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<1>
Accession Number
2013656960
Authors
Tabari M. Alipour M. Esalati H.
Institution
(Tabari, Alipour, Esalati) Department of Anesthesiology, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Title
Evaluation of oral tiazinidine effects on [intraoperative] hemodynamic
responses during direct laryngoscopy under general anesthesia.
Source
Iranian Red Crescent Medical Journal. 15 (7) (pp 541-546), 2013. Date of
Publication: July 2013.
Publisher
Iranian Red Crescent Society (PO Box: 2330, Dubai , UAE, United Arab
Emirates)
Abstract
Background: Direct laryngoscopy and tracheal intubation can result in
blood pressure and heart rate increase which in turn may lead to
myocardial ischemia, cerebral hemorrhage, and even death in susceptible
patients. Tizanidine is alpha2-receptor agonists that suppresses central
sympathetic system. Objectives: This study evaluates the effects of oral
Tizanidine on hemodynamic responses during operations and aims to
determine the appropriate Propofol dosage to maintain anesthesia under BIS
monitoring. Materials and Methods: A double-blind clinical trial has been
performed on 70 candidates for elective abdominal surgery undergoing
general anesthesia in Educational Hospital of Ghaem, Mashhad, Iran. 35
randomly selected patients (the case group) were given 4 mg of oral
Tizanidine 90 minutes before the induction of anesthesia whereas the
remaining subjects (the control group) were given placebo. Blood pressure
and heart rate before and after induction of anesthesia, and after
intubation and extubation, existence of postoperative shivering, and the
needed Propofol dosage were measured and recorded. Data analysis was done
with T-test and Chi-squared test, using SPSS software version 16. Results:
Variations of blood pressure and heart rate after anesthesia induction,
intubation and extubation were less in Tizanidine group generally.
Postoperative shivering was reported in 28.6% and 11.4% of patients in
control and case group respectively. Average propofol needed dose for
anesthesia maintenance in case group was 25% less than the needed amount
in the control group. Conclusions: Using oral Tizanidine as a
premedication, yielded stability in blood pressure and heart rate during
surgery and decreased required Propofol. Considering its short duration of
action, Tizanidine use as a premedication is recommended for sedation and
stabilization of hemodynamic responses during the operations. 2013,
Iranian Red Crescent Medical Journal.

<2>
Accession Number
2013649435
Authors
Abdallah M.S. Wang K. Magnuson E.A. Spertus J.A. Farkouh M.E. Fuster V.
Cohen D.J.
Institution
(Abdallah, Wang, Magnuson, Spertus, Cohen) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City School of Medicine,
4401Wornall Rd, Kansas City, MO 64111, United States
(Abdallah, Magnuson, Spertus, Cohen) University of Missouri-Kansas City
School of Medicine, Kansas City, MO, United States
(Farkouh, Fuster) Mount Sinai School of Medicine, New York, NY, United
States
(Farkouh) Peter Munk Cardiac Centre, Li Ka Shing Knowledge Institute,
University of Toronto, Toronto, ON, Canada
Title
Quality of life after PCI vs CABG among patients with diabetes and
multivessel coronary artery disease: A randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 310 (15) (pp
1581-1590), 2013. Date of Publication: 2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
IMPORTANCE: The FREEDOM trial demonstrated that among patients with
diabetes mellitus and multivessel coronary artery disease, coronary artery
bypass graft (CABG) surgery resulted in lower rates of death and
myocardial infarction but a higher risk of stroke when compared with
percutaneous coronary intervention (PCI) using drug-eluting stents.
Whether there are treatment differences in health status, as assessed from
the patient's perspective, is unknown. OBJECTIVES: To compare the relative
effects of CABG vs PCI using drug-eluting stents on health status among
patients with diabetes mellitus and multivessel coronary artery disease.
DESIGN, SETTING, AND PARTICIPANTS: Between 2005 and 2010, 1900 patients
from 18 countries with diabetes mellitus and multivessel coronary artery
disease were randomized to undergo either CABG surgery (n = 947) or PCI (n
= 953) as an initial treatment strategy. Of these, a total of 1880
patients had baseline health status assessed (935 CABG, 945 PCI) and
comprised the primary analytic sample. INTERVENTIONS: Initial
revascularization with CABG surgery or PCI. MAIN OUTCOMES AND MEASURES:
Health statuswas assessed using the angina frequency, physical
limitations, and quality-of-life domains of the Seattle Angina
Questionnaire at baseline, at 1, 6, and 12 months, and annually
thereafter. For each scale, scores range from 0 to 100 with higher scores
representing better health. The effect of CABG surgery vs PCI was
evaluated using longitudinal mixed-effect models. RESULTS: At baseline,
mean (SD) scores for the angina frequency, physical limitations, and
quality-of-life subscales of the Seattle Angina Questionnaire were 70.9
(25.1), 67.3 (24.4), and 47.8 (25.0) for the CABG group and 71.4 (24.7),
69.9 (23.2), and 49.2 (25.7) for the PCI group, respectively. At 2-year
follow-up, mean (SD) scores were 96.0 (11.9), 87.8 (18.7), and 82.2 (18.9)
after CABG and 94.7 (14.3), 86.0 (19.3), and 80.4 (19.6) after PCI, with
significantly greater benefit of CABG on each domain (mean treatment
benefit, 1.3 [95%CI, 0.3-2.2], 4.4 [95%CI, 2.7-6.1], and 2.2 [95%CI,
0.7-3.8] points, respectively; P < .01 for each comparison). Beyond 2
years, the 2 revascularization strategies provided generally similar
patient-reported outcomes. CONCLUSIONS AND RELEVANCE: For patients with
diabetes and multivessel CAD, CABG surgery provided slightly better
intermediate-term health status and quality of life than PCI using
drug-eluting stents. Themagnitude of benefit was small, without consistent
differences beyond 2 years, in part due to the higher rate of repeat
revascularization with PCI.

<3>
Accession Number
2013624943
Authors
Zakkar M. Frazer S. Hunt I.
Institution
(Zakkar, Frazer, Hunt) Department of Cardiothoracic Surgery, St. George's
Hospital, Blackshaw Road, London SW17 0QT, United Kingdom
Title
Is there a role for Gabapentin in preventing or treating pain following
thoracic surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (4) (pp 716-719),
2013. Date of Publication: October 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether gabapentin, a
commonly prescribed neuropathic analgesic and anticonvulsant, is safe and
beneficial in patients with post-thoracotomy pain following thoracic
surgery. Seventeen papers were identified using the search described
below, and five papers presented the best evidence to reach conclusions
regarding the issues of interest for this review. Side effects and
complications as well as evidence of benefit, typically using various
pain-scoring systems, were included in the assessment. The author, date
and country of publication, patient group studied, study type, relevant
outcomes, results and study weaknesses of the papers are tabulated. The
systematic review of two randomized controlled trials (RCTs) demonstrated
that the use of a single dose gabapentin does not reduce pain scores or
the need for epidural or morphine immediately in hospital following
thoracic surgery. One double-blinded RCT used multiple doses of gabapentin
perioperatively and showed that oral gabapentin administered
preoperatively and during the first 2 days postoperatively, in conjunction
with patient controlled analgesia morphine, provides effective analgesia
in thoracic surgery with a consequent improvement in postoperative
pulmonary function and less morphine consumption. One prospective clinical
study comparing a 2-month course of gabapentin with naproxen sodium for
chronic post thoracotomy pain following surgery showed significant
improvement in both the visual analogue scale (VAS) score and the Leeds
assessment of neuropathic symptoms and signs (LANSS) at 60 days in the
gabapentin (P = 0.001). One prospective study of out-patients with chronic
pain (>4 weeks since thoracotomy performed) suggested that gabapentin is
effective, safe and well tolerated when used for persistent postoperative
and post-traumatic pain in thoracic surgery patients. We conclude that
there is no evidence to support the role of a single preoperative oral
dose of gabapentin in reducing pain scores or opioid consumption following
thoracic surgery. Multiple dosing regimens may be beneficial in reducing
acute and chronic pain; however, more robust randomized control studies
are needed. The Author 2013. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<4>
Accession Number
2013624942
Authors
Greenwood A. West D.
Institution
(Greenwood, West) Department of Thoracic Surgery, Bristol Royal Infirmary,
Upper Maudlin Street, Bristol BS2 8HW, United Kingdom
Title
Is a thoracotomy rather than thoracoscopic resection associated with
improved survival after pulmonary metastasectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (4) (pp 720-724),
2013. Date of Publication: October 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'in patients undergoing
pulmonary metastasectomy, does a thoracotomy (rather than a thoracoscopic
approach) affect survival?' Altogether >153 papers were found using the
reported search, of which seven represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. No papers were greater than
level-three evidence. Length of stay and length of chest drainage were
found to be significantly shorter in the minimally invasive groups in one
study, although this result is undermined by significant differences
between the two cohorts. One paper demonstrated that, although there was a
significantly closer resection margin in thoracoscopic resections, this
had no effect on survival or recurrence rates. A prognostic analysis found
no correlation between surgical approach and survival across a number of
primary pathologies. However, by analysing the results by primary
pathology, the sample groups were small. Despite no difference being found
in outcome, more complications were seen with open resections in one
study, and although there was a trend towards improved disease survival
following resection of single resections by video-assisted thoracoscopic
surgery (VATS), this did not reach significance. We conclude that there
have been few high-quality studies to date, and further studies would be
beneficial. From the published data, VATS metastasectomy has been
associated with shorter hospital stays, chest drainage times and
perioperative complications. We did not find evidence for a survival
difference with either approach, and the lack of high-quality data makes
it impossible to recommend any particular surgical approach in terms of
long-term survival. The Author 2013. Published by Oxford University Press
on behalf of the European Association for Cardio-Thoracic Surgery. All
rights reserved.

