EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2013703341
Authors
Botrel T.E.A. Clark O.A.C. Queiroga M.C. Filho R.I.R. Pilla C.B. Arrieta
R.S. Cristovao S. Silva C.C. Esteves C.A. Oliveira E.C. Simoes L.C. Chamie
F. Neves J. Max R. