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<1>
Accession Number
2013632384
Authors
Bagai A. Thavendiranathan P. Sharieff W. Al Lawati H.A. Cheema A.N.
Institution
(Bagai, Al Lawati, Cheema) St. Michael's Hospital, 30 Bond Street,
Toronto, ON, M5B 1W8, Canada
(Thavendiranathan) University Health Network, Toronto, Canada
(Sharieff) Hamilton General Hospital, Hamilton, ON, Canada
Title
Non-infarct-related artery revascularization during primary percutaneous
coronary intervention for ST-segment elevation myocardial infarction: A
systematic review and meta-analysis.
Source
American Heart Journal. 166 (4) (pp 684-693.e1), 2013. Date of
Publication: October 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background In patients with ST-elevation myocardial infarction (STEMI) and
multivessel disease, guidelines recommend infarct-related artery (IRA)
only intervention during primary percutaneous coronary intervention (PCI)
except in patients with hemodynamic instability. To assess the available
evidence, we performed a systematic review and meta-analysis comparing
outcomes of non-IRA PCI as an adjunct to primary PCI (same sitting PCI
[SS-PCI]) with IRA only PCI (IRA-PCI) in the setting of STEMI. Methods and
Results A comprehensive search identified 14 studies [11 cohort, 3
randomized controlled trials] comprising of 35,239 patients. For cohort
studies, patients undergoing SS-PCI had higher rate of anterior infarction
(48% vs. 45%, P =.04) and cardiogenic shock (11% vs. 9%, P =.0001) at
baseline compared with IRA-PCI. The primary composite end point of death,
myocardial infarction and revascularization was higher in the SS-PCI group
in the short term (OR, 1.63; CI, 1.12-2.37) and long term (OR, 1.60; CI,
1.18-2.16). However, after excluding patients with shock, there was no
difference in primary endpoint for the short (OR, 1.33; CI, 0.67-2.63) and
long term (OR, 1.39; CI, 0.80-2.42) follow-up. In analyses limited to
randomized controlled trials, primary end point was similar during short
term (OR, 0.79; CI, 0.19-3.28) and significantly lower for SS-PCI group in
the long term (OR, 0.55; CI, 0.34-0.91). Conclusions There is paucity of
randomized data to guide management of STEMI patients with multivessel
disease. SS-PCI group in cohort studies has higher baseline risk compared
to IRA-PCI. The primary end point is higher for SS-PCI in observational
cohort studies but this difference did not persist after exclusion of
shock patients and for analysis limited to randomized controlled trials.
These findings underscore the need of a large randomized controlled trial
to guide therapy for a commonly encountered clinical situation. 2013
Mosby, Inc.

<2>
Accession Number
2013632383
Authors
Sambola A. Montoro J.B. Del Blanco B.G. Llavero N. Barrabes J.A. Alfonso
F. Bueno H. Cequier A. Serra A. Zueco J. Sabate M. Rodriguez-Leor O.
Garcia-Dorado D.
Institution
(Sambola, Del Blanco, Llavero, Barrabes, Garcia-Dorado) Cardiology
Department, Hospital Universitari Vall D'Hebron, Universitat Autonoma de
Barcelona, P. Vall d'Hebron 119-129, 08035 Barcelona, Spain
(Montoro) Pharmacy Department, Hospital Universitari Vall D'Hebron,
Universitat Autonoma de Barcelona, Barcelona, Spain
(Alfonso) Cardiology Department, Hospital Universitario Clinico San
Carlos, Madrid, Spain
(Bueno) Cardiology Department, Hospital General Universitario Gregorio
Maranon, Madrid, Spain
(Cequier, Serra) Cardiology Department, Hospital Universitari de
Bellvitge, L'Hospitalet Del Llobregat, Barcelona, Spain
(Zueco, Sabate) Cardiology Department, Hospital Santa Creu i Sant Pau,
Barcelona, Spain
(Rodriguez-Leor) Cardiology Department, Hospital Universitari Germans
Trias i Pujol, Badalona, Barcelona, Spain
Title
Dual antiplatelet therapy versus oral anticoagulation plus dual
antiplatelet therapy in patients with atrial fibrillation and
low-to-moderate thromboembolic risk undergoing coronary stenting: Design
of the MUSICA-2 randomized trial.
Source
American Heart Journal. 166 (4) (pp 669-675), 2013. Date of Publication:
October 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background Oral anticoagulation (OAC) is the recommended therapy for
patients with atrial fibrillation (AF) because it reduces the risk of
stroke and other thromboembolic events. Dual antiplatelet therapy (DAPT)
is required after percutaneous coronary intervention and stenting (PCI-S).