<5>
Accession Number
2013624941
Authors
Angadi U. Westrope C. Chowdhry M.F.
Institution
(Angadi, Westrope) Department of Paediatric Critical Care, University
Hospitals of Leicester, Douglas Court, Walnut Street, Leicester LE2 7GG,
United Kingdom
(Chowdhry) Department of Cardiothoracic Surgery, University Hospitals of
Leicester, Leicester, United Kingdom
Title
Is levosimendan effective in paediatric heart failure and post-cardiac
surgeries?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (4) (pp 710-714),
2013. Date of Publication: October 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was 'do children with heart
failure post-cardiac surgery undergoing treatment with levosimendan have
an acceptable haemodynamic improvement?' The use of levosimendan as a
vasoactive drug is an accepted intervention for patients with altered
haemodynamics post-cardiac surgeries. However, the role of levosimendan
and its efficacy have been debated. Eleven relevant papers were
identified, which represented the best evidence to answer the question.
The author, journal, date, country of publication and relevant outcomes
are tabulated. The 11 studies comprised 3 randomized trials, 2 of which
compared levosimendan and milrinone. A single-centre randomized study that
included 40 infants showed that cardiac output (CO) and cardiac index (CI)
increased overtime in the levosimendan group compared with the milrinone
group. The significant interaction for CO (P = 0.005) and CI (P = 0.007)
indicated different time courses in the two groups. A similar, European
randomized study undertaken on neonates (n = 63) showed better lactate
levels [P = 0.015 (intensive care admission); P = 0.048 (after 6 h) with
low inotropic scores in the levosimendan group. Although the length of
mechanical ventilation and mortality were less, this was statistically
insignificant. A retrospective cohort analysis (n = 13) in children
reported a reduced use of dobutamine and improvement in the ejection
fraction from 29.8 to 40.5% (P = 0.015) with the use of levosimendan. In a
questionnaire-based study from Finland, 61.1% of respondents felt that it
had saved the lives of some children when the other treatments had failed.
No study reported any adverse effect attributable to use of levosimendan.
In conclusion, the above studies were in favour of levosimendan as a safe
and feasible drug providing potential clinical benefit in low cardiac
output syndrome (LCOS) and post-cardiac surgeries when other vasoactive
drugs were insufficient to maintain stable haemodynamics. A small sample
size was indeed a limitation in all the above studies. Furthermore, it is
best used as a rescue drug on a named-patient basis. A small sample size
was indeed a limitation in all the above studies. Larger, well-designed
trials are required to further evaluate the efficacy and feasibility of
levosimendan in paediatric heart failure and post-cardiac surgeries. The
Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<6>
Accession Number
2013624940
Authors
Ishaq M. Pessotto R.
Institution
(Ishaq, Pessotto) Department of Cardiothoracic Surgery University
Hospital, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom
Title
Might rapid implementation of cardiopulmonary bypass in patients who are
failing to recover after a cardiac arrest potentially save lives?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (4) (pp 725-730),
2013. Date of Publication: October 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
The question addressed was whether it might be beneficial to have a
rapid-response emergency cardiopulmonary bypass service for patients who
suffer an in-hospital or an out-of-hospital cardiac arrest of any
aetiology. Eighty-five papers were reviewed using the reported search, of
which 15 represented the best evidence to answer the clinical question.
The authors, journal, date, country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
The concept of using emergency cardiopulmonary bypass (ECPB) for the
management of cardiogenic shock and refractory cardiac arrest was
developed in the late 1990s. Since this time, a large number of centres
worldwide have reported success with use of ECPB for cardiac arrest
refractory to conventional resuscitation techniques and for cardiogenic
shock. This is a relatively new advancement in resuscitative strategy and
is expanding in clinical practice. Clinical studies and experimental data
reveal that ECPB is a very effective tool in the return of spontaneous
circulation following refractory cardiac arrest. Resuscitation with this
technique demonstrated survival benefit when compared with patients having
conventional cardiopulmonary resuscitation for >10 min after witnessed
in-hospital arrest, especially if the cause of arrest is of cardiac
origin. The reported finding from a systematic review of 1494 patients
treated with ECPB noted that the overall survival rate was 47.4%; their
results indicate that the application of ECPB in cardiac arrest improves
survival and the likelihood of a satisfactory neurological outcome. An
additional review revealed that acceptable survival rate and neurological
outcomes (30%) can be achieved with extracorporeal cardiopulmonary
resuscitation in children after prolonged cardiac arrest (up to 95 min)
refractory to standard resuscitation. However, no study has provided
clear-cut evidence of the merits of ECPS in patients with out-of-hospital
cardiac arrest, although many case reports and case series have concluded
that it is an effective method. We conclude that institution of emergency
cardiopulmonary bypass may save the lives of patients in whom routine
attempts at resuscitation after a cardiac arrest fail, especially after
>10 min. The likelihood of success is much higher for patients who have
in-hospital witnessed cardiac arrest. The Author 2013. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
2013624938
Authors
Adamopoulos S. Gouziouta A. Mantzouratou P. Laoutaris I.D. Dritsas A.
Cokkinos D.V. Mourouzis I. Sfyrakis P. Iervasi G. Pantos C.
Institution
(Adamopoulos, Gouziouta, Laoutaris, Dritsas, Sfyrakis) Department of
Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
(Mantzouratou, Mourouzis, Pantos) Department of Pharmacology, University
of Athens, 75 Mikras Asias Ave., 11527 Goudi, Athens, Greece
(Cokkinos) Biomedical Research Foundation, Academy of Athens, Athens,
Greece
(Iervasi) Consiglio Nazionale Delle Ricerche (CNR), Institute of Clinical
Physiology, Fondazione Toscana G. Monasterio, Pisa, Italy
Title
Thyroid hormone signalling is altered in response to physical training in
patients with end-stage heart failure and mechanical assist devices:
Potential physiological consequences?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (4) (pp 664-668),
2013. Date of Publication: October 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESThe present study investigated the potential of the failing
myocardium of patients with ventricular assist devices (VAD) to respond to
physiological growth stimuli, such as exercise, by activating growth
signalling pathways. This may be of therapeutic relevance in identifying
novel pharmacological targets for therapies that could facilitate recovery
after VAD implantation.METHODSTwenty-two patients bridged to heart
transplantation (HTx) with VAD were included in the study. A group of
patients underwent moderate intensity aerobic exercise (GT), while another
group of patients did not receive exercise training (CG). Thyroid hormone
receptor alpha1 (TRalpha1) protein and total (t) and phosphorylated (p)
protein kinase B (Akt) and c-Jun N-terminal kinase (JNK) kinase signalling
were measured in myocardial tissue by western blotting at pre-VAD and
pre-HTx period. In addition, Thyroid hormone (TH) levels were measured in
plasma.RESULTSPeak oxygen consumption (VO₂) at pre-HTx period
was higher in patients subjected to training protocol [18.0 (0.8) for GT
when compared with 13.7 (0.7) for CG group, P = 0.002].
N-terminal-prohormone of brain natriuretic peptide (NT-proBNP) levels were
1068 (148) for CG vs 626 (115) for GT group, P = 0.035. A switch towards
up-regulation of physiological growth signalling was observed: the ratio
of p-Akt/t-Akt was 2-fold higher in GT vs CG, P < 0.05 while p-JNK/t-JNK
was 2.5-fold lower (P < 0.05) in GT vs CG, in pre-HTx samples. This
response was accompanied by a 2.0-fold increase in TRalpha1 expression in
pre-HTx samples with concomitant increase in circulating T3 in GT vs CG, P
< 0.05. No differences in peak VO_2, NT-proBNP, T3, TRalpha1,
p/t-AKT and p/t-JNK were found between groups in the pre-VAD
period.CONCLUSIONSThe unloaded failing myocardium responded to physical
training by enhancing thyroid hormone signalling. This response was
associated with an up-regulation of Akt and suppression of JNK activation.
The Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<8>
Accession Number
2013624932
Authors
Saxena P. Aggarwal S. Misso N.L. Passage J. Newman M.A.J. Thompson P.J.
D'Udekem Y. Praporski S. Konstantinov I.E.
Institution
(Saxena) School of Surgery, University of Western Australia, Perth,
Australia
(Saxena, Passage, Newman) Cardiothoracic Surgery Unit, Sir Charles
Gairdner Hospital, Perth, Australia
(Saxena, Aggarwal, Misso, Thompson) Centre for Asthma, Allergy and
Respiratory Research, University of Western Australia, Perth, Australia
(Saxena, Aggarwal, Misso, Thompson, Konstantinov) Lung Institute of
Western Australia, Perth, Australia
(D'Udekem, Praporski, Konstantinov) Royal Children's Hospital, Murdoch
Children's Research Institute, University of Melbourne, Melbourne,
Australia
Title
Remote ischaemic preconditioning down-regulates kinin receptor expression
in neutrophils of patients undergoing heart surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (4) (pp 653-658),
2013. Date of Publication: October 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESRemote ischaemic preconditioning (RIPC) may protect distant
organs against ischaemia-reperfusion injury. We investigated the impact of
RIPC on kinin receptor expression in neutrophils following RIPC in
patients undergoing coronary artery bypass grafting (CABG).METHODSPatients
undergoing elective CABG with cardiopulmonary bypass (CPB) were randomized
to RIPC (n = 15) or control (n = 15) groups. The study group underwent
RIPC by inflation of a blood pressure cuff on the arm. Expression of kinin
receptors, plasma concentrations of IL-6, IL-8, IL-10, TNF-alpha and
neutrophil elastase were determined at baseline (before RIPC/sham),
immediately before surgery (after RIPC/sham) and 30 min and 24 h after
surgery. Plasma bradykinin levels were assessed before and after
RIPC/sham, and at 30 min, 6, 12 and 24 h after surgery. Serum creatine
kinase (CK), troponin I, C-reactive protein (CRP) and lactate levels were
measured immediately prior to surgery and 30 min, 6, 12, 24 and 48 h after
surgery.RESULTSKinin B2 receptor expression did not differ between the
groups at baseline (pre-RIPC), but was significantly lower in the RIPC
group than in the control group after RIPC/sham (P < 0.05). Expressions of
both kinin B1 and B2 receptors were significantly down-regulated in the
RIPC group, and this persisted to 24 h after surgery (P < 0.001).
Neutrophil elastase levels were significantly increased after surgery.
There were no differences in CK, CRP, cytokine, lactate or troponin I
levels between the groups.CONCLUSIONSRIPC down-regulated the expression of
kinin B1 and B2 receptors in neutrophils of patients undergoing CABG. The
Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<9>
Accession Number
2013624925
Authors
Siddique A. Bose A.K. Ozalp F. Butt T.A. Muse H. Morley K.E. Dark J.H.
Parry G. Clark S.C.
Institution
(Siddique, Bose, Ozalp, Butt, Muse, Morley, Dark, Parry, Clark) Department
of Cardiothoracic Transplantation and Surgery, Freeman Hospital, High
Heaton, Newcastle upon Tyne NE7 7DN, United Kingdom
Title
Vascular anastomotic complications in lung transplantation: A single
institution's experience.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (4) (pp 625-631),
2013. Date of Publication: October 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESLung transplant recipients were reviewed to compare our early
and current experience of vascular complications. Since 1995, we have had
a policy of early identification and intervention.METHODSWe undertook a
retrospective review of all adult lung transplants performed at our
centre. Patients with pulmonary vascular complications before and after
1995 were identified and reviewed to determine changes in management and
outcome.RESULTSWe identified a total of 13 patients with either pulmonary
artery or venous obstruction out of a total of 720 adult lung transplants
(1.8%). There were 9 females and 4 males with an age range of 25-64 years.
Complications were more common in patients with fibrotic lung disease and
involved 15 vascular anastomoses, most commonly the pulmonary arterial
anastomosis. Prior to 1995, 5 cases were identified, all postoperatively.
In this group, the mean time for identification of the complication was
9.4 (range 4-14) days. Only 1 patient survived to discharge. After 1995,
vascular complications were identified intraoperatively in 4 cases and
corrected immediately. Four cases were identified postoperatively (at
<1-17 days) by a computed tomography pulmonary angiogram. Three were
treated surgically within 24 h of diagnosis (using cardiopulmonary bypass
with cold preservation). One patient was managed conservatively. Among
patients identified after 1995, 5 survived to discharge.CONCLUSIONSThough
rare, pulmonary vascular complications after lung transplantation carry
high mortality. In our opinion, early identification and intervention
improves outcome. Intraoperative assessment by pressure gradient
measurement and transoesophageal echocardiography is recommended. Despite
this, mortality remains high and prevention is better than cure. The
Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<10>
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Accession Number
2013669072
Authors
Hahn J.-Y. Song Y.B. Kim E.K. Yu C.W. Bae J.-W. Chung W.-Y. Choi S.-H.
Choi J.-H. Bae J.-H. An K.J. Park J.-S. Oh J.H. Kim S.-W. Hwang J.-Y. Ryu
J.K. Park H.S. Lim D.-S. Gwon H.-C.
Institution
(Hahn, Song, Kim, Choi, Choi, Gwon) Department of Medicine, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Chung) Sejong General Hospital, Bucheon, South Korea
(Bae) Chungbuk National University Hospital, Cheongju, South Korea
(Yu) Seoul National University, Boramae Medical Center, Seoul, South Korea
(Bae) Konyang University Hospital, Daejon, South Korea
(An) KEPCO Medical Center, Seoul, South Korea
(Park) Yeungnam University Hospital, Daegu, South Korea
(Oh) Samsung Changwon Hospital, Sungkyunkwan University School of
Medicine, Changwon, South Korea
(Kim) Chung-Ang University Hospital, Seoul, South Korea
(Hwang) Gyeongsang National University Hospital, Jinju, South Korea
(Ryu) Daegu Catholic University Medical Center, Daegu, South Korea
(Park) Kyungpook National University Hospital, Daegu, South Korea
(Lim) Korea University Anam Hospital, Seoul, South Korea
Title
Ischemic postconditioning during primary percutaneous coronary
intervention: The effects of postconditioning on myocardial reperfusion in
patients with st-segment elevation myocardial infarction (POST) randomized
trial.
Source
Circulation. 128 (17) (pp 1889-1896), 2013. Date of Publication: 22 Oct
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND - : Ischemic postconditioning has been reported to reduce
infarct size in patients with ST-segment-elevation myocardial infarction.
However, cardioprotective effects of postconditioning have not been
demonstrated in a large-scale trial. METHODS AND RESULTS - : We performed
a multicenter, prospective, randomized, open-label, blinded end-point
trial. A total of 700 patients undergoing primary percutaneous coronary
intervention (PCI) for ST-segment-elevation myocardial infarction within
12 hours after symptom onset were randomly assigned to the
postconditioning group or to the conventional primary PCI group in a 1:1
ratio. Postconditioning was performed immediately after restoration of
coronary flow as follows: The angioplasty balloon was positioned at the
culprit lesion and inflated 4 times for 1 minute with low-pressure (<6
atm) inflations, each separated by 1 minute of deflation. The primary end
point was complete ST-segment resolution (percentage resolution of
ST-segment elevation >70%) measured at 30 minutes after PCI. Complete
ST-segment resolution occurred in 40.5% of patients in the
postconditioning group and 41.5% of patients in the conventional PCI group
(absolute difference, -1.0%; 95% confidence interval, -8.4 to 6.4;
P=0.79). The rate of myocardial blush grade of 0 or 1 and the rate of
major adverse cardiac events (a composite of death, myocardial infarction,
severe heart failure, or stent thrombosis) at 30 days did not differ
significantly between the postconditioning group and the conventional PCI
group (17.2% versus 22.4% [P=0.20] and 4.3% versus 3.7% [P=0.70],
respectively). CONCLUSION - : Ischemic postconditioning did not improve
myocardial reperfusion in patients with ST-segment-elevation myocardial
infarction undergoing primary PCI with current standard practice. CLINICAL
TRIAL REGISTRATION - : URL: http://clinicaltrials.gov. Unique identifier:
NCT00942500. 2013 American Heart Association, Inc.

