patients with HF undergoing interventions to improve
cardiac function (eg, heart transplantation) and among patients examined
over short time periods (<1 year). Studies comparing patients' cognition
over time with their own baseline tended to report improvements, whereas
studies using a comparison group without HF tended to report declines or
stability in cognition over time among patients with HF.
Conclusions-Patients with HF are at increased risk for cognitive decline,
but this risk seems to be modifiable with cardiac treatment. Further
research is needed to identify the mechanisms that cause cognitive changes
in HF. 2013 American Heart Association, Inc.

<19>
[Use Link to view the full text]
Accession Number
2013596654
Authors
Spertus J.A. Maron D.J. Cohen D.J. Kolm P. Hartigan P. Weintraub W.S.
Berman D.S. Teo K.K. Shaw L.J. Sedlis S.P. Knudtson M. Aslan M. Dada M.
Boden W.E. John Mancini G.B.
Institution
(Spertus, Cohen) Department of Cardiovascular Research, Saint Luke's Mid
America Heart Institute, University of Missouri-Kansas City, 4401 Wornall
Rd, Kansas City, MO, United States
(Maron) Vanderbilt University Medical Center, Nashville, TN, United States
(Kolm, Weintraub) Christiana Care Health System, Newark, DE, United States
(Hartigan, Aslan) Clinical Epidemiology Research Center, VA Connecticut
Healthcare System, West Haven, CT, United States
(Berman) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Teo) McMaster University Medical Center, Hamilton, ON, Canada
(Shaw) Emory University, Atlanta, GA, United States
(Sedlis) Departments of Medicine, Divisions of Cardiology VA New York
Harbor Health Care System, New York University School of Medicine, New
York, NY, United States
(Knudtson) Libin Cardiovascular Institute, Calgary, AB, Canada
(Dada) Hartford Hospital, Hartford, CT, United States
(Boden) Western New York VA Healthcare Network, Buffalo General Hospital,
SUNY, Buffalo, NY, United States
(John Mancini) University of British Columbia, Vancouver, BC, Canada
Title
Frequency, predictors, and consequences of crossing over to
revascularization within 12 months of randomization to optimal medical
therapy in the Clinical Outcomes Utilizing Revascularization and
Aggressive Drug Evaluation (COURAGE) trial.
Source
Circulation: Cardiovascular Quality and Outcomes. 6 (4) (pp 409-418),
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
Background-In the Clinical Outcomes Utilizing Revascularization and
Aggressive Drug Evaluation (COURAGE) trial, some patients with stable
ischemic heart disease randomized to optimal medical therapy (OMT) crossed
over to early revascularization. The predictors and outcomes of patients
who crossed over from OMT to revascularization are unknown. Methods and
Results-We compared characteristics of OMT patients who did and did not
undergo revascularization within 12 months and created a Cox regression
model to identify predictors of early revascularization. Patients' health
status was measured with the Seattle Angina Questionnaire. To quantify the
potential consequences of initiating OMT without percutaneous coronary
intervention, we compared the outcomes of crossover patients with a
matched cohort randomized to immediate percutaneous coronary intervention.
Among 1148 patients randomized to OMT, 185 (16.1%) underwent early
revascularization. Patient characteristics independently associated with
early revascularization were worse baseline Seattle Angina Questionnaire
scores and healthcare system. Among 156 OMT patients undergoing early
revascularization matched to 156 patients randomized to percutaneous
coronary intervention, rates of mortality (hazard ratio=0.51 [0.13-2.1])
and nonfatal myocardial infarction (hazard ratio=1.9 [0.75-4.6]) were
similar, as were 1-year Seattle Angina Questionnaire scores. OMT patients,
however, experienced worse health status over the initial year of
treatment and more unstable angina admissions (hazard ratio=2.8
[1.1-7.5]). Conclusion-Among COURAGE patients assigned to OMT alone,
patients' angina, dissatisfaction with their current treatment, and, to a
lesser extent, their health system were associated with early
revascularization. Because early crossover was not associated with an
increase in irreversible ischemic events or impaired 12-month health
status, these findings support an initial trial of OMT in stable ischemic
heart disease with close follow-up of the most symptomatic patients.
Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00007657. 2013 American Heart Association, Inc.

<20>
[Use Link to view the full text]
Accession Number
2013596510
Authors
Miller C.A. Naish J.H. Bishop P. Coutts G. Clark D. Zhao S. Ray S.G. Yonan
N. Williams S.G. Flett A.S. Moon J.C. Greiser A. Parker G.J.M. Schmitt M.
Institution
(Miller, Ray, Yonan, Williams, Schmitt) North West Heart Centre and The
Transplant Centre, University Hospital of South Manchester, Wythenshawe
Hospital, Manchester, United Kingdom
(Bishop) Department of Pathology, University Hospital of South Manchester,
Wythenshawe Hospital, Manchester, United Kingdom
(Miller, Naish, Zhao, Parker, Schmitt) Centre for Imaging Sciences and
Biomedical Imaging Institute, University of Manchester, United Kingdom
(Miller, Ray, Yonan, Williams) Cardiovascular Research Group, University
of Manchester, United Kingdom
(Coutts) Christie Medical Physics and Engineering, Christie Hospital,
Manchester, United Kingdom
(Clark) Alliance Medical Cardiac MRI Unit, Wythenshawe Hospital,
Manchester, United Kingdom
(Flett, Moon) Heart Hospital Imaging Centre, Heart Hospital, London,
United Kingdom
(Flett, Moon) Institute of Cardiovascular Science, University College
London, London, United Kingdom
(Greiser) Siemens AG Healthcare Sector, Erlangen, Germany
Title
Comprehensive validation of cardiovascular magnetic resonance techniques
for the assessment of myocardial extracellular volume.
Source
Circulation: Cardiovascular Imaging. 6 (3) (pp 373-383), 2013. Date of
Publication: May 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Extracellular matrix expansion is a key element of ventricular
remodeling and a potential therapeutic target. Cardiovascular magnetic
resonance (CMR) T₁-mapping techniques are increasingly used to
evaluate myocardial extracellular volume (ECV); however, the most widely
applied methods are without histological validation. Our aim was to
perform comprehensive validation of (1) dynamic-equilibrium CMR
(DynEq-CMR), where ECV is quantified using hematocrit-adjusted myocardial
and blood T₁ values measured before and after gadolinium bolus;
and (2) isolated measurement of myocardial T₁, used as an ECV
surrogate. Methods and Results: Whole-heart histological validation was
performed using 96 tissue samples, analyzed for picrosirius red collagen
volume fraction, obtained from each of 16 segments of the explanted hearts
of 6 patients undergoing heart transplantation who had prospectively
undergone CMR before transplantation (median interval between CMR and
transplantation, 29 days). DynEq-CMR-derived ECV was calculated from T
₁ measurements made using a modified Look-Locker inversion
recovery sequence before and 10 and 15 minutes post contrast. In addition,
ECV was measured 2 to 20 minutes post contrast in 30 healthy volunteers.
There was a strong linear relationship between DynEq-CMR-derived ECV and
histological collagen volume fraction (P<0.001; within-subject: r=0.745;
P<0.001; r²=0.555 and betweensubject: r=0.945; P<0.01;
r²=0.893; for ECV calculated using 15-minute postcontrast
T₁). Correlation was maintained throughout the entire heart.
Isolated postcontrast T₁ measurement showed significant
within-subject correlation with histological collagen volume fraction
(r=-0.741; P<0.001; r²=0.550 for 15-minute postcontrast
T₁), but between-subject correlations were not significant.
DynEq-CMR-derived ECV varied significantly according to contrast dose,
myocardial region, and sex. Conclusions: DynEq-CMR-derived ECV shows a
good correlation with histological collagen volume fraction throughout the
whole heart. Isolated postcontrast T₁ measurement is
insufficient for ECV assessment. 2013 American Heart Association, Inc.

<21>
[Use Link to view the full text]
Accession Number
2013596476
Authors
Schinkel A.F.L.
Institution
(Schinkel) Department of Cardiology, Thoraxcenter, Erasmus MC,
s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
Title
Implantable cardioverter defibrillators in arrhythmogenic right
ventricular dysplasia/cardiomyopathy: Patient outcomes, incidence of
appropriate and inappropriate interventions, and complications.