In patients with AF requiring PCI-S, the association of DAPT and OAC
carries an increased risk of bleeding, whereas OAC therapy or DAPT alone
may not protect against the risk of developing new ischemic or
thromboembolic events. Objective The MUSICA-2 study will test the
hypothesis that DAPT compared with triple therapy (TT) in patients with
nonvalvular AF at low-to-moderate risk of stroke (CHADS₂ score
<=2) after PCI-S reduces the risk of bleeding and is not inferior to TT
for preventing thromboembolic complications. Design The MUSICA-2 is a
multicenter, open-label randomized trial that will compare TT with DAPT in
patients with AF and CHADS₂ score <=2 undergoing PCI-S. The
primary end point is the incidence of stroke or any systemic embolism or
major adverse cardiac events: death, myocardial infarction, stent
thrombosis, or target vessel revascularization at 1 year of PCI-S. The
secondary end point is the combination of any cardiovascular event with
major or minor bleeding at 1 year of PCI-S. The calculated sample size is
304 patients. Conclusions The MUSICA-2 will attempt to determine the most
effective and safe treatment in patients with nonvalvular AF and
CHADS₂ score <=2 after PCI-S. Restricting TT for AF patients at
high risk for stroke may reduce the incidence of bleeding without
increasing the risk of thromboembolic complications. 2013 Mosby, Inc.

<3>
Accession Number
2013630192
Authors
Zampi J.D. Hirsch J.C. Gurney J.G. Donohue J.E. Yu S. Lapage M.J. Hanauer
D.A. Charpie J.R.
Institution
(Zampi, Donohue, Yu, Lapage, Charpie) Division of Pediatric Cardiology,
Department of Pediatrics, University of Michigan Medical School, Ann Arbor
MI, United States
(Hirsch) Division of Pediatric Cardiac Surgery, Department of Surgery,
University of Michigan Medical School, Ann Arbor MI, United States
(Gurney) St. Jude Children's Research Hospital, Memphis TN, United States
(Hanauer) Department of Pediatrics, University of Michigan Medical School,
Ann Arbor MI, United States
(Zampi) University of Michigan Congenital Heart Center, C.S. Mott
Children's Hospital, 1540 E. Hospital Drive, Ann Arbor MI 48109-4204,
United States
Title
Junctional ectopic tachycardia after infant heart surgery: Incidence and
outcomes.
Source
Pediatric Cardiology. 33 (8) (pp 1362-1369), 2012. Date of Publication:
December 2012.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Junctional ectopic tachycardia (JET) is an arrhythmia observed almost
exclusively after open heart surgery in children. Current literature on
JET has not focused on patients at the highest risk of both developing and
being negatively impacted by JET. The purpose of this study was to
determine the overall incidence of JET in an infant patient cohort
undergoing open cardiac surgery, to identify patient- and
procedure-related factors associated with developing JET, and to assess
the clinical impact of JET on patient outcomes. We performed a nested
case-control study from the complete cohort of patients at our institution
younger than 1 year of age who underwent open heart surgery between 2005
and 2010. JET patients were compared with an age matched control group
undergoing open heart surgery without JET regarding potential risk factors
and outcomes. The overall incidence of JET in infants after open cardiac
surgery was 14.3 %. From multivariate analyses, complete repair of
tetralogy of Fallot [adjusted odds ratio (AOR) 2.0, 95 % CI 1.12-3.57] and
longer aortic cross clamp times (AOR 1.02, 95 % CI 1.01-1.03) increased
the risk of developing JET. Patients with JET had longer length of
intubation, intensive care unit stays, and total length of
hospitalization, and were more likely to require extracorporeal membrane
oxygenation support (13 vs. 4.3 %). JET is a common postoperative
arrhythmia in infants after open heart operations. Both anatomic substrate
and surgical procedure contribute to the overall risk of developing JET.
Developing JET is associated with worse clinical outcomes. 2012 Springer
Science+Business Media, LLC.

<4>
Accession Number
2013599493
Authors
Eikelboom J.W. Connolly S.J. Brueckmann M. Granger C.B. Kappetein A.P.
Mack M.J. Blatchford J. Devenny K. Friedman J. Guiver K. Harper R. Khder
Y. Lobmeyer M.T. Maas H. Voigt J.-U. Simoons M.L. Van De Werf F.
Institution
(Eikelboom, Connolly) McMaster University, Hamilton Health Sciences,
Hamilton, ON, Canada
(Brueckmann, Lobmeyer, Maas) Boehringer Ingelheim, Ingelheim am Rhein,
Germany
(Brueckmann) Faculty of Medicine Mannheim, University of Heidelberg,
Mannheim, Germany
(Granger) Duke Clinical Research Institute, Durham, NC, United States
(Kappetein) Department of Cardio-Thoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Simoons) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Mack) Heart Hospital Baylor, Plano, TX, United States
(Blatchford, Devenny, Guiver, Harper) Boehringer Ingelheim, Bracknell,
United Kingdom
(Friedman) Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, United
States
(Khder) Boehringer Ingelheim, Paris, France
(Voigt, Van De Werf) Department of Cardiovascular Sciences, KU Leuven,
University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
Title
Dabigatran versus warfarin in patients with mechanical heart valves.
Source
New England Journal of Medicine. 369 (13) (pp 1206-1214), 2013. Date of
Publication: 2013.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Dabigatran is an oral direct thrombin inhibitor that has been
shown to be an effective alternative to warfarin in patients with atrial
fibrillation. We evaluated the use of dabigatran in patients with
mechanical heart valves. METHODS: In this phase 2 dose-validation study,
we studied two populations of patients: those who had undergone aortic- or
mitral-valve replacement within the past 7 days and those who had
undergone such replacement at least 3 months earlier. Patients were
randomly assigned in a 2:1 ratio to receive either dabigatran or warfarin.
The selection of the initial dabigatran dose (150, 220, or 300 mg twice
daily) was based on kidney function. Doses were adjusted to obtain a
trough plasma level of at least 50 ng per milliliter. The warfarin dose
was adjusted to obtain an international normalized ratio of 2 to 3 or 2.5
to 3.5 on the basis of thromboembolic risk. The primary end point was the
trough plasma level of dabigatran. RESULTS: The trial was terminated
prematurely after the enrollment of 252 patients because of an excess of
thromboembolic and bleeding events among patients in the dabigatran group.
In the as-treated analysis, dose adjustment or discontinuation of
dabigatran was required in 52 of 162 patients (32%). Ischemic or
unspecified stroke occurred in 9 patients (5%) in the dabigatran group and
in no patients in the warfarin group; major bleeding occurred in 7
patients (4%) and 2 patients (2%), respectively. All patients with major
bleeding had pericardial bleeding. CONCLUSIONS: The use of dabigatran in
patients with mechanical heart valves was associated with increased rates
of thromboembolic and bleeding complications, as compared with warfarin,
thus showing no benefit and an excess risk. Copyright 2013 Massachusetts
Medical Society.

<5>
Accession Number
2013618348
Authors
Zhang J.-F. Wu Y.-C. Shen W.-F. Kong Y.
Institution
(Zhang, Kong) Department of Cardiac Surgery Shanghai Chest Hospital,
Shanghai Jiao Tong University, Shanghai 200030, China
(Wu) Department of Cardiac Surgery, Rui Jin Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai 200025, China
(Shen) Department of Cardiology, Rui Jin Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai 200025, China
Title
Impact of prosthesis-patient mismatch on survival after mitral valve
replacement: A systematic review.
Source
Chinese Medical Journal. 126 (19) (pp 3762-3766), 2013. Date of
Publication: 2013.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Objective To determine whether the prosthesis-patient mismatch has a
deleterious impact on survival after mitral valve replacement. Data
sources A comprehensive literature search of PubMed, Embase, and
ScienceDirect was carried out. References and cited papers of relevant
articles were also checked. Study selection All articles published after
January 1980 was initially considered. Non-English and non-human studies,
case reports, and reviews were excluded from the initial search.
References and cited papers of relevant articles were also checked.
Results A total of 8 retrospective cohort studies were identified for this
review. The overall incidence of prosthesis-patient mismatch (<1.3 to <1.2
cm²/m²) after mitral valve replacement ranged from
3.7% to 85.9% (moderate prosthesis-patient mismatch (0.9 to 1.2
cm²/m²) in 37.4% to 69.5%, severe prosthesis-patient
mismatch (<0.9 cm²/m²) in 8.7% to 16.4%). Four
studies demonstrated an association of prosthesis-patient mismatch with
reduced long-term survival, but the other four studies found no
significant deleterious impact of prosthesis-patient mismatch after mitral
valve replacement. No definite conclusion could be derived from these
conflicting results. Conclusions Current evidence is insufficient to
derive a definite conclusion whether mitral prosthesis-patient mismatch
affects long-term survival because of the biases and confounding factors
that interfere with late clinical outcomes. Goodquality prospective
studies are warranted to evaluate the impact of mitral prosthesis-patient
mismatch after mitral valve replacement in the future.

<6>
Accession Number
2013613652
Authors
Sarmento R.A. Silva F.M. Sbruzzi G. Schaan B.D. de Almeida J.C.
Institution
(Sarmento, Sbruzzi, Schaan) Instituto de Cardiologia do Rio Grande do Sul,
Fundacao Universitaria de Cardiologia, Porto Alegre, RS, Brazil
(Sarmento, Silva, Schaan, de Almeida) Servico de Endocrinologia do
Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande
do Sul, Porto Alegre, RS, Brazil
(Schaan, de Almeida) Departamento de Medicina Interna, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
Title
Antioxidant micronutrients and cardiovascular risk in patients with
diabetes: A systematic review.