<11>
Accession Number
2013661134
Authors
Seo J.-H. Kwon T.-K. Jeon Y. Hong D.M. Kim H.J. Bahk J.-H.
Institution
(Seo, Jeon, Hong, Kim, Bahk) Department of Anaesthesiology and Pain
Medicine, Seoul National University College of Medicine, 101 Daehak-ro,
Jongno-gu, Seoul 110-744, South Korea
(Kwon) Department of Otorhinolaryngology Head and Neck Surgery, Seoul
National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744,
South Korea
Title
Comparison of techniques for double-lumen endobronchial intubation:
90degree or 180degree rotation during advancement through the glottis.
Source
British Journal of Anaesthesia. 111 (5) (pp 812-817), 2013. Date of
Publication: November 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundDuring endobronchial intubation with a double-lumen
endobronchial tube (DLT), the DLT is conventionally rotated through
90degreewhen the bronchial tip is just past the vocal cords. This study
was performed to investigate if rotation of the DLT through
180degreedecreases postoperative hoarseness, sore throat, or vocal cord
injuries.MethodsPatients (n=164) undergoing thoracic surgery were
randomized into two groups. Just after the bronchial tip passed the
glottis, left-sided DLTs were rotated 90degree(Group 90, n=84) or
180degree(Group 180, n=80) counterclockwise and advanced. In the Group
180, DLTs were re-rotated 90degreeclockwise after the tracheal tip passed
the glottis. Resistance during the advance of DLTs was assessed.
Hoarseness and sore throat were evaluated for three postoperative days.
Vocal cords were examined on the first postoperative day.ResultsIn nine
patients allocated to Group 90, the DLT could not be advanced past the
glottis because of severe resistance. There was less resistance to
advancement of the DLT in Group 180 compared with Group 90 (P<0.001). The
incidence of hoarseness was comparable between the two groups. Sore throat
and vocal cord injuries occurred less frequently in Group 180 compared
with Group 90 (20 vs 40%, P=0.008; 19 vs 47%, P=0.032).
ConclusionsRotation of a DLT through 180degreefacilitated its passage
through the glottis and reduced the incidence of postoperative sore throat
and vocal cord injuries.ClinicalTrials.gov registration numberNCT01441362.
The Author [2013]. Published by Oxford University Press on behalf of the
British Journal of Anaesthesia. All rights reserved.

<12>
Accession Number
2013657066
Authors
Taghipour H. Shafiei H. Assar O. Ghiasi M.S.
Institution
(Taghipour) Trauma research center, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Shafiei) Cardiac Surgery Ward, Baqiyatallah Hospital, Tehran, Iran,
Islamic Republic of
(Assar) Cardiovascular Research Center, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Ghiasi) Jamaran Heart Hospitals, Tehran, Iran, Islamic Republic of
Title
The effect of systemic arterial-line leukocyte filtration on the outcome
of adult patients undergoing cardiac surgery.
Source
Iranian Red Crescent Medical Journal. 15 (5) (pp 414-417), 2013. Date of
Publication: May 2013.
Publisher
Iranian Red Crescent Society (PO Box: 2330, Dubai , UAE, United Arab
Emirates)
Abstract
Background: It is known that cardiopulmonary bypass causes an inflammatory
reaction with associated morbidity and mortality. Several
anti-inflammatory strategies have been implemented to reduce this
response, including leukocyte removal from the circulation using
specialized filters. Objectives: The aim of this randomized clinical study
was to assess the impact of arterial-line systemic leukocyte filtration on
the postoperative outcome of adult patients undergoing elective cardiac
surgery. Patients and Methods: 114 patients undergoing CABG or valve
replacement in Baqiyatallah hospital, Tehran, Iran from May to August 2011
were randomly assigned to two groups: with and without leukocyte
filtration and their outcomes were compared. Results: The postoperative
intubation time was significantly shorter in patients with leukocyte
filters (0.014). There was no significant difference between two groups
regarding other outcome relatedvariables. Conclusions: Systemic arterial
leukocyte filtration reduces the intubation time but has no other
beneficial effect on the outcome of patients undergoing CABG or valve
surgery. 2013, Iranian Red Crescent Medical Journal.

<13>
Accession Number
2013635491
Authors
Shahbazi S. Panah A. Sahmeddini M.A.
Institution
(Shahbazi, Panah, Sahmeddini) Shiraz Anesthesiology and Intensive Care
Research Center, Nemazee Hospital, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
Title
Evaluation of factors influencing liver function test in on-pump coronary
artery bypass graft surgery.
Source
Iranian Journal of Medical Sciences. 38 (4) (pp 308-313), 2013. Date of
Publication: 2013.
Publisher
Shiraz University of Medical Sciences (Nemazee Hospital, P.O.Box:
71345-1978, Shiraz 71934, Iran, Islamic Republic of)
Abstract
Liver dysfunction during on-pump coronary artery bypass graft surgery
(CABG) is a rare complication but is associated with significant morbidity
and mortality. The ability to identify high-risk patients may be helpful
in planning appropriate management strategies. We aimed to evaluate the
factors influencing liver function tests during on-pump CABG. Methods: In
146 patients scheduled for on-pump CABG, the liver function test was done
preoperatively and on the first postoperative day. Some preoperative and
intraoperative risk factors were checked and then the postoperative liver
function tests were compared with the preoperative ones. Probable
relationships between these changes and the preoperative and
intraoperative risk factors were studied. Results: A medical history of
diabetes had a significant relationship with the changes in direct
bilirubin. Preoperative central venous pressure had a significant
relationship with the changes in aspartate aminotransferase and alanine
aminotransferase. Use of intra-aortic balloon pump and duration of aortic
cross-clamp were significantly related to the changes in the liver
function tests except for alanine aminotransferase and alkaline
phosphatase. Conclusion: It seems that the techniques for the reduction of
cardiopulmonary bypass and aortic cross-clamp duration may be useful to
protect liver function. We recommend that a larger population of patients
be studied to confirm these findings.

<14>
Accession Number
2013658631
Authors
Meister R. Princip M. Schmid J.-P. Schnyder U. Barth J. Znoj H. Herbert C.
von Kanel R.
Institution
(Meister, Princip, von Kanel) Department of General Internal Medicine,
Division of Psychosomatic Medicine, Inselspital Bern University Hospital,
University of Bern, Bern, Switzerland
(Meister, Princip, von Kanel) Department of Clinical Research, University
of Bern, Bern, Switzerland
(Meister, Princip, Znoj) Institute of Psychology, Division of Clinical
Psychology and Psychotherapy, University of Bern, Bern, Switzerland
(Schmid, von Kanel) Department of Cardiology, Cardiovascular Prevention,
Rehabilitation and Sports Medicine, Inselspital Bern University Hospital,
University of Bern, Bern, Switzerland
(Schnyder) Department of Psychiatry and Psychotherapy, University Hospital
Zurich, Zurich, Switzerland
(Barth) Institute of Social and Preventive Medicine, University of Bern,
Bern, Switzerland
(Herbert) The Oxford Development Center Ltd., Oxfordshire, United Kingdom
Title
Myocardial Infarction - Stress PRevention INTervention (MI-SPRINT) to
reduce the incidence of posttraumatic stress after acute myocardial
infarction through trauma-focused psychological counseling: Study protocol
for a randomized controlled trial.
Source
Trials. 14 (1) , 2013. Article Number: 329. Date of Publication: 11 Oct
2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Posttraumatic Stress Disorder (PTSD) may occur in patients
after exposure to a life-threatening illness. About one out of six
patients develop clinically relevant levels of PTSD symptoms after acute
myocardial infarction (MI). Symptoms of PTSD are associated with impaired
quality of life and increase the risk of recurrent cardiovascular events.
The main hypothesis of the MI-SPRINT study is that trauma-focused
psychological counseling is more effective than non-trauma focused
counseling in preventing posttraumatic stress after acute
MI.Methods/Design: The study is a single-center, randomized controlled
psychological trial with two active intervention arms. The sample consists
of 426 patients aged 18 years or older who are at 'high risk' to develop
clinically relevant posttraumatic stress symptoms. 'High risk' patients
are identified with three single-item questions with a numeric rating
scale (0 to 10) asking about 'pain during MI', 'fear of dying until
admission' and/or 'worrying and feeling helpless when being told about
having MI'. Exclusion criteria are emergency heart surgery, severe
comorbidities, current severe depression, disorientation, cognitive
impairment and suicidal ideation. Patients will be randomly allocated to a
single 45-minute counseling session targeting either specific MI-triggered
traumatic reactions (that is, the verum intervention) or the general role
of psychosocial stress in coronary heart disease (that is, the control
intervention). The session will take place in the coronary care unit
within 48 hours, by the bedside, after patients have reached stable
circulatory conditions. Each patient will additionally receive an
illustrated information booklet as study material. Sociodemographic
factors, psychosocial and medical data, and cardiometabolic risk factors
will be assessed during hospitalization. The primary outcome is the
interviewer-rated posttraumatic stress level at three-month follow-up,
which is hypothesized to be at least 20% lower in the verum group than in
the control group using the t-test. Secondary outcomes are posttraumatic
stress levels at 12-month follow-up, and psychosocial functioning and
cardiometabolic risk factors at both follow-up assessments. Discussion: If
the verum intervention proves to be effective, the study will be the first
to show that a brief trauma-focused psychological intervention delivered
within a somatic health care setting can reduce the incidence of
posttraumatic stress in acute MI patients.Trial registration:
ClinicalTrials.gov: NCT01781247. 2013 Meister et al.; licensee BioMed
Central Ltd.

<15>
Accession Number
2013636397
Authors
Kobashigawa J.A. Pauly D.F. Starling R.C. Eisen H. Ross H. Wang S.-S.
Cantin B. Hill J.A. Lopez P. Dong G. Nicholls S.J.
Institution
(Kobashigawa) Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center,
Los Angeles, CA, United States
(Pauly, Hill) Division of Cardiovascular Medicine, University of Florida
College of Medicine, Gainesville, FL, United States
(Starling, Nicholls) Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH, United States
(Eisen) Division of Cardiology, Drexel University College of Medicine,
Philadelphia, PA, United States
(Ross) Division of Experimental Therapeautics, Toronto Medical Hospital,
Toronto, ON, Canada
(Wang) Department of Cardiovascular Surgery, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Cantin) Lipid Research Center, Laval University Medical Center, QC,
Canada
(Lopez) Novartis Pharma AG, Basel, Switzerland
(Dong) Novartis Pharmaceuticals Corporation, East Hanover, NJ, United
States
Title
Cardiac allograft vasculopathy by intravascular ultrasound in
hearttransplantpatients. Substudy fromthe everolimus versus mycophenolate
mofetil randomized, multicenter trial.
Source
JACC: Heart Failure. 1 (5) (pp 389-399), 2013. Date of Publication:
October 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: A pre-planned substudy of a larger multicenter randomized
trial was undertaken to compare the efficacy of everolimus with
reduced-dose cyclosporine in the prevention of cardiac allograft
vasculopathy (CAV) after heart transplantation to that of mycophenolate
mofetil (MMF) with standard-dose cyclosporine. Background: CAV is a major
cause of long-term mortality following heart transplantation. Everolimus
has been shown to reduce the severity and incidence of CAV as measured by
first year intravascular ultrasound (IVUS). MMF, in combination with
cyclosporine, has also been shown to have a beneficial effect in slowing
the progression of CAV. Methods: Study patients were a pre-specified
subgroup of the 553. -patient Everolimus versus mycophenolate mofetil in
heart transplantation: a randomized, multicenter trial who underwent heart
transplantation and were randomized to everolimus 1.5 mg or MMF 3 g/day.
IVUS was performed at baseline and at 12 months. Evaluable IVUS data were
available in 189 patients (34.6%). Results: Increase in average maximal
intimal thickness (MIT) from baseline to month 12 was significantly
smaller in the everolimus 1.5 mg group compared with the MMF group (0.03
mm vs. 0.07 mm, p< 0.001). The incidence of CAV, defined as an increase in
MIT from baseline to month 12 of greater than 0.5 mm, was 12.5% with
everolimus versus 26.7% with MMF (p= 0.018). These findings remained
irrespective of sex, age, diabetic status, donor disease, and across lipid
categories. Conclusions: Everolimus was significantly more efficacious
than MMF in preventing CAV as measured by IVUS among heart-transplant
recipients after 1 year, a finding, which was maintained in a range of
patient subpopulations. CV surgery: transplantation, ventricular
assistance, cardiomyopathy. 2013 American College of Cardiology
Foundation.

<16>
Accession Number
2013661305
Authors
D'Onofrio A. Rizzoli G. Messina A. Alfieri O. Lorusso R. Salizzoni S.
Glauber M. Di Bartolomeo R. Besola L. Rinaldi M. Troise G. Gerosa G.
Institution
(D'Onofrio, Rizzoli, Besola, Gerosa) Division of Cardiac Surgery,
University Hospital Centro Gallucci, University of Padova, Via Giustiniani
2, Padova 35128, Italy
(Messina, Troise) Division of Cardiac Surgery, Poliambulanza Hospital,
Brescia, Italy
(Alfieri) Department of Cardiac Surgery, San Raffaele University Hospital,
Milan, Italy
(Lorusso) Cardiac Surgery Unit, Community Hospital, Brescia, Italy
(Salizzoni, Rinaldi) Division of Cardiac Surgery, University of Turin,
Turin, Italy
(Glauber) Department of Adult Cardiac Surgery, G. Pasquinucci Heart
Hospital, Massa, Italy
(Di Bartolomeo) Division of Cardiac Surgery, University of Bologna,
Bologna, Italy
Title
Conventional surgery, sutureless valves, and transapical aortic valve
replacement: What is the best option for patients with aortic valve
stenosis? A multicenter, propensity-matched analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (5) (pp 1065-1071),
2013. Date of Publication: November 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective Although surgical aortic valve replacement (SAVR) is the
treatment of choice for patients with aortic valve stenosis, transcatheter
aortic valve replacement (TAVR) and sutureless aortic valve replacement
(SU-AVR) have shown good results. The aim of our multicenter,
propensity-matched study was to compare the clinical and hemodynamic
outcomes of surgical SAVR, transapical TAVR (TA-TAVR), and SU-AVR. Methods
We analyzed data from 566 TA-TAVR, 349 SAVR, and 38 SU-AVR patients
treated from January 2009 to March 2012. We used a propensity-matching
strategy to compare on-pump (SAVR, SU-AVR) and off-pump (TA-TAVR) surgical
techniques. The outcomes were analyzed using multivariate weighted
logistic regression or multinomial logistic analysis. Results In the
matched cohorts, the 30-day overall mortality was significantly lower
after SAVR than TA-TAVR (7% vs 1.8%, P =.026), with no differences in
mortality between SU-AVR and TA-TAVR. Multivariate analysis showed SU-AVR
to have a protective effect, although not statistically significant,
against aortic regurgitation, pacemaker implantation, and renal
replacement therapy compared with TA-TAVR. Compared with TA-TAVR, SAVR
demonstrated significant protection against aortic regurgitation (odds
ratio, 0.04; P <.001) and a trend toward protection against death,
pacemaker implantation, and myocardial infarction. The mean transaortic
gradient was 10.3 +/- 4.4 mm Hg, 11 +/- 3.4 mm Hg, and 16.5 +/- 5.8 mm Hg
in the TA-TAVR, SU-AVR, and SAVR patients, respectively. Conclusions SAVR
was associated with lower 30-day mortality than TA-TAVR. SAVR was also
associated with a lower risk of postoperative aortic regurgitation
compared with TA-TAVR. We did not find other significant differences in
outcomes among matched patients treated with SAVR, SU-AVR, and TA-TAVR.
Copyright 2013 by The American Association for Thoracic Surgery.