Source
Circulation: Arrhythmia and Electrophysiology. 6 (3) (pp 562-568), 2013.
Date of Publication: June 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Arrhythmogenic right ventricular dysplasia/cardiomyopathy
(ARVD/C) is a cardiomyopathy characterized by ventricular arrhythmias and
an abnormal right ventricle. Implantable cardioverter defibrillator (ICD)
therapy may prevent sudden cardiac death in patients with ARVD/C.
Currently, an overview of outcomes, appropriate and inappropriate
interventions, and complications of ICD therapy in ARVD/C is lacking.
Methods and Results-A literature search was performed to identify studies
reporting outcome and complications in patients with ARVD/C who underwent
ICD implantation. Of 641 articles screened, 24 studies on 18 cohorts were
eligible for inclusion. In case of multiple publications on a cohort, the
most recent publication was included in the meta-analysis. There were 610
patients (mean age, 40.4 years; 42% women), who had an ICD for primary or
secondary prevention of sudden cardiac death. Risk factors for sudden
cardiac death were presyncope (61%), syncope (31%), previous cardiac
arrest (14%), ventricular tachycardia (58%), and ventricular fibrillation
(6%). Antiarrhythmic medication consisted mostly of beta-blockers (38%),
amiodarone (14%), or sotalol (30%). During the 3.8-year follow-up,
annualized cardiac mortality rate was 0.9%, annualized noncardiac
mortality rate was 0.8%, and annualized heart transplant rate was 0.9%.
The annualized appropriate and inappropriate ICD intervention rates were
9.5% and 3.7%, respectively. ICD-related complications consisted of
difficult lead placement (18.4%), lead malfunction (9.8%), infection
(1.4%), lead displacement (3.3%), and any complication (20.3%).
Conclusions-Cardiac and noncardiac mortality rates after ICD implantation
in patients with ARVD/C are low. Appropriate ICD interventions occur at a
rate of 9.5%/y. Inappropriate ICD interventions and complications lead to
considerable ICDrelated morbidity. 2013 American Heart Association, Inc.

<22>
Accession Number
2013593849
Authors
Dangas G.D. Serruys P.W. Kereiakes D.J. Hermiller J. Rizvi A. Newman W.
Sudhir K. Smith Jr. R.S. Cao S. Theodoropoulos K. Cutlip D.E. Lansky A.J.
Stone G.W.
Institution
(Dangas, Theodoropoulos, Stone) Division of Cardiology, Mount Sinai
Medical Center, New York, NY, United States
(Dangas, Theodoropoulos) Mount Sinai Medical Center, Cardiovascular
Research Foundation, 111 East 59th Street, New York, NY 10022, United
States
(Serruys) Cardialysis and Thoraxcenter, Rotterdam, Netherlands
(Kereiakes) Christ Hospital Heart and Vascular Center, Lindner Research
Center, Cincinnati, OH, United States
(Hermiller, Rizvi) Heart Center of Indiana, Indianapolis, IN, United
States
(Newman) Division of Cardiology, Wake Medical Center, Raleigh, NC, United
States
(Sudhir, Smith Jr., Cao) Abbott Vascular, Santa Clara, CA, United States
(Cutlip) Division of Cardiology, Harvard Clinical Research Institute,
Boston, MA, United States
(Lansky) Division of Cardiology, Yale University Medical Center, New
Haven, CT, United States
(Stone) Division of Cardiology, Columbia University Medical Center, New
York-Presbyterian Hospital, New York, NY, United States
Title
Meta-analysis of everolimus-eluting versus paclitaxel-eluting stents in
coronary artery disease: Final 3-year results of the SPIRIT clinical
trials program (Clinical evaluation of the Xience v everolimus eluting
coronary stent system in the treatment of patients with de novo native
coronary artery lesions).