Source
Arquivos Brasileiros de Cardiologia. 101 (3) (pp 240-248), 2013. Date of
Publication: September 2013.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Background: Inverse associations between micronutrient intake and
cardiovascular outcomes have been previously shown, but did not focus on
diabetic patients.Objective: To systematically review the role of
micronutrients in the development/presence of cardiovascular outcomes in
patients with diabetes. Methods: We searched Medline, Embase, and Scopus
(January/1949-March/2012) for observational studies that evaluated
micronutrients and cardiovascular outcomes in patients with diabetes, and
then selected and extracted the data (two independent reviewers).Results:
From the 15 658 studies identified, five were included, comprising three
case-control and two cohorts, with a follow-up of 7-15 years. A
meta-analysis was not performed due to the different antioxidant
micronutrients (types and measurement methods) and outcomes evaluated. The
micronutrients assessed were vitamin C intake in diet and/or
supplementation, chromium and selenium in toenail samples, and
alpha-tocopherol and zinc in serum levels. Intake of > 300 mg of vitamin C
through supplementation was associated with increased risk of
cardiovascular disease, coronary artery disease (CAD), and stroke (RR
1.69-2.37). High levels of alpha-tocopherol in serum were associated with
30% lower CAD risk in another study (HR 0.71; 95%CI 0.53-0.94). Among
minerals (zinc, selenium, and chromium), an inverse association between
zinc and CAD was observed; levels lower than 14.1 mumol/L were associated
with an increased risk for CAD (RR 1.70; 95%CI 1.21-2.38).Conclusion: The
information available on this issue is scarce. Further prospective studies
are needed to elucidate the role of these nutrients in the cardiovascular
risk of patients with diabetes.

<7>
Accession Number
2013627310
Authors
Bjorgvinsdottir L. Arnar D.O. Indridason O.S. Heidarsdottir R. Skogstrand
K. Torfason B. Hougaard D.M. Palsson R. Skuladottir G.V.
Institution
(Bjorgvinsdottir, Arnar, Heidarsdottir, Torfason, Palsson, Skuladottir)
School of Health Sciences, University of Iceland, Reykjavik, Iceland
(Arnar, Indridason, Palsson) Internal Medicine Services, Landspitali - the
National University Hospital of Iceland, Reykjavik, Iceland
(Skogstrand, Hougaard) Surgical Services, Landspitali - the National
University Hospital of Iceland, Reykjavik, Iceland
(Torfason) Department of Clinical Biochemistry, Statens Serum Institut,
Copenhagen, Denmark
Title
Do high levels of n-3 polyunsaturated fatty acids in cell membranes
increase the risk of postoperative atrial fibrillation?.
Source
Cardiology (Switzerland). 126 (2) (pp 107-114), 2013. Date of Publication:
September 2013.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Objectives: Postoperative atrial fibrillation (POAF) has been associated
with an inflammatory response to the surgical procedure. n-3 long-chain
polyunsaturated fatty acids (LC-PUFA) have been proposed for the
prevention of POAF. We investigated the relationship between the plasma
concentration of inflammatory mediators, levels of n-3 LC-PUFA in red
blood cell (RBC) membrane lipids, and the risk of POAF after coronary
artery bypass grafting (CABG). Methods: A total of 125 patients who
underwent CABG were studied. Inflammatory mediators in plasma and the
content of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in
RBC membranes were assessed. Results: Sixty-two patients (49.6%) developed
POAF. The POAF group had higher RBC levels of total n-3 LC-PUFA and DHA
than did patients remaining in sinus rhythm (p < 0.05). Of the
inflammatory mediators, only postoperative interleukin-6 levels differed,
being higher in the POAF group (p < 0.05). Inflammatory mediators were not
independent predictors of POAF by multivariable logistic regression
analysis. Higher levels of DHA and total n-3 LC-PUFA in RBC membranes,
measured immediately prior to CABG and on postoperative day 3, were
linearly associated with an increased risk of POAF (p < 0.05).
Conclusions: Our findings suggest that inflammatory mediators are not
associated with the occurrence of POAF. Interestingly, high n-3 LC-PUFA
levels in RBC membranes appear to increase the risk of POAF. Copyright
2013 S. Karger AG, Basel.

<8>
Accession Number
2013626105
Authors
Xia W.-F. Liu Y. Zhou Q.-S. Tang Q.-Z. Zou H.-D.
Institution
(Xia) Departments of Critic Care Medicine and Cardiology, Renmin Hospital
of Wuhan University, Wuhan 430060, China
(Liu, Tang) Department of Cardiology, Renmin Hospital of Wuhan University,
Wuhan 430060, China
(Liu, Tang) Cardiovascular Research Institute, Wuhan University, Wuhan
430060, China
(Zhou, Zou) Department of Critic Care Medicine, Renmin Hospital of Wuhan
University, Wuhan 430060, China
Title
Protective effect of propofol and its relation to postoperation recovery
in children undergoing cardiac surgery with cardiopulmonary bypass.
Source
Pediatric Cardiology. 32 (7) (pp 940-946), 2011. Date of Publication:
October 2011.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
The aim of this study was to investigate the effect of propofol and its
relation to postoperation recovery in children undergoing cardiac surgery
with cardiopulmonary bypass (CPB). Twenty ASA class I-II children with
congenital heart disease undergoing cardiac surgery were randomly
allocated to a propofol group (n = 10) or a control group (n = 10). Blood
samples were collected at five time points: before operation (T
₀), before the start of CPB (T ₁), 25 min after the
aorta was cross-clamped (T ₂), 30 min after release of the
aortic cross-clamp (T ₃), and 2 h after the cessation of CPB (T
₄). The myocardial samples were collected at the time of
incubation into the right atrium before CPB and at 30 min after
reperfusion. After CPB, propofol significantly suppressed the increase of
the serum lactate dehydrogenase (LDH), creatine phosphokinase (CK), and
interleukin-6 (IL-6) levels and the decrease of the serum superoxide
dismutase (SOD) level. In addition, propofol inhibited the increase of
myocardial nuclear factor-B (NF-B) expression and inflammatory cells
infiltration after CPB. Furthermore, propofol significantly shortened the
tracheal extubation time. In conclusion, propofol exerts a protective
effect and improves postoperation recovery through its antioxidant and
anti-inflammatory actions in children undergoing cardiac surgery with CPB.