<17>
Accession Number
2013661308
Authors
Shen Y. Zhong M. Wu W. Wang H. Feng M. Tan L. Wang Q.
Institution
(Shen, Wang, Feng, Tan, Wang) Division of Thoracic Surgery, Zhongshan
Hospital, Fudan University, 180 Fenglin Rd, Shanghai, China
(Zhong, Wu) Department of Anesthesiology, Zhongshan Hospital, Fudan
University, Shanghai, China
Title
The impact of tidal volume on pulmonary complications following minimally
invasive esophagectomy: A randomized and controlled study.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (5) (pp 1267-1274),
2013. Date of Publication: November 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background Minimally invasive esophagectomy (MIE) has been advantageous
for lowering pulmonary complications compared with open
approaches.¹ However, pulmonary complications remain the most
common morbidity after surgical resection of esophageal
cancer.^2,3 The aim of this prospective, randomized, controlled,
clinical trial was designed to see whether low tidal volume (VT) could
further minimize pulmonary complications after MIE. Methods Between June
2011 and July 2012, a total of 101 patients who underwent MIE received
left-lung ventilation during thoracoscopic esophagectomy. All patients
received left-lung ventilation during thoracoscopic esophagectomy.
Patients were randomly assigned to a low VT (5 mL/kg + 5 cm H₂O
positive end-expiratory pressure) preserved ventilation (PV) group (n =
53) and a conventional VT (8 mL/kg) controlled ventilation (CV) group (n =
48) in the thoracic stage. Alveolar lavage fluid was harvested from the
ventilated lung at intubation and at 18 hours after surgery for analysis
of interleukin (IL)-1s, IL-6, and IL-8 levels. Clinical characteristics,
including patient demographics, operation features, and changes in
oxygenation index, were recorded and analyzed. Pulmonary complications
were identified and statistically compared between the 2 groups. Results
The clinical characteristics and operation features were comparable
between the 2 groups. IL-1s, IL-6, and IL-8 expressions in preoperative
alveolar lavage fluid were similar between the 2 groups. Significantly
lower IL expressions were observed in the PV group than those in the CV
group at 18 hours after MIE (IL-1s, 25.42 +/- 31.01 vs 94.96 +/- 118.24
pg/mL; IL-6, 30.86 +/- 75.78 vs 92.99 +/- 72.90 pg/mL; IL-8, 258.75 +/-
188.24 vs 403.95 +/- 151.44 pg/mL; all P <.05). The 18-hour postoperative
oxygenation index was lower in the CV group than that in the PV group
(292.85 +/- 28.74 vs 326.35 +/- 34.43; P =.046). Pulmonary complications
were observed in 18 cases of our series, occurring more frequently on the
ventilation side (right, 6 cases; and left, 12 cases). All patients were
cured by conservative therapy without severe sequelae. The occurrence of
pulmonary complications in the PV group was lower than that in the CV
group (9.43% vs 27.08%; P =.021). Conclusions Lung injury due to
intraoperative single-lung ventilation may contribute to pulmonary
complications after MIE. Low VT ventilation could decrease
ventilation-associated lung inflammation, thus minimizing pulmonary
complications after MIE. Further studies, based on a larger volume of
populations, are required to confirm these findings. Copyright 2013 by
The American Association for Thoracic Surgery.

<18>
Accession Number
2013665209
Authors
Dasari T.W. Patel B. Saucedo J.F.
Institution
(Dasari, Saucedo) Cardiovascular Section, Department of Internal Medicine,
University of Oklahoma Health Sciences Center, Oklahoma City, OK, United
States
(Patel) Department of Internal Medicine, University of Oklahoma Health
Sciences Center, Oklahoma City, OK, United States
Title
Systematic review of effectiveness of oral sirolimus after bare-metal
stenting of coronary arteries for prevention of in-stent restenosis.
Source
American Journal of Cardiology. 112 (9) (pp 1322-1327), 2013. Date of
Publication: 01 Nov 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Neointimal hyperplasia after percutaneous coronary intervention is a major
determinant of in-stent restenosis (ISR). Drug-eluting stents (DES)
mitigate neointimal hyperplasia and thereby lead to a lower rate of ISR
compared with bare-metal stents (BMS). Recent studies have demonstrated
that short-term use of oral sirolimus after BMS leads to a significant
reduction in ISR. We therefore sought to do a systematic review of studies
to determine the angiographic and clinical benefits of early short-term
use of oral sirolimus after BMS of native coronary arteries. We conducted
PubMed, Embase, Cochrane database review, and Web of Science search of
studies comparing oral sirolimus after BMS to BMS alone or DES. Outcomes
analyzed were ISR and target lesion revascularization (TLR) as well as
major adverse cardiovascular events. A total of 488 patients from 4
studies were included in the review (2006 to 2010). Three studies,
comparing BMS alone versus BMS plus oral sirolimus, demonstrated
significant reduction in ISR in the oral sirolimus group. Two of these
studies also demonstrated significant reduction in TLR at 6-12 month
follow-up. The fourth study comparing BMS plus oral sirolimus versus DES
showed a lower but nonsignificant reduction in TLR in addition to
significant cost saving in the group treated with oral sirolimus. In
conclusion, our systematic review demonstrates that early short-term
systemic use of sirolimus after BMS resulted in a significant reduction in
ISR and TLR. In addition, ISR rates were comparable to DES with the added
benefit of cost saving. 2013 Elsevier Inc. All rights reserved.

<19>
Accession Number
2013663900
Authors
Dabbagh A. Bastanifar E. Foroughi M. Rajaei S. Keramatinia A.A.
Institution
(Dabbagh, Bastanifar, Foroughi, Keramatinia) Anesthesiology Research
Center, Anesthesiology Department, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Rajaei) School of Allied Medical Sciences, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
The effect of intravenous magnesium sulfate on serum levels of N-terminal
pro-brain natriuretic peptide (NT pro-BNP) in elective CABG with
cardiopulmonary bypass.
Source
Journal of Anesthesia. 27 (5) (pp 693-698), 2013. Date of Publication:
October 2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Introduction: Nowadays, many patients undergo coronary artery bypass
grafting (CABG) with a cardiopulmonary bypass (CPB); while a number of
therapeutic agents have been used to suppress its related inflammatory
process. Magnesium sulfate (MgSO₄) solution has been used as an
anti-inflammatory agent. Among the cardiac biomarkers, N-terminal pro
brain natriuretic peptide (NT Pro-BNP) is one of the most widely
recognized. We performed this study to assess the effect of
MgSO₄ solution on NT Pro-BNP levels in patients undergoing CABG
with CPB. Materials and methods: In a double-blind clinical trial, after
IRB approval for ethical considerations, during a 12-month period, 88
adult patients aged 40-70 years qualified for the study after inclusion
and exclusion criteria were considered. After random allocation of the
patients between the two groups, anesthesia, surgical procedure,
cardiopulmonary bypass (CPB) methods, and postoperative care were made as
similar as possible; however, one group received a MgSO₄
infusion (15 mg/kg/h) and the other group saline (placebo). Pre- and
post-operative levels of NT Pro-BNP were assessed using an electrochemical
luminescence immunoassay in an Elecsys 2010 (Roche, Indianapolis, IN,
USA). The results were compared using a Student's t-test. A P value less
than 5 % was considered significant. Results: The MgSO₄ group
had shorter postoperative mechanical ventilation, lower postoperative
morphine requirements and lower postoperative pain scores. Also, 24 h
postoperative NT Pro-BNP levels were significantly lower in the
MgSO₄ group. Conclusion: Administration of MgSO₄ in
elective CABG with CPB can decrease the postoperative NT Pro-BNP levels;
also, it decreases their time of postoperative mechanical ventilation.
2013 Japanese Society of Anesthesiologists.

<20>
Accession Number
2013661330
Authors
Michler R.E. Rouleau J.L. Al-Khalidi H.R. Bonow R.O. Pellikka P.A. Pohost
G.M. Holly T.A. Oh J.K. Dagenais F. Milano C. Wrobel K. Pirk J. Ali I.S.
Jones R.H. Velazquez E.J. Lee K.L. Di Donato M.
Institution
(Michler) Montefiore Medical Center, Albert Einstein College of Medicine,
3400 Bainbridge Ave, New York, NY 10467, United States
(Rouleau) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Al-Khalidi, Milano, Jones, Velazquez, Lee) Duke Clinical Research
Institute, Duke University Medical Center, Durham, NC, United States
(Bonow, Holly) Northwestern University, Feinberg School of Medicine,
Chicago, IL, United States
(Pellikka, Oh) Echocardiography Core Laboratory, Mayo Clinic, Rochester,
MN, United States
(Pohost) University of Southern California, Keck School of Medicine, Los
Angeles, CA, United States
(Pohost) University of Southern California, Viterbi School of Engineering,
Los Angeles, CA, United States
(Dagenais) Laval Hospital, Quebec Heart Institute, Sainte-Foy, QC, Canada
(Wrobel) John Paul II Hospital, Krakow, Poland
(Pirk) Institute for Clinical and Experimental Medicine, Prague, Czech
Republic
(Ali) Libin CV Institute of Alberta, Calgary, AB, Canada
(Di Donato) San Donato Hospital, Milan, Italy
Title
Insights from the STICH trial: Change in left ventricular size after
coronary artery bypass grafting with and without surgical ventricular
reconstruction.
Source
Journal of Thoracic and Cardiovascular Surgery. 146 (5) (pp 1139-1145.e6),
2013. Date of Publication: November 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The present analysis of the Surgical Treatment for Ischemic
Heart Failure randomized trial data examined the left ventricular volumes
at baseline and 4 months after surgery to determine whether any magnitude
of postoperative reduction in end-systolic volume affected survival after
coronary artery bypass grafting alone compared with bypass grafting plus
surgical ventricular reconstruction. Methods: Of the 1000 patients
randomized, 555 underwent an operation and had a paired imaging assessment
with the same modality at baseline and 4 months postoperatively. Of the
remaining 455 patients, 424 either died before the 4-month study or did
not have paired imaging tests and were excluded, and 21 were not
considered because they had died before surgery or did not receive
surgery. Results: Surgical ventricular reconstruction resulted in improved
survival compared with coronary artery bypass grafting alone when the
postoperative end-systolic volume index was 70 mL/m² or less.
However, the opposite was true for patients achieving a postoperative
volume index greater than 70 mL/m². A reduction in the
end-systolic volume index of 30% or more compared with baseline was an
infrequent event in both treatment groups and did not produce a
statistically significant survival benefit with ventricular
reconstruction. Conclusions: In patients undergoing coronary artery bypass
grafting plus surgical ventricular reconstruction, a survival benefit was
realized compared with bypass alone, with the achievement of a
postoperative end-systolic volume index of 70 mL/m ² or less.
Extensive ventricular remodeling at baseline might limit the ability of
ventricular reconstruction to achieve a sufficient reduction in volume and
clinical benefit. Copyright 2013 by The American Association for Thoracic
Surgery.