Source
JACC: Cardiovascular Interventions. 6 (9) (pp 914-922), 2013. Date of
Publication: September 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives This study sought to investigate whether the everolimus-eluting
stent (EES) is superior to the paclitaxel-eluting stent (PES) with respect
to long-term individual clinical outcomes. Background Individual studies
have indicated a clinical advantage of coronary EES compared with PES with
respect to restenosis and the composite endpoint of major adverse cardiac
events. However, these trials were not powered for superiority in
low-frequency event rates and have reported limited data beyond 1-year
follow-up. Methods We conducted a meta-analysis of the final 3-year
results from the international SPIRIT (Clinical Evaluation of the Xience V
Everolimus Eluting Coronary Stent System in the Treatment of Patients With
De Novo Native Coronary Artery Lesions) II, III, and IV clinical trials.
Individual patient data from 4,989 patients who were prospectively
randomized to treatment with EES (n = 3,350) or PES (n = 1,639) were
pooled for analysis. Results At 3-year follow-up, EES was superior to PES
in reducing the following event rates: target lesion failure (8.9% vs.
12.5%, hazard ratio [HR]: 0.71, 95% confidence interval [CI]: 0.59 to
0.85; p = 0.0002), all-cause mortality (3.2% vs 5.1%, HR: 0.65, 95% CI:
0.49 to 0.86; p = 0.003), myocardial infarction (3.2% vs. 5.1%, HR: 0.64,
95% CI: 0.48 to 0.85; p = 0.002), cardiac death or myocardial infarction
(4.4% vs. 6.3%, HR: 0.70, 95% CI: 0.54 to 0.90; p = 0.005),
ischemia-driven target lesion revascularization (6.0% vs. 8.2%, HR: 0.72,
95% CI: 0.58 to 0.90; p = 0.004), stent thrombosis (0.7% vs. 1.7%, HR:
0.45, 95% CI: 0.26 to 0.78; p = 0.003), and major adverse cardiac events
(9.4% vs. 13.0%, HR: 0.71, 95% CI: 0.60 to 0.85; p = 0.0002). No
interaction was present between stent type and the 3-year relative rates
of target lesion failure across a broad range of subgroups, with the
exception of diabetes and vessel (left anterior descending vs. other).
Conclusions In this large dataset with 3-year follow-up, coronary
implantation of EES compared with PES resulted in reduced rates of
all-cause mortality, myocardial infarction, ischemia-driven target lesion
revascularization, stent thrombosis, and target lesion failure. Further
research is warranted to characterize possible interactions between stent
type, diabetes, and vessel. 2013 by the American College of Cardiology
Foundation.

<23>
Accession Number
2013593108
Authors
Karkouti K. Von Heymann C. Jespersen C.M. Korte W. Levy J.H. Ranucci M.
Sellke F.W. Song H.K.
Institution
(Karkouti) Department of Anesthesia, University of Toronto, Toronto
General Hospital, Toronto, ON M5G 2C4, Canada
(Von Heymann) Department of Anesthesiology and Intensive Care Medicine,
Charite-Universitatsmedizin Berlin, Campus Virchow-Klinikum, Berlin,
Germany
(Jespersen) Safety Surveillance, Global Safety, Novo Nordisk, Bagsvaerd,
Denmark
(Korte) Center for Laboratory Medicine, St Gallen, Switzerland
(Levy) Department of Anesthesiology, Cardiothoracic Anesthesiology and
Critical Care, Emory University, School of Medicine, Atlanta, GA, United
States
(Ranucci) Department of Cardiothoracic-Vascular Anesthesia and Intensive
Care, Istituto di Ricovero e Cura A Carattere Scientifico, Policlinico San
Donato, San Donato Milanese (Milan), Italy
(Sellke) Division of Cardiothoracic Surgery, Brown University, And Rhode
Island Hospital, Providence, RI, United States
(Song) Division of Cardiothoracic Surgery, Oregon Health and Science
University, Portland, OR, United States
Title
Efficacy and safety of recombinant factor XIII on reducing blood
transfusions in cardiac surgery: A randomized, placebo-controlled,
multicenter clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (4) (pp 927-939),
2013. Date of Publication: October 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Cardiac surgery with cardiopulmonary bypass frequently leads
to excessive bleeding, obligating blood product transfusions. Because low
factor XIII (FXIII) levels have been associated with bleeding after
cardiac surgery, we investigated whether administering recombinant FXIII
after cardiopulmonary bypass would reduce transfusions. Methods: In this
double-blinded, placebo-controlled, multicenter trial, 409 cardiac
surgical patients at moderate risk for transfusion were randomized to
receive an intravenous dose of recombinant FXIII, 17.5 IU/kg (n = 143), 35
IU/kg (n = 138), or placebo (n = 128) after cardiopulmonary bypass.