2011 Springer Science+Business Media, LLC.

<9>
[Use Link to view the full text]
Accession Number
2013624660
Authors
Friesen R.H. Nichols C.S. Twite M.D. Cardwell K.A. Pan Z. Pietra B.
Miyamoto S.D. Auerbach S.R. Darst J.R. Ivy D.D.
Institution
(Friesen, Nichols, Twite, Cardwell) Department of Anesthesiology,
Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave.,
Aurora, CO 80045, United States
(Pan) Department of Pediatrics, Research Institute, University of
Colorado, Denver, CO, United States
(Pietra, Miyamoto, Auerbach, Darst, Ivy) Department of Pediatrics
(Cardiology), Children's Hospital Colorado, University of Colorado,
Denver, CO, United States
Title
The hemodynamic response to dexmedetomidine loading dose in children with
and without pulmonary hypertension.
Source
Anesthesia and Analgesia. 117 (4) (pp 953-959), 2013. Date of Publication:
October 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND:: Dexmedetomidine, an alpha-2 receptor agonist, is widely used
in children with cardiac disease. Significant hemodynamic responses,
including systemic and pulmonary vasoconstriction, have been reported
after dexmedetomidine administration. Our primary goal of this
prospective, observational study was to quantify the effects of
dexmedetomidine initial loading doses on mean pulmonary artery pressure
(PAP) in children with and without pulmonary hypertension. METHODS::
Subjects were children undergoing cardiac catheterization for either
routine surveillance after cardiac transplantation (n = 21) or pulmonary
hypertension studies (n = 21). After anesthetic induction with sevoflurane
and tracheal intubation, sevoflurane was discontinued and anesthesia was
maintained with midazolam 0.1 mg/kg IV (or 0.5 mg/kg orally
preoperatively) and remifentanil IV infusion 0.5 to 0.8 mug/kg/min.
Ventilation was mechanically controlled to maintain PCO2 35 to 40 mm Hg.
When end-tidal sevoflurane was 0% and fraction of inspired oxygen (FIO2)
was 0.21, baseline heart rate, mean arterial blood pressure, PAP, right
atrial pressure, pulmonary artery occlusion pressure, right ventricular
end-diastolic pressure, cardiac output, and arterial blood gases were
measured, and indexed systemic vascular resistance, indexed pulmonary
vascular resistance, and cardiac index were calculated. Each subject then
received a 10-minute infusion of dexmedetomidine of 1 mug/kg, 0.75 mug/kg,
or 0.5 mug/kg. Measurements and calculations were repeated at the
conclusion of the infusion. RESULTS:: Most hemodynamic responses were
similar in children with and without pulmonary hypertension. Heart rate
decreased significantly, and mean arterial blood pressure and indexed
systemic vascular resistance increased significantly. Cardiac index did
not change. A small, statistically significant increase in PAP was
observed in transplant patients but not in subjects with pulmonary
hypertension. Changes in indexed pulmonary vascular resistance were not
significant. CONCLUSION:: Dexmedetomidine initial loading doses were
associated with significant systemic vasoconstriction and hypertension,
but a similar response was not observed in the pulmonary vasculature, even
in children with pulmonary hypertension. Dexmedetomidine does not appear
to be contraindicated in children with pulmonary hypertension. 2013
International Anesthesia Research Society.

<10>
Accession Number
2013592196
Authors
Iida M. Yamamoto M. Ishiguro Y.S. Yamazaki M. Ueda N. Honjo H. Kamiya K.
Institution
(Iida, Yamamoto, Ishiguro, Yamazaki) Department of Cardiology, Mitsubishi
Nagoya Hospital, Nagoya, Japan
(Ueda, Honjo, Kamiya) Department of Cardiovascular Research, Research
Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
Title
Utility of cystatin C as a marker for the severity of aortic regurgitation
in hypertensive patients.
Source
Clinica Chimica Acta. 425 (pp 259-264), 2013. Date of Publication: 21 Oct
2013.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: Cystatin C, a cathepsin inhibitor, is involved in the
remodeling of human aortic valve and left ventricle (LV). Objective:
Cystatin C may be related to the severity of aortic regurgitation (AR).
Methods: We measured cystatin C and CRP in hypertensive patients with
mild-to-moderate AR (n = 120) and in those without AR (n = 128).