<21>
Accession Number
2013646948
Authors
Rief M. Zimmermann E. Stenzel F. Martus P. Stangl K. Greupner J. Knebel F.
Kranz A. Schlattmann P. Laule M. Dewey M.
Institution
(Rief, Zimmermann, Stenzel, Greupner, Kranz, Dewey) Department of
Radiology, Charite, Institut fur Radiologie, Chariteplatz 1, 10117 Berlin,
Germany
(Martus) Institute for Clinical Epidemiology and Applied Biostatistics,
Eberhard Karls University, Tubingen, Germany
(Stangl, Knebel, Laule) Department of Cardiology, Charite, Berlin, Germany
(Schlattmann) Department of Medical Statistics, Informatics and
Documentation, University Hospital of Friedrich-Schiller University Jena,
Jena, Germany
Title
Computed tomography angiography and myocardial computed tomography
perfusion in patients with coronary stents: Prospective intraindividual
comparison with conventional coronary angiography.
Source
Journal of the American College of Cardiology. 62 (16) (pp 1476-1485),
2013. Date of Publication: 15 Oct 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This study sought to determine whether adding myocardial
computed tomography perfusion (CTP) to computed tomography angiography
(CTA) improves diagnostic performance for coronary stents. Background CTA
of coronary stents has been limited by nondiagnostic studies caused by
metallic stent material and coronary motion. Methods CTA and CTP were
performed in 91 consecutive patients with stents before quantitative
coronary angiography, the reference standard for obstructive stenosis
(>=50%). If a coronary stent or vessel was nondiagnostic on CTA, adenosine
stress CTP in the corresponding myocardial territory was read for combined
CTA/CTP. Results Patients had an average of 2.5 +/- 1.8 coronary stents (1
to 10), with a diameter of 3.0 +/- 0.5 mm. Significantly more patients
were nondiagnostic for stent assessment by CTA (22%; mainly due to metal
artifacts [75%] or motion [25%]) versus CTP (1%; p < 0.001; severe angina
precluded CTP in 1 case). The per-patient diagnostic accuracy of CTA/CTP
for stents (87%, 95% confidence interval [CI]: 78% to 93%) was
significantly higher than that of CTA alone (71%, 95% CI: 61% to 80%; p <
0.001), mainly because nondiagnostic examinations were significantly
reduced (p < 0.001). In the analysis of any coronary artery disease,
diagnostic accuracy and nondiagnostic rate were also significantly
improved by the addition of CTP (p < 0.001). CTA/CTP (7.9 +/- 2.8 mSv) had
a significantly lower effective radiation dose than angiography (9.5 +/-
5.1 mSv; p = 0.005). The area under the receiver-operating characteristic
curve for CTA/CTP (0.82, 95% CI: 0.69 to 0.95) was superior to that for
CTA (0.69, 95% CI: 0.57 to 0.82; p < 0.001) in identifying patients
requiring stent revascularization. Conclusions Combined coronary CTA and
myocardial CTP improves diagnosis of CAD and in-stent restenosis in
patients with stents compared with CTA alone. (Coronary Artery Stent
Evaluation With 320-Slice Computed Tomography - The CArS 320 Study
[CARS-320]; NCT00967876). 2013 by the American College of Cardiology
Foundation Published by Elsevier Inc.

<22>
Accession Number
2013646944
Authors
Garcia S. Sandoval Y. Roukoz H. Adabag S. Canoniero M. Yannopoulos D.
Brilakis E.S.
Institution
(Garcia, Adabag) Division of Cardiology, Department of Medicine,
Minneapolis Veterans Affairs Healthcare System, One Veterans Drive
(111-C), Minneapolis, MN 55417, United States
(Garcia, Roukoz, Adabag, Yannopoulos) Department of Medicine, University
of Minnesota Medical School, Minneapolis, MN, United States
(Sandoval) Department of Medicine, Hennepin County Medical Center,
Minneapolis, MN, United States
(Canoniero) Department of Medicine, Division of Cardiology, Park Nicollet
Clinic Heart and Vascular Center, St. Louis Park, MN, United States
(Brilakis) Department of Medicine, Division of Cardiology, VA North Texas
Healthcare System, Dallas, TX, United States
(Brilakis) University of Texas Southwestern Medical School, Dallas, TX,
United States
Title
Outcomes after complete versus incomplete revascularization of patients
with multivessel coronary artery disease: A meta-analysis of 89,883
patients enrolled in randomized clinical trials and observational studies.
Source
Journal of the American College of Cardiology. 62 (16) (pp 1421-1431),
2013. Date of Publication: 15 Oct 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This study sought to perform a systematic review and
meta-analysis of studies comparing complete revascularization (CR) versus
incomplete revascularization (IR) in patients with multivessel coronary
artery disease. Background There are conflicting data regarding the
benefits of CR in patients with multivessel coronary artery disease.
Methods We identified observational studies and subgroup analysis of
randomized clinical trials (RCT) published in PubMed from 1970 through
September 2012 using the following keywords: "percutaneous coronary
intervention" (PCI); "coronary artery bypass graft" (CABG); "complete
revascularization"; and "incomplete revascularization." Main outcome
measures were total mortality, myocardial infarction, and repeat
revascularization procedures. Results We identified 35 studies including
89,883 patients, of whom 45,417 (50.5%) received CR and 44,466 (49.5%)
received IR. IR was more common after PCI than after CABG (56% vs. 25%; p
< 0.001). Relative to IR, CR was associated with lower long-term mortality
(risk ratio [RR]: 0.71, 95% confidence interval [CI]: 0.65 to 0.77; p <
0.001), myocardial infarction (RR: 0.78, 95% CI: 0.68 to 0.90; p = 0.001),
and repeat coronary revascularization (RR: 0.74, 95% CI: 0.65 to 0.83; p <
0.001). The mortality benefit associated with CR was consistent across
studies irrespective of revascularization modality (CABG: RR: 0.70, 95%
CI: 0.61 to 0.80; p < 0.001; and PCI: RR: 0.72, 95% CI: 0.64 to 0.81; p <
0.001) and definition of CR (anatomic definition: RR: 0.73, 95% CI: 0.67
to 0.79; p < 0.001; and nonanatomic definition: RR: 0.57, 95% CI: 0.36 to
0.89; p = 0.014). Conclusions CR is achieved more commonly with CABG than
with PCI. Among patients with multivessel coronary artery disease, CR may
be the optimal revascularization strategy. 2013 by the American College
of Cardiology Foundation Published by Elsevier Inc.

<23>
Accession Number
2013646933
Authors
Kumbhani D.J. Bavry A.A. Desai M.Y. Bangalore S. Bhatt D.L.
Institution
(Kumbhani) Division of Cardiology, University of Texas Southwestern
Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9047, United
States
(Bavry) Division of Cardiology, University of Florida, Gainesville, FL,
United States
(Desai) Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH,
United States
(Bangalore) New York University School of Medicine, New York, NY, United
States
(Bhatt) Veterans Affairs Boston Healthcare System, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
Title
Role of aspiration and mechanical thrombectomy in patients with acute
myocardial infarction undergoing primary angioplasty: An updated
meta-analysis of randomized trials.
Source
Journal of the American College of Cardiology. 62 (16) (pp 1409-1418),
2013. Date of Publication: 15 Oct 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This meta-analysis was designed to update data on clinical
outcomes with aspiration thrombectomy or mechanical thrombectomy before
primary percutaneous coronary intervention (PCI) compared with
conventional primary PCI alone. Background The clinical efficacy of
thrombectomy in acute myocardial infarction (AMI) remains uncertain.
Methods Clinical trials that randomized AMI patients to aspiration (18
trials, n = 3,936) or mechanical thrombectomy (7 trials, n = 1,598) before
PCI compared with conventional PCI alone were included. Results The
weighted mean duration of clinical follow-up was 6 months. Aspiration
thrombectomy vs. conventional primary PCI (18 trials, n=3,936): Major
adverse cardiac events (MACE) (risk ratio [RR]: 0.76; 95% confidence
interval [CI]: 0.63 to 0.92; p = 0.006) and all-cause mortality (RR: 0.71;
95% CI: 0.51 to 0.99; p = 0.049) were significantly reduced with
aspiration thrombectomy. Beneficial trends were noted for recurrent MI (p
= 0.11) and target vessel revascularization (p = 0.06). Final infarct size
(p = 0.64) and ejection fraction (p = 0.32) at 1 month were similar.
ST-segment resolution (STR) at 60 min (RR: 1.31; 95% CI: 1.16 to 1.48; p <
0.0001) and Thrombolysis In Myocardial Infarction blush grade (TBG) 3
post-procedure (RR: 1.37; 95% CI: 1.19 to 1.59; p < 0.0001) were both
improved with aspiration thrombectomy. Mechanical thrombectomy vs.
conventional primary PCI (7 trials, n = 1,598): there was no difference
between the mechanical thrombectomy and conventional primary PCI arms in
the incidence of MACE (RR: 1.10; 95% CI: 0.59 to 2.05; p = 0.77),
mortality (p = 0.57), recurrent MI (p = 0.32), target vessel
revascularization (p = 0.19), or final infarct size (p = 0.47). A benefit
in STR at 60 min (RR: 1.25; 95% CI: 1.06 to 1.47; p = 0.007), but not TBG
3 (RR: 1.09; 95% CI: 0.86 to 1.38; p = 0.48) was noted. Conclusions
Thrombectomy during AMI by manual catheter aspiration, but not
mechanically, is beneficial in reducing MACE, including mortality, at 6 to
12 months compared with conventional primary PCI alone. 2013 by the
American College of Cardiology Foundation Published by Elsevier Inc.

<24>
Accession Number
2013646929
Authors
Rodrigo R. Korantzopoulos P. Cereceda M. Asenjo R. Zamorano J.
Villalabeitia E. Baeza C. Aguayo R. Castillo R. Carrasco R. Gormaz J.G.
Institution
(Rodrigo, Carrasco, Gormaz) Molecular and Clinical Pharmacology Program,
Institute of Biomedical Sciences, University of Chile, Independencia 1027
Casilla 70058, Santiago 7, Chile
(Korantzopoulos) Department of Cardiology, University of Ioannina Medical
School, Ioannina, Greece
(Cereceda, Asenjo, Zamorano) Department of Cardiology, University of Chile
Clinical Hospital, Santiago, Chile
(Villalabeitia, Baeza, Aguayo) Cardiothoracic Surgery Unit, San Juan de
Dios Hospital, Santiago, Chile
(Castillo) Institute of Biomedical Sciences, Faculty of Medicine,
University of Chile, Santiago, Chile
Title
A randomized controlled trial to prevent post-operative atrial
fibrillation by antioxidant reinforcement.
Source
Journal of the American College of Cardiology. 62 (16) (pp 1457-1465),
2013. Date of Publication: 15 Oct 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives This study was designed to assess whether the reinforcement of
the antioxidant system, through n-3 fatty acids plus antioxidant vitamin
supplementation, could reduce the incidence of post-operative atrial
fibrillation. Background Therapy to prevent post-operative atrial
fibrillation remains suboptimal. Although oxidative stress plays a key
role in the pathogenesis of this arrhythmia, antioxidant reinforcement has
produced controversial results. Methods A total of 203 patients scheduled
for on-pump cardiac surgery were randomized to placebo or supplementation
with n-3 polyunsaturated fatty acids (2 g/day) (eicosapentaenoic
acid:docosahexaenoic acid ratio 1:2), vitamin C (1 g/day), and vitamin E
(400 IU/day). The primary outcome was the occurrence of post-operative
atrial fibrillation. Secondary outcomes were the biomarkers related to
oxidative stress and inflammation. Results Post-operative atrial
fibrillation occurred in 10 of 103 patients (9.7%) in the supplemented
group versus 32 of 100 patients (32%) in the placebo group (p < 0.001).
Early after surgery, placebo patients presented with increased levels of
biomarkers of inflammation and oxidative stress, which were markedly
attenuated by antioxidant supplementation. The activity of catalase,
superoxide dismutase, and glutathione peroxidase in atrial tissue of the
supplemented patients was 24.0%, 17.1%, and 19.7% higher than the
respective placebo values (p < 0.05). The atrial tissue of patients who
developed atrial fibrillation showed NADPH oxidase p47-phox subunit
protein and mRNA expression 38.4% and 35.7% higher, respectively, than
patients in sinus rhythm (p < 0.05). Conclusions This safe,
well-tolerated, and low-cost regimen, consisting of n-3 polyunsaturated
fatty acids plus vitamins C and E supplementation, favorably affected
post-operative atrial fibrillation, increased antioxidant potential, and
attenuated oxidative stress and inflammation. (Prevention of
Post-Operative Atrial Fibrillation: Pathophysiological Characterization of
a Pharmacological Intervention Based on a Novel Model of Nonhypoxic
Pre-Conditioning; ISRCTN45347268). 2013 by the American College of
Cardiology Foundation Published by Elsevier Inc.

<25>
Accession Number
2013639967
Authors
Azab S. El-Shahawy H. Samy A. Mahdy W.
Institution
(Azab, El-Shahawy, Samy) Cardiothoracic Surgery Department, Ain Shams
University, Egypt
(Mahdy) Cardiothoracic Surgery Department, National Heart Institute, Egypt
Title
Permanent complete heart block following surgical closure of isolated
ventricular septal defect.
Source
Egyptian Journal of Chest Diseases and Tuberculosis. 62 (3) (pp 529-533),
2013. Date of Publication: July 2013.
Publisher
Egyptian Society Of Chest Diseases And Tuberculosis (Egypt)
Abstract
A serious complication after surgical closure of ventricular septal defect
(VSD) is complete heart block (CHB). It continues to be a leading cause of
long-term postoperative cardiac morbidity despite all surgical technical
improvements, especially with performance of more surgical procedures in
increasingly younger patients. Objective: This study was undertaken to
determine the incidence of early postoperative CHB requiring pacemaker
implantation following surgical repair of isolated ventricular septal
defect, and try to identify possible procedural risk factors. Design:
Prospective study design. Setting: Multicenter study: Ain-Shams University
Hospital, Aboul Reesh Student Hospital and The National Heart Institute.
Method: We reviewed four hundred patients who had a surgical repair of
isolated VSD from 2009 to 2011. Results: 14 out of 400 patients (3.5%)
developed permanent post-operative CHB. All; but one; underwent closure of
large perimembranous VSD. CHB patients had a significant lower body weight
(8.36 vs. 12.68. kg, p<. 0.01), longer ACC time (42.6 vs. 36.4. min, p<.
0.01), longer CPB time (75.4 vs. 67.4. min, p<. 0.01) and longer hospital
stay (19 vs. 8.3. days, p<. 0.01). Tricuspid valve detachment was
performed in 28 patients (7%) and was associated with a higher incidence
of CHB (7% vs. 3.75%, p=0.6). Conclusion: Large perimembranous VSD and
lower body weight appear to be independent risk factors for permanent CHB
following the surgical closure of isolated VSD. 2013.