Transfusion guidelines were standardized. The primary efficacy outcome was
avoidance of allogeneic blood products for 7 days postsurgery. Secondary
outcomes included amount of blood products transfused and reoperation
rate. Serious adverse events were measured for 7 weeks. Results: Study
groups had comparable baseline characteristics and an approximately 40%
decrease in FXIII levels after cardiopulmonary bypass. Thirty minutes
postdose, FXIII levels were restored to higher than the lower 2.5th
percentile of preoperative activity in 49% of the placebo group, and 85%
and 95% of the 17.5- and 35-IU/kg recombinant FXIII groups, respectively
(P <.05 for both treatments vs placebo). Transfusion avoidance rates were
64.8%, 64.3%, and 65.9% with placebo, 17.5 IU/kg, and 35 IU/kg recombinant
FXIII (respective odds ratios against placebo, 1.05 [95% confidence
interval, 0.61-1.80] and 0.99 [95% confidence interval, 0.57-1.72]).
Groups had comparable adverse event rates. Conclusions: Replenishment of
FXIII levels after cardiopulmonary bypass had no effect on transfusion
avoidance, transfusion requirements, or reoperation in moderate-risk
cardiac surgery patients (ClinicalTrials.gov identifier: NCT00914589).
Copyright 2013 by The American Association for Thoracic Surgery.

<24>
Accession Number
2013593116
Authors
Costanzo S. Di Niro V. Di Castelnuovo A. Gianfagna F. Donati M.B. De
Gaetano G. Iacoviello L.
Institution
(Costanzo, Di Niro, Di Castelnuovo, Gianfagna, Donati, De Gaetano,
Iacoviello) Laboratorio di Epidemiologia Genetica Ed Ambientale,
Laboratori di Ricerca, Universita Cattolica, Campobasso, Italy
Title
Prevention of postoperative atrial fibrillation in open heart surgery
patients by preoperative supplementation of n-3 polyunsaturated fatty
acids: An updated meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (4) (pp 906-911),
2013. Date of Publication: October 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Several randomized clinical trials evaluated whether
preoperative supplementation of omega-3 (n-3) polyunsaturated fatty acids
protects against postoperative atrial fibrillation after cardiac surgery,
a condition associated with increased cardiac and cerebral mortality.
However, their efficacy remains still controversial. An updated
meta-analysis was performed to clarify if preoperative n-3 polyunsaturated
fatty acid supplementation prevents postoperative atrial fibrillation in
patients undergoing cardiac surgery. Methods: Articles were retrieved
until November 2012 by screening electronic databases (PubMed, EMBASE, Web
of Science, and Cochrane Central Register of Controlled Trials) and cross
references. Two of us independently reviewed articles and agreed to select
8 randomized clinical trials. For each study, the incidence of atrial
fibrillation in both the intervention and placebo groups was extracted to
calculate odd ratio and 95% confidence intervals (CIs). Weighted
study-specific estimates were combined using fixed (Mantel-Haenszel
method) and random-effects (DerSimonian-Laird method) models. Results:
This meta-analysis includes 2687 patients (1337 in the intervention group)
who underwent cardiac surgery. Pooled analysis using fixed-effects models
showed a significant reduction (average, 16%; 95% CI, 1%-29%) in
postoperative atrial fibrillation by preoperative n-3 polyunsaturated
fatty acids. There was a low heterogeneity among studies (P =.07 and I
² = 46%). By using a random-effects model, the reduction
averaged 25% (odds ratio, 0.75; 95% CI, 0.57-1.00; P =.05). When isolated
coronary artery bypass graft surgery was only considered (7 studies), a
significant protection averaging 34% was observed in a fixed model (odds
ratio, 0.66; 95% CI, 0.50-0.87; P =.003; I² = 26%, P =.23).