Echocardiography was performed to assess the vena contracta width (the
narrowest region of regurgitant jet, VCW) as a marker of the severity of
AR, relative wall thickness as a marker of LV concentric remodeling, and
the ratio of early peak mitral flow to early diastolic mitral annular
velocity (E/e') as an index of LV diastolic function. Glomerular
filtration rate (GFR) was estimated using the MDRD methods. Results:
Cystatin C levels were greater in hypertensive patients with AR than in
those without AR. A multiple linear regression analysis indicated cystatin
C levels correlated with the VCW independent of GFR, body mass index, CRP,
relative wall thickness, and E/e' in hypertensive patients with AR.
Conclusions: Cystatin C was associated with the severity of regurgitation
independent of renal function body composition chronic inflammation LV
remodeling and diastolic function in hypertensive patients with
mild-to-moderate AR. 2013 Elsevier B.V.

<11>
Accession Number
71104808
Authors
Guo Z. Ju W. He M. He X.
Institution
(Guo, Ju, He, He) Organ Transplant Center, 1st Affiliated Hospital of Sun
Yat-sen University, Guangzhou, China
Title
The effects of gender on transplant outcomes: A meta-analysis.
Source
Liver Transplantation. Conference: 19th Annual International Congress of
the International Liver Transplantation Society, ILTS 2013 Sydney, NSW
Australia. Conference Start: 20130612 Conference End: 20130615. Conference
Publication: (var.pagings). 19 (6 SUPPL. 1) (pp S293-S294), 2013. Date of
Publication: June 2013.
Publisher
John Wiley and Sons Ltd
Abstract
Background: There are hot debates on whether and how donor/recipient
gender affects transplant outcomes. Herein, we performed a meta-analysis
to evaluate the effects of donor/recipient gender alone, match and pairing
on major organ transplant outcomes. Methods: PubMed/Medline, Embase, and
Cochrane library databases were researched for studies comparing
transplant outcomes between donor/recipient gender match and mismatch, as
well as four gender pairs. Survival rates were pooled and ranked among
four gender pairs. Results: Twelve studies (174177 patients) for kidney;
four studies (29815 patients) for liver, and four studies (19184 patients)
for heart transplantation were included. Compared with donor/recipient
gender match, gender mismatch was associated with significantly lower 1-,
3-, 5-year kidney graft survivals (1-year OR 0.91 (95% confidence
interval, 0.88-0.94); 3-year: 0.92 (0.90-0.94); 5-year: 0.94 (0.92-0.96)),
liver graft survivals (1-year: 0.81 (0.76-0.86); 3-year: 0.85 (0.81-0.90);
and 5-year: 0.89 (0.85-0.94)) and heart patient survivals (1-year: 0.81
(0.74-0.89); 3-year: 0.83 (0.77-0.89); 5-year; 0.83 (0.78-0.89)). Compared
with female to male pairing, male to male pairing has significant
advantage in kidney graft survival (5-year: 1.22(1.15-1.26)), liver graft
survival (5-year: 1.21(1.11-1.32)) and heart patient survival (5-year:
1.15(1.11-1.32)). Conclusions Gender matching significantly affects
transplant outcomes in major organ transplantation. Female to male pairing
has the worst prognosis in kidney and liver transplantation: while male to
female pairing has long term advantageous potential. Male to male pairing
has the most favorable outcomes in all three types of transplantation.
These results provide important information for allograft
allocation.(Figure presented).

<12>
Accession Number
71191875
Authors
Glass A. Donndorf A.P. Kaminski G. Steinhoff G. Kundt
Institution
(Glass, Kundt) Institute for Biostatistics and Informatics, Medicine and
Ageing Research, University of Rostock, Rostock, Germany
(Donndorf, Kaminski, Steinhoff) Department of Cardiac Surgery, University
of Rostock, Rostock, Germany
Title
Meta-analysis of cardiac surgical trials concerning intramyocardial bone
marrow stem cell transplantation.
Source
Clinical Trials. Conference: 32nd Meeting of the Society of Clinical
Trials Vancouver, BC Canada. Conference Start: 20110515 Conference End:
20110518. Conference Publication: (var.pagings). 8 (4) (pp 523-524), 2011.
Date of Publication: August 2011.
Publisher
SAGE Publications Ltd
Abstract
Objectives Clinical studies have suggested that intramyocardial bone
marrow stem cell (BMSC) transplantation combined with coronary artery
bypass surgery (CABG) might improve left ventricular function, and thus
prove to be a new therapeutic option for patients with endstage ischemic
heart disease. To quantify the overall treatment effect of three
functional parameters we conducted a meta-analysis of relevant studies,
regarding efficacy and safety of BMSC transplantation during CABG. Methods
Database searches (PUBMED, MEDLINE, Cochrane trials register,
ClinicalTrials.gov) revealed 4 RCT's and 2 cohort studies to include. The
analysis (STATA 9.0) was stratified by the difference between BMSC and
control group. Each mean difference was weighted by the inverse of
variance, before being pooled with either the fixed or random effects
model, depending on I-squared and Cochran's Chi-square-test of
homogeneity. In case of heterogeneity a meta-regression analysis was
added. To test significance of the overall effect we performed the z-test.