<26>
Accession Number
2013657769
Authors
Lopez M. Patoir A. Varlet F. Perez-Etchepare E. Tiffet T. Villard A.
Tiffet O.
Institution
(Lopez, Patoir, Varlet, Perez-Etchepare, Tiffet, Villard, Tiffet) Unit of
Chest Wall Deformities Children and Adults, University Hospital of Saint
Etienne, 42055 Saint Etienne, France
(Lopez, Patoir, Varlet, Tiffet) Department of Pediatric Surgery,
University Hospital of Saint Etienne, Saint Etienne, France
(Patoir, Tiffet) Department of General and Thoracic Surgery, University
Hospital of Saint Etienne, Saint Etienne, France
Title
Preliminary study of efficacy of dynamic compression system in the
correction of typical pectus carinatum.
Source
European Journal of Cardio-thoracic Surgery. 44 (5) (pp e316-e319), 2013.
Article Number: ezt425. Date of Publication: November 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: This preliminary study evaluates, by qualitative score, the
efficacy of the dynamic compression system (DCS) with a pressuremeasuring
device in the treatment of pectus carinatum (PC) as an alternative to
surgery. Methods: A total of 68 patients (infants, adolescents and young
adults) presenting with typical PC (64 males and 4 females) were evaluated
in our Chest Wall Deformities Unit, between October 2011 and February
2013. The criteria for including subjects were: patients with typical
condrogladiolar PC and pressure for initial correction (PIC) = 9 PSI
(pound square inch). Seven patients were excluded in this study: three
typical PC were treated by minimal invasive surgery (Abramson technique)
due to highly elevated PIC and four atypical PC, hybrids forms (PE and PC)
were treated by cup suction for pectus excavatum and by the DCS for the
PC. The management protocol included: adjustment of the DCS, strengthening
exercises and monthly clinical follow-up. The partial and final results
were evaluated by the patients, by their parents or by both, using a
qualitative scoring scale that was measured in a three-step grading
system, where C is a low or very low result, B is acceptable and A is a
very good or excellent result. Results: A total of 61 patients (59 males
and 2 females) presenting with typical PC were treated by the DCS and
included: symmetric PC in 43 cases and asymmetric PC in 18 cases. The mean
age was 13.5 years (5-25). The mean PIC was 6.3 PSI (3-9 PSI). The mean
utilization time was 19 h daily. The patients were divided into three
groups. In Group I, consisting of 35 cases, all the patients have already
completed the treatment with excellent aesthetic results (A). In 12 cases,
Group II, the normal shape of the thorax has been obtained; all the
patients in this group rated their results as excellent (A); however,
these patients are still wearing the brace as a retainer for 3 additional
months. Fourteen patients, Group III, are progressing and improving under
active treatment, and surgeons and patients are very satisfied with the
initial results. None of the 61 patients in this study abandoned the
treatment and no complications were found. Conclusions: This preliminary
study demonstrated that the DCS with a pressure-measuring device is a
minimal invasive system effective for treatment of PC in patients where
the anterior chest wall is still compliant. The control of different
pressure measurements could be used as the inclusion criterion as well as
a predictive factor for aesthetic results and treatment duration. The
Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<27>
Accession Number
2013657758
Authors
Thimour-Bergstrom L. Roman-Emanuel C. Schersten H. Friberg O. Gudbjartsson
T. Jeppsson A.
Institution
(Thimour-Bergstrom, Roman-Emanuel, Schersten, Jeppsson) Department of
Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg,
Sweden
(Friberg) Department of Cardiothoracic Surgery, Orebro University
Hospital, Orebro, Sweden
(Gudbjartsson) Department of Cardiothoracic Surgery, Landspitali
University Hospital and Faculty of Medicine, University of Iceland
Reykjavik, Reykjavik, Iceland
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Title
Triclosan-coated sutures reduce surgical site infection after open vein
harvesting in coronary artery bypass grafting patients: A randomized
controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 44 (5) (pp 931-938), 2013.
Article Number: ezt063. Date of Publication: November 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
OBJECTIVES: The incidence of surgical site infection (SSI) after open vein
harvesting in coronary artery bypass grafting (CABG) patients ranges in
different studies between 2 and 20%. Triclosan is an antibacterial
substance that reduces the growth of bacteria by inhibiting fatty acid
synthesis. We hypothesized that wound closure with triclosan-coated
sutures would reduce SSI after open vein harvesting. METHODS: An
investigator-initiated prospective randomized double-blind single-centre
study was performed with 374 patients, randomized to subcutaneous and
intracutaneous leg-wound closure with either triclosan-coated sutures
(Vicryl Plus and Monocryl Plus, Ethicon, Somerville, NJ, USA) (n = 184) or
identical sutures without triclosan (n = 190) from the same manufacturer.
All patients were followed up after 30 days (clinical visit) and 60 days
(telephone interview). Primary endpoint was SSI within 60 days after
surgery according to the definition of Center for Disease Control.
Predefined secondary endpoints included culture-proven and
antibiotictreated SSI. RESULTS: The primary endpoint occurred in 23
patients (12.5%) with triclosan-coated sutures and in 38 patients (20.0%)
in the group without triclosan (P = 0.0497, risk ratio 0.63, (95%
confidence interval 0.39-1.00). Corresponding figures for culture-proven
infections were 7.6 vs 12.1%, (P = 0.15), and for antibiotic-treated
infections, 10.9 vs 18.4%, (P = 0.039). Staphylococcus aureus and
coagulasenegative staphylococci were the most common pathogens in both
groups. Insulin-treated diabetes and vein-harvesting time were associated
with SSI after vein harvesting. CONCLUSIONS: Leg-wound closure with
triclosan-coated sutures in CABG patients reduces SSIs after open vein
harvesting. (ClinicalTrials.gov number NCT01212315). The Author 2013.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<28>
Accession Number
2013657754
Authors
De Oliveira Sa M.P.B. Escobar R.R. Ferraz P.E. Vasconcelos F.P. Lima R.C.
Institution
(De Oliveira Sa, Escobar, Ferraz, Vasconcelos, Lima) Division of
Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco -
PROCAPE, Av. Eng. Domingos Ferreira no. 4172. Edf. Paqueta apt 405,
Recife, Pernambuco 51021-040, Brazil
(De Oliveira Sa, Escobar, Ferraz, Vasconcelos, Lima) Department of
Cardiothoracic Surgery, University of Pernambuco - UPE, Recife, Brazil
(De Oliveira Sa, Escobar, Ferraz, Vasconcelos, Lima) Nucleus of
Postgraduate and Research in Health Sciences, Faculty of Medical Sciences
and Biological Sciences Institute - FCM/ICB, Recife, Brazil
Title
Complete versus partial preservation of mitral valve apparatus during
mitral valve replacement: Meta-analysis and meta-regression of 1535
patients.
Source
European Journal of Cardio-thoracic Surgery. 44 (5) (pp 905-912), 2013.
Article Number: ezt059. Date of Publication: November 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
OBJECTIVES: To determine if there is any real difference between complete
preservation (CP) and partial preservation (PP) of the mitral valve
apparatus during mitral valve replacement (MVR) in terms of hard outcomes.
METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and
reference lists of relevant articles were searched for clinical studies
that compared outcomes [30-day mortality, postoperative low cardiac output
syndrome (LCOS), 5-year mortality or left ventricle ejection fraction
(LVEF) before and after surgery] between MVR-CP vs MVR-PP during MVR until
July 2012. The principal summary measures were odds ratios (ORs) with 95%
confidence interval (CI)-for categorical variables (30-day mortality,
postoperative LCOS, 5-year mortality); difference means and standard error
(SE)-for continuous variables (LVEF before and after surgery) and P values
(that will be considered statistically significant when <0.05). The ORs
were combined across studies using DerSimonian-Laird random effects
weighted model. The same procedure was executed for continuous variables,
taking into consideration the difference in means. RESULTS: Eight studies
(2 randomized and 6 non-randomized) were identified and included a total
of 1535 patients (597 for MVR-CP and 938 for MVR-PP). There was no
significant difference between MVR-CP or MVR-PP groups in the risk for
30-day mortality (OR 0.870; 95% CI 0.50-1.52; P = 0.63) or postoperative
LCOS (OR 0.35; 95% CI 0.11-1.08 and P = 0.07) or 5-year mortality (OR
0.70; 95% CI 0.43-1.14; P = 0.15). Taking into consideration LVEF, neither
MVR-CP nor MVR-CP demonstrated a statistically significant improvement in
LVEF before and after surgery, and both strategies were not different from
each other. No publication bias was observed. CONCLUSIONS: We found
evidence that argues against any superiority between both techniques of
preservation (complete or partial) of mitral valve apparatus during MVR.
The Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<29>
Accession Number
2013657736
Authors
Dunning J. Nagendran M. Alfieri O.R. Elia S. Kappetein A.P. Lockowandt U.
Sarris G.E. Kolh P.H.
Institution
(Dunning) Department of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom
(Nagendran) John Radcliffe Hospital, University of Oxford, Oxford, United
Kingdom
(Alfieri) Division of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy
(Elia) Department of Experimental Medicine and Surgery, General Thoracic
Surgery, University Tor Vergata, Rome, Italy
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Lockowandt) Department of Cardiothoracic Surgery, Karolinska University
Hospital, Stockholm, Sweden
(Sarris) Department of Pediatric and Congenital Heart Surgery, Mitera
Children's and Hygeia Hospitals, Athens, Greece
(Kolh) Department of Cardiothoracic Surgery, University Hospital of Liege,
Liege, Belgium
Title
Guideline for the surgical treatment of atrial fibrillation.
Source
European Journal of Cardio-thoracic Surgery. 44 (5) (pp 777-791), 2013.
Article Number: ezt413. Date of Publication: November 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia
and its prevalence is ~1-2% of the general population, but higher with
increasing age and in patients with concomitant heart disease. The
Cox-maze III procedure was a groundbreaking development and remains the
surgical intervention with the highest cure rate, but due to its technical
difficulty alternative techniques have been developed to create the
lesions sets. The field is fast moving and there are now multiple energy
sources, multiple potential lesion sets and even multiple guidelines
addressing the issues surrounding the surgical treatment of AF both for
patients undergoing this concomitantly with other cardiac surgical
procedures and also as stand-alone procedures either via sternotomy or via
videothoracoscopic techniques. The aim of this document is to bring
together all major guidelines in this area into one resource for
clinicians interested in surgery for AF. Where we felt that guidance was
lacking, we also reviewed the evidence and provided summaries in those
areas. We conclude that AF surgery is an effective intervention for
patients with all types of AF undergoing concomitant cardiac surgery to
reduce the incidence of AF, as demonstrated in multiple randomized
studies. There is some evidence that this translates into reduced stroke
risk, reduced heart failure risk and longer survival. In addition,
symptomatic patients with AF may be considered for surgery after failed
catheter intervention or even as an alternative to catheter intervention
where either catheter ablation is contraindicated or by patient choice.
The Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<30>
Accession Number
2013657082
Authors
Soltani G. Abbasi Tashnizi M. Moeinipour A.A. Ganjifard M. Esfahanizadeh
J. Sepehri Shamloo A. Purafzali Firuzabadi S.J. Zirak N.
Institution
(Soltani, Ganjifard) Department of Anesthesiology, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Abbasi Tashnizi, Moeinipour, Esfahanizadeh, Sepehri Shamloo, Purafzali
Firuzabadi, Zirak) Department of Cardiac Surgery, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Title
Comparing the effect of preoperative administration of methylprednisolone
and its administration before and during surgery on the clinical outcome
in pediatric open heart surgeries.
Source
Iranian Red Crescent Medical Journal. 15 (6) (pp 483-487), 2013. Date of
Publication: June 2013.
Publisher
Iranian Red Crescent Society (PO Box: 2330, Dubai , UAE, United Arab
Emirates)
Abstract
Background: Cardiac surgery under Cardiopulmonary bypass causes a systemic
inflammatory response with a multifactorial etiology including direct
tissue damage, ischemia and stimulation of immune system induced by
cardiopulmonary bypass. This study was designed due to the high prevalence
and complications of this stimulated immune system in mortality,
morbidity, length of ICU stay, and mechanical ventilation. Objectives:
This study was aimed to compare preoperative and intraoperative
methylprednisolone (MP) to intraoperative MP alone with respect to
postbypass inflammation and clinical outcome. Patients and Methods: Sixty
pediatric patients (age < 5years) undergoing cardiopulmonary bypass
surgery between September 2011-2012 at Imam Reza hospital-Mashhad were
randomly assigned to receive preoperative and intraoperative MP (group 1:
30 mg/kg, 4 hours before bypass and in bypass prime, n = 30) or
intraoperative MP only (group 2: 30 mg/kg, n = 30). Postoperative
temperature (peak temperature and average temperature during the first 24
hours), amount of inotropic, duration of mechanical ventilation, ICU stay,
WBC, BUN, creatinine, and CRP were recorded and compared in both groups.
Data were analyzed with SPSS version 13 by T-test, Mann-Whitney test if
necessary, and Chi-squared distribution. Results: Patient characteristics
including age, weight, gender, and duration of bypass were almost similar
in both groups (P > 0.05). No significant difference in amount of
inotropic medications used for hemodynamic supports, duration of
mechanical ventilation, peak and average temperature and length of ICU
stay was observed. Among the laboratory tests (WBC, BUN, creatinine, CRP)
only WBC counts raised more in group 2 when compared to group 1(P < 0.05).
Conclusions: There was no difference in clinical outcome after cardiac
surgery when we administered an additional dose of methylprednisolone
compared to a single dose of methylprednisolone. 2013, Iranian Red
Crescent Medical Journal.