Conclusions: A preoperative supplementation of n-3 polyunsaturated fatty
acids significantly prevents the occurrence of postoperative atrial
fibrillation in patients undergoing cardiac surgery, in particular
coronary artery bypass surgery. Copyright 2013 by The American
Association for Thoracic Surgery.

<25>
Accession Number
2013593117
Authors
Al Jaaly E. Fiorentino F. Reeves B.C. Ind P.W. Angelini G.D. Kemp S.
Shiner R.J.
Institution
(Al Jaaly) Cardiothoracic Surgery, Hammersmith Hospital, Imperial College
NHS Trust, London, United Kingdom
(Fiorentino, Angelini) National Heart and Lung Institute, Imperial
College, Hammersmith Hospital, London, United Kingdom
(Reeves) Clinical Trials and Evaluation Unit, University of Bristol,
Bristol Royal Infirmary, Bristol, United Kingdom
(Ind, Shiner) Respiratory Department, Imperial College, Hammersmith
Hospital, London, United Kingdom
(Kemp) Department of Anaesthesia, Hammersmith Hospital, Imperial College
NHS Trust, London, United Kingdom
Title
Effect of adding postoperative noninvasive ventilation to usual care to
prevent pulmonary complications in patients undergoing coronary artery
bypass grafting: A randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (4) (pp 912-918),
2013. Date of Publication: October 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: We compared the efficacy of noninvasive ventilation with
bilevel positive airway pressure added to usual care versus usual care
alone in patients undergoing coronary artery bypass grafting. Methods: We
performed a 2-group, parallel, randomized controlled trial. The primary
outcome was time until fit for discharge. Secondary outcomes were partial
pressure of carbon dioxide, forced expiratory volume in 1 second,
atelectasis, adverse events, duration of intensive care stay, and actual
postoperative stay. Results: A total of 129 patients were randomly
allocated to bilevel positive airway pressure (66) or usual care (63).
Three patients allocated to bilevel positive airway pressure withdrew. The
median duration of bilevel positive airway pressure was 16 hours
(interquartile range, 11-19). The median duration of hospital stay until
fit for discharge was 5 days for the bilevel positive airway pressure
group (interquartile range, 4-6) and 6 days for the usual care group
(interquartile range, 5-7; hazard ratio, 1.68; 95% confidence interval,
1.08-2.31; P =.019). There was no significant difference in duration of
intensive care, actual postoperative stay, and mean percentage of
predicted forced expiratory volume in 1 second on day 3. Mean partial
pressure of carbon dioxide was significantly reduced 1 hour after bilevel
positive airway pressure application, but there was no overall difference
between the groups up to 24 hours. Basal atelectasis occurred in 15
patients (24%) in the usual care group and 2 patients (3%) in the bilevel
positive airway pressure group. Overall, 30% of patients in the bilevel
positive airway pressure group experienced an adverse event compared with
59% in the usual care group. Conclusions: Among patients undergoing
elective coronary artery bypass grafting, the use of bilevel positive
airway pressure at extubation reduced the recovery time. Supported by
trained staff, more than 75% of all patients allocated to bilevel positive
airway pressure tolerated it for more than 10 hours. Copyright 2013 by
The American Association for Thoracic Surgery.

<26>
Accession Number
2013590402
Authors
Yang S.-S. Tang L. Ge G.-H. Ma J.-W. Qiao Z.-Y. Hou Y.-M. Zhang L. Liu
H.-J. Cao H. Hao Z.-M. Cheng W.-B. Wang H.-W. Zhang R.-Y.
Institution
(Yang, Ge, Ma, Qiao, Hou, Zhang, Liu, Cao, Hao, Cheng, Wang, Zhang)
Department of Cardiology, Central Hospital, Fengxian District, Shanghai,
China
(Tang) School of Medical Graduate, Shanghai Jiaotong University, Shanghai,
China
Title
Meta-analysis of the long term effects of different interventions on
chronic total coronary occlusions.
Source
European Review for Medical and Pharmacological Sciences. 17 (12) (pp
1583-1589), 2013. Date of Publication: 2013.