The presence of publication bias was assessed by funnel plots, Begg's rank
correlation test and Egger's weighted regression method. Results Compared
with control group, the BMSC group showed significant improvement of the
left ventricular ejection fraction from baseline (5.40%, 95%CI: 1.36 to
9.44, p=0.009), and improvement of overall change of left ventricular
end-diastolic volume (9.55 ml, 95%CI: -2.82 to 21.92, p=0.13). Major
adverse cardiovascular events were not significantly different.
Conclusions BMSC transplantation in combination with CABG is associated
with improvements of functional parameters in patients with chronic
ischemic heart disease. Surgical intramyocardial BMSC transplantation
appears to be safe.

<13>
Accession Number
71191779
Authors
Hutton B. Joseph L. Fergusson D. Shapiro S. Mazer D.
Institution
(Hutton, Joseph, Fergusson, Shapiro, Mazer) McGill University, Montreal,
Canada
Title
Risk of death with aprotinin in cardiac surgery: A bayesian evidence
synthesis of randomized and observational studies.
Source
Clinical Trials. Conference: 32nd Meeting of the Society of Clinical
Trials Vancouver, BC Canada. Conference Start: 20110515 Conference End:
20110518. Conference Publication: (var.pagings). 8 (4) (pp 476), 2011.
Date of Publication: August 2011.
Publisher
SAGE Publications Ltd
Abstract
Background: Inclusion of observational studies in meta-analysis with
randomized controlled trials (RCT) is a debated practice. Given past
conflicts regarding the safety of aprotinin in cardiac surgery from
different study designs, an advanced approach to synthesize all evidence
is of interest. Objective: To estimate bias-adjusted meta- analyses of
mortality for aprotinin compared to tranexamic acid (TXA), aminocaproic
acid (ACA), and no treatment using both RCTs and observational studies,
and to assess the comparability of these estimates relative to
meta-analyses of RCTs. Methods: We searched Medline, Embase, and the
Cochrane Database. A three-stage approach to metaanalysis was pursued:
Stage 1- meta-analysis of RCTs only, and RCTs and observational studies
together; Stage 2- meta-regression analyses of RCTs and observational
studies; and Stage 3- meta- regression analyses of RCTs and observational
studies coupled with bias adjustment at the study level. All meta-
analyses used a Bayesian hierarchical approach, and bias adjustments of
observational studies were derived from a clinical expert. Results: Totals
of 77, 26 and 12 studies were available for comparisons of aprotinin with
no therapy, TXA, and ACA, respectively. Using these alternatives as
reference groups for assessments versus aprotinin, comparisons of
mortality based on RCTs alone resulted in estimated odds ratios of 0.92
(95% CrI 0.64- 1.33), 1.45 (0.62-3.54), and 1.68 (0.23- 25.40), while
inclusion of observational evidence modified estimates to 1.16
(0.82-1.59), 1.35 (0.99-1.85), and 1.93 (1.18-3.24). Multivariate
meta-regression further changed estimates to 0.82 (0.33-1.76), 1.28 (0.52-
2.79), and 1.67 (1.07-2.98), while incorporation of bias adjustments
produced final estimates of 0.77 (0.29-1.51), 1.24 (0.47- 2.73), and 1.67
(1.05- 3.06). Conclusions: Pooled estimates suggested that aprotinin is
associated with an increased mortality risk compared to ACA, while
comparisons with TXA and no therapy are inconclusive. Inclusion of
observational studies reduced uncertainty, while bias adjustments had a
minimal impact on point estimates and mildly widened credible intervals.

<14>
Accession Number
71190808
Authors
Piriou N. Sassier J. Valleix-Terruin F. Roy-Giocosa J. Floch F. Gueffet
J.P. Trochu J.N.
Institution
(Piriou, Sassier, Valleix-Terruin, Roy-Giocosa, Floch, Gueffet, Trochu)
Institut du thorax, University Hospital of Nantes, Nantes, France
Title
Dual inhibition of phosophodiesterases type 3 and 5 can reverse reactive
and fixed pulmonary hypertension in advanced heart failure patients.
Source
European Journal of Heart Failure, Supplement. Conference: Heart Failure
2012 Belgrade Serbia. Conference Start: 20120519 Conference End: 20120522.
Conference Publication: (var.pagings). 11 (pp S55), 2012. Date of
Publication: May 2012.