<31>
Accession Number
2013643188
Authors
Kristeller J.L. Zavorsky G.S. Prior J.E. Keating D.A. Brady M.A. Romaldini
T.A. Hickman T.L. Stahl R.F.
Institution
(Kristeller, Romaldini, Hickman) Department of Pharmacy Practice, Nesbitt
College of Pharmacy and Nursing, Wilkes University, 84 West South Street,
Wilkes-Barre, PA 18766, United States
(Zavorsky) Human Physiology Laboratory, Marywood University, Scranton, PA,
United States
(Zavorsky, Prior, Stahl) Commonwealth Medical College, Scranton, PA,
United States
(Keating, Brady, Stahl) Department of Cardiothoracic Surgery, Geisinger
Community Medical Center, Scranton, PA, United States
Title
Lack of effectiveness of sodium bicarbonate in preventing kidney injury in
patients undergoing cardiac surgery: A randomized controlled trial.
Source
Pharmacotherapy. 33 (7) (pp 710-717), 2013. Date of Publication: July
2013.
Publisher
Pharmacotherapy Publications Inc. (750 Washington Street, Boston MA 02111,
United States)
Abstract
STUDY OBJECTIVE Because alkalinization of the renal tubules can
theoretically protect against the mechanisms of acute kidney injury, we
sought to determine whether a sodium bicarbonate infusion can prevent
acute kidney injury after cardiac surgery. DESIGN Prospective, randomized,
double-blind, controlled trial. SETTING Cardiac surgery service in a
community hospital. PATIENTS Ninety-two patients with stage 3 or higher
chronic kidney disease who underwent cardiac surgery using cardiopulmonary
bypass. INTERVENTION Forty-eight patients received a perioperative
intravenous infusion of 0.9% sodium chloride 154 mEq/L, and 44 patients
received an infusion of sodium bicarbonate infusion 150 mEq/L in 5%
dextrose solution; the infusions were started 1 hour preoperatively and
continued for 6 hours after cardiopulmonary bypass. MEASUREMENTS AND MAIN
RESULTS The primary outcome was the development of any stage of acute
kidney injury within 5 days after surgery as defined by the Acute Kidney
Injury Network criteria. No statistically significant difference in the
primary outcome was noted between the two groups: 32% in the bicarbonate
group versus 42% in the sodium chloride group (p=0.12). Likewise, no
significant differences in the 30-day hospital mortality rate or other
adverse outcomes were noted between the two groups. CONCLUSION A
perioperative infusion of sodium bicarbonate did not reduce the rate of
acute kidney injury or adverse outcomes in patients with chronic kidney
disease who underwent cardiac surgery. 2013 Pharmacotherapy Publications,
Inc.

<32>
Accession Number
2013640221
Authors
Unverdorben M. Kleber F.X. Heuer H. Figulla H.-R. Vallbracht C. Leschke M.
Cremers B. Hardt S. Buerke M. Ackermann H. Boxberger M. Degenhardt R.
Scheller B.
Institution
(Unverdorben, Degenhardt) Institut fur Klinische Forschung, Herz- und
Kreislaufzentrum, Rotenburg an der Fulda, Germany
(Kleber) Klinik fur Innere Medizin, Unfallkrankenhaus Berlin, Charite
Universitatsmedizin, Berlin, Germany
(Heuer) Medizinische Klinik, Kardiologie, St. Johannes Hospital, Dortmund,
Germany
(Figulla) Klinik fur Innere Medizin, Universitatsklinikum Jena, Jena,
Germany
(Vallbracht) Kardiologische Klinik, Herz- und Kreislaufzentrum, Rotenburg
an der Fulda, Germany
(Leschke) Klinik fur Kardiologie, Pneumologie und Angiologie, Klinikum
Esslingen, Esslingen, Germany
(Cremers, Scheller) Klinik fur Innere Medizin III, Universitatsklinikum
des Saarlandes, Kirrberger Strasse, 66421 Homburg/Saar, Germany
(Hardt) Innere Medizin III, Universitatsklinikum, Heidelberg, Germany
(Buerke) Universitatsklinik und Poliklinik fur Innere Medizi III, Halle,
Germany
(Ackermann) Zentrum fur Medizinische Informatik, Abteilung fur
Biomathematik, Universitat Frankfurt/Main, Frankfurt/Main, Germany
(Boxberger) B. Braun Melsungen AG, Vascular Systems, Berlin, Germany
Title
Treatment of small coronary arteries with a paclitaxel-coated balloon
catheter in the PEPCAD i study: Are lesions clinically stable from 12 to
36 months?.
Source
EuroIntervention. 9 (5) (pp 620-628), 2013. Date of Publication: September
2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The one-year outcome of lesions in small coronary arteries by using
a paclitaxel-iopromide-coated (3 mug/mm²) balloon catheter
(DCB) has yielded good six-month angiographic and one-year clinical data.
We now report the three-year clinical follow-up. Methods and results: One
hundred and twenty patients with >70% stenoses <22 mm in length in small
coronary vessels (vessel diameter: 2.25-2.8 mm) were treated with the DCB.
The primary endpoint was angiographic in-segment late lumen loss. The
secondary endpoints encompassed all other angiographic and clinical data
up to three years post intervention. In total 82/120 (68.3%) patients with
a vessel diameter of 2.35+/-0.19 mm were treated with the DCB only, and
32/120 (26.7%) patients required additional bare metal stent (BMS)
deployment. Both the 12- and 36-month major adverse cardiac event rates
were 5/82 (6.1%) for DCB only and 12/32 (37.5%) for DCB+BMS, primarily due
to the need for target lesion revascularisation in 4/82 (4.9%) patients
and 9/32 (28.1%) (p<0.001) patients, respectively. Total MACE rate after
36 months was 18/120 (15%; intention-to-treat). Conclusions: Treatment of
small vessel coronary artery disease with a paclitaxel-iopromide-coated
balloon exhibited good six-month angiographic and one-year clinical data
that persisted during the three-year followup period. Randomised trials
will clarify its role as an alternative to drug-eluting stents in the
treatment of small vessel coronary artery disease. (ClinicalTrials.gov
Identifier: NCT00404144). Europa Digital & Publishing 2013. All rights
reserved.

<33>
Accession Number
2013639900
Authors
Deo S.V. Shah I.K. Dunlay S.M. Erwin P.J. Dillon J.M. Park S.J.
Institution
(Deo, Shah, Park) Division of Cardiovascular Surgery, Mayo Clinic,
Rochester 55901, United States
(Dunlay) Division of Cardiovascular Diseases, Mayo Clinic, Rochester
55901, United States
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester 55901, United States
(Dillon) Division of Nephrology and Hypertension, Mayo Clinic, Rochester
55901, United States
(Deo) Adventist Wockhardt Heart Hospital, Surat, Gujarat, India
Title
Myocardial revascularisation in renal dysfunction: A systematic review and
meta-analysis.
Source
Heart Lung and Circulation. 22 (10) (pp 827-835), 2013. Date of
Publication: October 2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Coronary artery disease is highly prevalent in patients with
end-stage renal disease. Yet randomised controlled trials are lacking, and
decisions are based on retrospective cohort studies which present
conflicting outcomes. Hence we conducted a systematic review and
meta-analysis comparing outcomes in patients with end-stage renal disease
and renal dysfunction undergoing percutaneous intervention (PCI) and
coronary artery bypass grafting (CABG), with a particular focus on
contemporary studies implementing drug-eluting stents. Methods: MEDLINE,
EMBASE, World of Science, and the Cochrane library were searched for
randomised controlled (RCT) and observational studies comparing clinical
outcomes such as early mortality, myocardial infarction, need for repeat
revascularisation and angina in patients undergoing PCI or CABG. We used
random effect models to compare risk ratios (RR) within groups. Results:
One RCT and 15 observational studies (7588 PCI and 9206 CABG patients) met
inclusion criteria. Early mortality favoured the PCI cohort (4.2% vs 8.5%)
[risk ratio. =. 0.51(0.40, 0.64), p<. 0.01]. The need for repeat
revascularisation was significantly lower in the CABG cohort (7.3% vs
17.8%; p<. 0.01). Pooled analysis of studies implementing a drug eluting
stent still favoured CABG with regards to repeat revascularisation (5% vs
14%; p<. 0.01) and MACE (15% vs 27%; p=. 0.03), while early mortality was
less in the DES-PCI cohort (2.4% vs 5.1%; p=. 0.04). Conclusion: Compared
to percutaneous intervention, coronary artery bypass grafting is
associated with higher early/30-day mortality in patients with renal
dysfunction or end-stage renal disease. The need for repeat
revascularisation is significantly higher with percutaneous intervention,
even with the use of a drug-eluting stent. 2013 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ).

<34>
Accession Number
2013626411
Authors
Buja P. Lanzellotti D. Isabella G. Napodano M. Panfili M. Favaretto E.
Iliceto S. Tarantini G.
Institution
(Buja, Lanzellotti, Isabella, Napodano, Panfili, Favaretto, Iliceto,
Tarantini) Division of Cardiology, Department of Cardiac Thoracic and
Vascular Sciences, University of Padua Medical School, Via Giustiniani 2,
35128 Padua, Italy
Title
Comparison between sirolimus- and paclitaxel-eluting stents for the
treatment of older patients affected by coronary artery disease: Results
from a single-center allcomers registry.
Source
Heart and Vessels. 27 (6) (pp 553-558), 2012. Date of Publication:
November 2012.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
The treatment of elderly patients with coronary artery disease (CAD) is
challenging because this population is complex and greatly expanding.
Drug-eluting stents (DES) generally improve the outcome in high-risk
cases. We evaluated the clinical impact of different first-generation DES,
i.e., sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES),
in this context. A prospective, nonrandomized, single-center, allcomers
registry consecutively enrolling all patients aged >=75 years eligible for
percutaneous coronary intervention (PCI) with DES was carried out. Only
one type of DES was implanted per protocol for each patient. Two groups
were identified according to the type of implanted stent, i.e., SES and
PES. The primary end point encompassed major adverse cardiac events
(MACE), including death, myocardial infarction, and target lesion
revascularization (TLR). The secondary end point encompassed the rate of
definite/probable stent thrombosis and target vessel revascularization
(TVR). From June 2004 to May 2008, 151 patients were enrolled. Among them,
112 (74.2%) received SES and 39 (25.8%) received PES. Baseline clinical
characteristics were similar, while few angiographic features (ostial
location, stent diameter, proximal reference vessel diameter) showed minor
differences. At the median follow-up of 22.6 months, primary and secondary
end points did not significantly differ in terms of MACE (SES 12.5% vs PES
20.5%, P = 0.3), death (SES 5.4% vs PES 7.7%, P = 0.7), myocardial
infarction (SES 4.5% vs PES 10.3%, P = 0.2), TLR (SES 2.7% vs PES 2.6%, P
= 1.0), stent thrombosis (SES 1.8% vs PES 5.1%, P = 0.3), and TVR (SES
1.8% vs PES 0%, P = 0.6). In this real-world population of elderly
patients treated by DES-PCI for CAD, the overall efficacy and safety have
been excellent in both DES, and the choice between SES and PES did not
influence the clinical outcome. 2011 Springer.