Publisher
Verduci Editore (Via Gregorio VII 186, Roma 00165, Italy)
Abstract
BACKGROUND: Coronary chronic total occlusion (CTO) is the end stage of
coronary artery atherosclerosis. CTO revascularization can be performed by
percutaneous transluminal coronary angioplasty (PTCA), bare metal stent
(BMS) or drug-eluting stent (DES). It is important to scientifically
evaluate the effectiveness of CTO interventional treatments. METHODS:
Relevant studies of long term outcomes for several kinds of CTO treatments
were examined. Data were extracted and assessed by two independent
clinical experts, pooled and analyzed using meta-analysis. RESULTS: (1)
Totally 8 articles comparing outcomes between PTCA and BMS treatment were
analyzed. Follow-up variables such as mortality, subsequent coronary
artery bypass graft surgery (CABG), re-occlusion, re-stenosis and target
lesion revascularization (TLR) were analyzed by metaanalysis. Compared
with BMS intervention, PTCA was associated with significant higher rate of
reocclusion, re-stenosis, subsequent PTCA and TLR. (2) Totally 12 articles
compared long term outcomes between BMS groups and DES groups, encompassed
3605 CTO patients. During the longterm follow-up, six variables as major
adverse cardiac events (MACE), myocardial infarction, allcause death,
subsequent CABG, accumulated MACE-free survival rate,
re-stenosis/re-occlusion rate were analyzed by meta-analysis. Compared
with patients in DES groups, patients in BMS groups had significant higher
MACE, subsequent CABG, re-stenosis/re-occlusion rate, TLR, target vessel
revascularization, while lower MACE-free survival rate. CONCLUSIONS:
Incidence of re-occlusion, restenosis, subsequent PTCA and TLR were
significantly lower for BMS implantation than for PTCA
procedure.Variables, including MACE, subsequent CABG,
re-stenosis/re-occlusion rate were higher while accumulated MACE-free
survival rate was lower in BMS groups than in DES groups.

<27>
Accession Number
2013586447
Authors
Yongcharoen S. Rattanasiri S. McDaniel D.O. McEvoy M. Viwatwongkaseam C.
Rojanavipart P. Thakkinstian A.
Institution
(Yongcharoen, Rattanasiri, Thakkinstian) Section for Clinical Epidemiology
and Biostatistics, Mahidol University, Ramathibodi Hospital, Bangkok
10400, Thailand
(McDaniel) Department of Surgery, University of Mississippi Medical
Center, Jackson, MS 39216, United States
(McEvoy) Centre for Clinical Epidemiology and Biostatistics, University of
Newcastle, Newcastle, NSW 2300, Australia
(Viwatwongkaseam, Rojanavipart) Department of Biostatistics, Faculty of
Public Health, Mahidol University, Bangkok 10400, Thailand
Title
Meta-analysis of cytokine gene polymorphisms and outcome of heart
transplantation.
Source
BioMed Research International. 2013 , 2013. Article Number: 387184. Date
of Publication: 2013.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
We performed a systematic review and meta-analysis with the aim of
assessing the association between cytokine gene polymorphisms and graft
rejection in heart transplantation. We identified relevant studies from
Medline and Embase using PubMed and Ovid search engines, respectively.
Allele frequencies and allele and genotypic effects were pooled.
Heterogeneity and publication bias were explored. Four to 5 studies were
included in pooling of 3 gene polymorphisms. The prevalences of the minor
alleles for TNFalpha-308, TGFbeta1-c10, and TGFbeta1-c25 were 0.166 (95%
CI: 0.129, 0.203), 0.413 (95% CI: 0.363, 0.462), and 0.082 (95% CI: 0.054,
0.111) in the control groups, respectively. Carrying the A allele for the
TNFalpha-308 had 18% (95% CI of OR: 0.46, 3.01) increased risk, but this
was not significant for developing graft rejection than the G allele.
Conversely, carrying the minor alleles for both TGFbeta1-c10 and c25 had
nonsignificantly lower odds of graft rejection than major alleles, with
the pooled ORs of 0.87 (95% CI: 0.65, 1.18) and 0.70 (95% CI: 0.40, 1.23),
respectively. There was no evidence of publication bias for all poolings.
An updated meta-analysis is required when more studies are published to
increase the power of detection for the association between these
polymorphisms and allograft rejection. 2013 Sasitorn Yongcharoen et al.