Publisher
Oxford University Press
Abstract
Background: Post-capillary pulmonary hypertension (PH) is highly prevalent
in advanced heart failure (HF) patients. PH can evolve to a reactive
profile, defined by ESC guidelines from right heart catheterization (RHC)
parameters. When reactive PH is fixed despite reversibilty drug testing
(RDT), isolated heart transplantation is contraindicated. This study
reports on a single center's experience of open-label 3 months sildenafil
therapy, a selective inhibitor of type 5 phosphodiesterase (PDE) in HF
patients with reactive PH, focusing on the effects on pulmonary
hemodynamics in basal conditions and during RDT with systematic use of
enoximone, a selective inhibitor of type 3 PDE. Methods: We conducted a
retrospective systematic review of patients addressed in our hospital for
PH RDT before heart transplantation and who secondly received sildenafil
therapy at the dose of 60 mg daily because of reactive PH despite optimal
treatment. We compared trans-pulmonary gradient (TPG), cardiac index (CI)
and pulmonary vascular resistance (PVR) at baseline and after three months
of sildenafil, before and after RDTusing systematically intra-veinous
enoximone. Dobutamine, diuretics, nitrates or inhaled nitric oxide (NO)
could be associated to reach PH reversibility criteria defined by ESC
guidelines. Patients that did not reach those criteria were considered
with fixed PH. Results: 12 patients were treated by sildenafil in this
indication. Basal values of RHC at 3 months showed a 22% decrease in TPG
(18 +/- 4.5 to 14 +/- 3.6 mm Hg), a 16% increase in CI (1.9 +/- 0.5 to 2.2
+/- 0.6 L /mn/m²), and a 26% decrease in PVR (5 +/- 1.7 to 3.7
+/- 1.2 UW). None of these hemodynamic variations reached statistical
significancy because of the small sample size and subsequent heterogeneity
of individual responses to the therapy. However, regarding every
individuals, all had reactive PH at baseline and three of them evolved to
a passive PH at 3 months. Concerning PH RDT, 5 on the 12 patients had a
fixed PH at baseline. At 3 months, 4 evolved to a reversible PH and 3 on
these 4 patients had a successful isolated heart transplantation.
Conclusion: In advanced HF patients with reactive PH, 3 months sildenafil
therapy was associated with an increase in CI and a decrease of TPG and
PVR on basal RHC. Dual inhibition of type 5 and 3 PDE with combined
sildenafil and intra-veinous enoximone during RDT was able to reverse
reactive and fixed PH to a reversible profile which is a crucial point for
therapeutic decision in these patients. These results suggest a strong
implication of NO and PDE pathway in reactive PH secondary to HF.

<15>
Accession Number
71186712
Authors
Shah A. Culligan M. Friedberg J.S. Sterman D.H. Alley E. Stevenson J.P.
Glatstein E. Cengel K. Hahn S.M. Simone C.B.
Institution
(Shah) Columbia University, New York, NY, United States
(Culligan, Friedberg, Sterman, Alley, Glatstein, Cengel, Hahn, Simone)
University of Pennsylvania, Philadelphia, PA, United States
(Stevenson) Cleveland Clinic, Cleveland, OH, United States
Title
Malignant pleural mesothelioma patients' willingness to participate in a
randomized controlled trial of radical pleurectomy with or without
intraoperative photodynamic therapy.
Source
International Journal of Radiation Oncology Biology Physics. Conference:
55th Annual Meeting of the American Society for Radiation Oncology, ASTRO
2013 Atlanta, GA United States. Conference Start: 20130922 Conference End:
20130925. Conference Publication: (var.pagings). 87 (2 SUPPL. 1) (pp
S486), 2013. Date of Publication: 01 Oct 2013.
Publisher
Elsevier Inc.
Abstract
Purpose/Objective(s): Radical pleurectomy (RP) is a lung-sparing
alternative to extrapleural pneumonectomy (EPP) for patients with
malignant pleural mesothelioma (MPM). Adjuvant radiation therapy after RP
is associated with a greater complication rate than after EPP.
Intraoperative photodynamic therapy (PDT) has been delivered as an
alternate to radiation therapy after RP with excellent reported survival.
It is unclear if these outcomes are due to RP, PDT, or both. We therefore
investigated patients' willingness to participate (WTP) in a randomized
controlled trial (RCT) of RP alone versus RP plus PDT. Materials/Methods:
All consecutive patients with histologically confirmed MPM seen in
consultation from March 2012-December 2012 and eligible for RP and PDT
were prospectively enrolled in this IRBapproved study. Immediately after
radiation oncology and thoracic surgery consultations, patients
participated in structured interviews in which they reviewed a written
description of a hypothetical RCT comparing RP alone to RP plus PDT, were
asked open-ended and focused questions regarding their motivations for and
concerns about RCT enrollment, and completed a written questionnaire. WTP
was evaluated using a 6-point Likert scale (1 = definitely not, 6 =
definitely). Interview transcripts were analyzed using qualitative
research methodology, including thematic data analysis and constant
comparison techniques. Results: Twenty-two patients were enrolled, all of
whom were white. Participants had a median age of 67 years and were
predominantly male (73%) and diagnosed with MPM within 3 months of
interview (77%). Many patients had knowledge of RP (52%) or PDT (48%)
prior to consultation. We identified 15 factors that impacted patients'
WTP that largely focused on five major themes: (1) randomization, (2) hope
for cure, (3) desire to compare treatments, (4) altruism, and (5)
physician opinion (Table). Overall, 50% stated they would "definitely" or
"probably" participate, whereas 32% may enroll, and 18% would "probably
not" or "definitely not" participate. Following consultation, 59% elected
to undergo RP plus PDT. Conclusions: A considerable percentage of patients
express a willingness to participate in a RCT comparing RP alone versus RP
plus PDT for MPM. Patients' motivations for and concerns about RCT
enrollment elicited in this study are being used to optimize trial design
and accrual strategies for a planned phase II/III RCT.