<35>
Accession Number
2013654820
Authors
Kleinbongard P. Baars T. Mohlenkamp S. Kahlert P. Erbel R. Heusch G.
Institution
(Kleinbongard, Heusch) Institut fur Pathophysiologie, Universitatsklinikum
Essen, Essen, Germany
(Baars, Kahlert, Erbel) Klinik fur Kardiologie, Universitatsklinikum
Essen, Essen, Germany
(Mohlenkamp) Bethanien-Krankenhaus Moers, Moers, Germany
Title
Aspirate from human stented native coronary arteries vs. saphenous vein
grafts: More endothelin but less particulate debris.
Source
American Journal of Physiology - Heart and Circulatory Physiology. 305 (8)
(pp H1222-H1229), 2013. Date of Publication: 15 Oct 2013.
Publisher
American Physiological Society (9650 Rockville Pike, Bethesda MD
20814-3991, United States)
Abstract
Stent implantation into atherosclerotic coronary arteries releases
particulate debris and soluble substances that contribute to impaired
microvascular perfusion. Here we addressed the potential for microvascular
obstruction in patients with stenotic native right coronary arteries
(nRCA) compared with saphenous vein grafts on right coronary arteries
(SVG-RCA). We enrolled symptomatic, male patients with stable angina
pectoris and a flow-limiting stenosis in their nRCA or SVG-RCA (n =
18/18). Plaque volume and composition were analyzed using intravascular
ultrasound before stent implantation. Coronary aspirate was retrieved
during stent implantation under protection with a distal
occlusion/aspiration device and divided into particulate debris and
plasma. The release of catecholamines, endothelin, serotonin, thromboxane
B₂, and tumor necrosis factor-alpha was measured. The response
of rat mesenteric arteries with intact (+E) and denuded (-E) endothelium
to aspirate plasma (without and with selective endothelin receptor
blockade) was normalized to that by potassium chloride (KCl_max
100%). Plaque volume and composition were not different between nRCA and
SVG-RCA. There was less particulate debris (65 +/- 8 vs. 146 +/- 23 mg;
P<0.05) and more endothelin release (5.8 +/- 0.8 vs. 1.3 +/- 0.7 pg/ml; P
<0.05) in nRCA than in SVG-RCA, whereas the release of the other mediators
was not different. Aspirate from nRCA induced stronger vasoconstriction
than that from SVG-RCA [nRCA, 78 +/- 6% (+E)/84 +/- 5% (-E); SVG-RCA, 59
+/- 6% (+E)/68 +/-3% (-E); P<0.05 nRCA vs. SVG-RCA], which was attenuated
by a nonspecific endothelin and a specific endothelin receptor A
antagonist. Thus coronary aspirate from stented nRCA is characterized by
less debris but more endothelin and stronger vasoconstrictor response than
that from SVG-RCA. 2013 the American Physiological Society.

<36>
Accession Number
71168466
Title
2013 Annual Meeting Society for the Advancement of Blood Management, SABM
2013.
Source
Transfusion. Conference: 2013 Annual Meeting Society for the Advancement
of Blood Management, SABM 2013 Los Angeles, CA United States. Conference
Start: 20130919 Conference End: 20130921. Conference Publication:
(var.pagings). 53 (8) , 2013. Date of Publication: August 2013.
Publisher
Blackwell Publishing Inc.
Abstract
The proceedings contain 30 papers. The topics discussed include: the
association of perioperative red blood cell transfusion and decreased
survival after cardiac surgery: a meta analysis; pre-surgical optimization
workflow in an academic medical center; risk-adjusted clinical outcomes
are equivalent or better in patients who refuse, compared to those who
accept allogeneic blood transfusion; a novel method of data analysis for
utilization of red cell transfusion; treatment of 119 Jehovah's witnesses
with hematological malignancies using high dose chemotherapy and
autologous stem cell transplant; ferumoxytol - an additional treatment
strategy for iron deficient anemia and pre-operative hemoglobin
optimization; comparison of intravenous iron sucrose prescribing before
and after implementation of a mandatory order set across four system
hospitals; and a patient blood management program's effect on post-op
transfusion rates and discharge hemoglobin levels.

<37>
Accession Number
71168462
Authors
Goldfarb T. Liu J. Rosero E. Landgraf K. Burner J. Greilich P.
Institution
(Goldfarb, Liu, Rosero, Landgraf, Burner, Greilich) Department of
Anesthesiology and Pain Management, Division of Cardiothoracic
Anesthesiology, University of Texas Southwestern Medical Center, Dallas,
TX, United States
Title
Are more randomized controlled trials warranted to evaluate the safety and
efficacy of erythropoietin in cardiac surgical patients?.
Source
Transfusion. Conference: 2013 Annual Meeting Society for the Advancement
of Blood Management, SABM 2013 Los Angeles, CA United States. Conference
Start: 20130919 Conference End: 20130921. Conference Publication:
(var.pagings). 53 (8) (pp 10A-11A), 2013. Date of Publication: August
2013.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: Preoperative anemia is a silent epidemic in cardiac surgery.
It is associated with a two-fold increase in postoperative morbidity and
leads to perioperative erythrocyte transfusion in 80% of these patients.
Studies supporting the use of an erythrocyte stimulating agent (ESA) in
cardiac surgery is considered, by many, to be inconclusive. We conducted a
review of the literature to determine if gaps in our current understanding
of ESA use in this population warrants a further randomized controlled
trial comparing its use to other blood conservation measures alone.
Methods: We reviewed 130 papers and focused on 6 (see table) leading
articles on the use of preoperative ESAs, without autologous pre-donation,
in patients with and without anemia undergoing open-heart surgery.
Results: Erythropoietin administration was found to increase perioperative
hemoglobin levels and reduce the incidence of allogenic blood transfusion
(ABT) and appears to be more effective than administration of oral or
intravenous iron alone. There is no convincing evidence that ESAs increase
the incidence of adverse outcomes, including thromboembolic events, when
2-3 doses were administered to anemic patients 1-2 weeks prior to surgery.
However, many of these trials were underpowered to detect complications.
One study did report a concerning trend (p > 0.06) toward increased 30-day
mortality in erythropoietin treated patients. A number of limitations in
these studies were noted and include: 1) treatment duration that was
insufficient to increase red blood cell mass enough to avoid more than 1U
of red blood cells 2) sub-optimal dosing regimen given ESA pharmacodynamic
characteristics; 3) methods for insuring transfusion triggers and safety
concerns outlined in the package insert were observed and 4) optimal use
of iron to support effective erythrocytosis in anemic patients.
Conclusion: A randomized controlled pilot study designed to treat anemic
patients with ESA and intravenous iron for 1-4 weeks prior to cardiac
surgery is needed. Compliance with surveillance strategies for adhering to
transfusion triggers and withholding doses of ESA, when indicated, should
be measured. Endpoints such as percent of patients receiving no ABT and a
composite measure of adverse outcome should be collected to perform sample
size calculations for a larger multi-center trial in the future. Patient
surveys and a method to assess the economic impact of ESA in cardiac
surgery should also be included. We believe preoperative use of ESAs hold
great potential for reducing ABT and improving outcomes in anemic patient
scheduled for elective cardiac surgery. (Table Presented).

<38>
Accession Number
71168436
Authors
Chen Q.S.C. Wang X.W. Lin R. Fen J.-H. Tang Y.-M.
Institution
(Chen, Wang, Lin, Fen, Tang) Department of Thoracic and Cardiovascular
Surgery, Children's Hospital, Zhejiang University, Hangzhou, China
Title
The association of perioperative red blood cell transfusion and decreased
survival after cardiac surgery: A meta analysis1.
Source
Transfusion. Conference: 2013 Annual Meeting Society for the Advancement
of Blood Management, SABM 2013 Los Angeles, CA United States. Conference
Start: 20130919 Conference End: 20130921. Conference Publication:
(var.pagings). 53 (8) (pp 2A), 2013. Date of Publication: August 2013.
Publisher
Blackwell Publishing Inc.
Abstract
Background: The survival effects of perioperative red blood cell (RBC)
transfusion in patients undergoing cardiac surgery remain a subject of
debate, with some studies finding decreased long-term survival in
transfused patients, while other studies revealing conflicting results.
Patients and Methods: To evaluate the impact of perioperative RBC
transfusion on survival after cardiac surgery, we performed a
meta-analysis of published studies that investigated the interaction
between perioperative transfusion of 1or 2 units of RBCs and early as well
as late survival after cardiac surgery. Results: Four studies covering a
total of 33,828 cardiac surgery patients were included in this analysis.
The summary HR for early survival was 1.31 (95% confidence interval (CI):
1.18-1.45; p = 0.000) in patients who received 1 or 2 units of RBCs
compared to those who did not receive any RBC. The corresponding ratio for
late survival was 1.06 (95% CI: 1.03-1.08; p = 0.000). Conclusion: These
findings indicate that RBC transfusion has an adverse impact on the
outcome for patients undergoing cardiac surgery. Thus, our results may
justify blood conservation strategies to avoid the small doses of RBCs (1
or 2 units) transfusion for cardiac surgery patients.

<39>
Accession Number
71200720
Title
Annual Scientific Sessions of the Asia Pacific Heart Association 2013.
Source
Heart. Conference: Annual Scientific Sessions of the Asia Pacific Heart
Association 2013 Singapore Singapore. Conference Start: 20130419
Conference End: 20130421. Conference Publication: (var.pagings). 99 ,
2013. Date of Publication: April 2013.
Publisher
BMJ Publishing Group
Abstract
The proceedings contain 250 papers. The topics discussed include:
variations of left ventricular conduction system and markers of successful
ablation in patients with verapamil-sensitive idiopathic left ventricular
tachycardia; relationship of thickness of left atrial epicardial adipose
tissue and atrial fibrillation; trans-brachial approach with a standard
electrophysiology catheter is also feasible for renal sympathetic
denervation: a Chinese experience; drug-eluting stenting versus coronary
artery bypass graft for unprotected left main coronary artery disease: a
meta-analysis based on time-to-event data from randomized controlled
trials; a meta-analysis of percutaneous coronary intervention for chronic
total coronary oclusions recanalization; interventional treatment in
maintenance hemodialysis patients with acute coronary syndrome; and effect
of adenosine on myocardial protection in patients with acute myocardial
infarction undergoing emergency percutaneous coronary intervention.

<40>
Accession Number
71200679
Authors
Long J. Xiaoshu C. Renqiang Y. Yingli F. Rui Z. Lijuan H.
Institution
(Long, Xiaoshu, Renqiang, Yingli, Rui, Lijuan) Second Affiliated Hospital,
Nanchang University, China
Title
A meta-analysis of percutaneous coronary intervention for chronic total
coronary occlusions recanalization.
Source
Heart. Conference: Annual Scientific Sessions of the Asia Pacific Heart
Association 2013 Singapore Singapore. Conference Start: 20130419
Conference End: 20130421. Conference Publication: (var.pagings). 99 (pp
A69-A70), 2013. Date of Publication: April 2013.
Publisher
BMJ Publishing Group
Abstract
Background Despite advances in procedural techniques and expertise, PCI
for CTO recanalization in select patients remains a challenge. Objective
To perform an evaluation (meta-analysis) on short-term and long-term
prognosis of percutaneous coronary intervention (PCI) for patients with
chronic total occlusions (CTO) recanalization. Methods Data sources
included published studies from a search of PUBMED, ELSEVIER, and
CLINICAL.COM from January 2000 to July 2012. Selected studies were either
observational studies or randomised clinical trials that compared PCI
treatment of CTO recanalization to medical management. The endpoints were
analysed using pooled estimates for death, myocardial infarction (MI),
coronary artery bypass surgery (CABG), angina symptoms, repeat
revascularization, and major adverse cardiac events (MACE). Results
Sixteen observational studies comparing outcomes after failed or
successful CTO recanalization with PCI were included in the current
analysis. Collectively, these studies enrolled 10,256 patients who were
observed at an average follow-up period of 5 years. Patients with
successful CTO recanalization demonstrated significantly reduced rates of
all-cause death (P < 0.00001), cardiac death (P < 0.00001), MACE (P <
0.0001), MI (P = 0.003), subsequent CABG (P < 0.00001), and long-term
repeat revascularization (P = 0.03). In addition, successful CTO improved
quality of life (P = 0.0001), reduced both MACE (P < 0.00001) and
mortality (P = 0.004) in patients with multivessel disease, and resulted
in a lower death rate in patients with single vessel disease (SVD; P =
0.02); although there was no difference in MACE events in patients with
SAD. Conclusions PCI should be considered an effective option for the
patients with CTO lesions.

<41>
Accession Number
71200677
Authors
Wenbing J. Wei Z. Hao C. Youyang W. Jianhua Z. Yi W. He H. Changling L.
Guosheng F.
Institution
(Wenbing, Wei, Hao, Youyang, Jianhua, Yi) Department of Cardiology,
Wenzhou Third People's Hospital, Wenzhou, Zhejiang, China
(He, Changling, Guosheng) Department of Cardiology, Sir. Run Run Shaw
Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang,
China
Title
Drug-eluting stenting versus coronary artery bypass graft for unprotected
left main coronary artery disease: A meta-analysis based on time-to-event
da ta from randomised controlled trials.
Source
Heart. Conference: Annual Scientific Sessions of the Asia Pacific Heart
Association 2013 Singapore Singapore. Conference Start: 20130419
Conference End: 20130421. Conference Publication: (var.pagings). 99 (pp
A69), 2013. Date of Publication: April 2013.
Publisher
BMJ Publishing Group
Abstract
Objective Drug eluting stent (DES) with percutaneous coronary intervention
is increasingly used to treat unprotected left main coronary artery (LMCA)
disease. We undertook a meta analysis to assess outcomes for coronary
artery bypass graft (CABG) and DES for unprotected LMCA disease. Methods
We conducted a PubMed/EMBASE/CENTRAL search for RCTs evaluating CABG
versus DES for unprotected LMCA. Primary outcome was survival. Secondary
outcomes were major adverse cardiac and cerebrovascular event (MACCE) and
target vessel revascularization (TVR). Results Four randomised controlled
trials were identified evaluating a total of 2, 706 patients with
unprotected LMCA. There was no significant difference between the CABG and
DES groups in the risk for mortality (HR [hazard ratio]:0.76; 95% CI
[confidence interval]: 0.47-1.23). The risks were lower for MACCE (0.78
[95% CI: 0.60-1.02]) and for TVR (0.73 [95% CI: 0.61-0.87]). Conclusions
our meta-analysis of RCTs suggests that there are no significant
differences in terms of survival and MACCE in patients with unprotected
LMCA disease suitable for either DES or CABG, but CABG is superior to DES
in reducing the incidence of TVR.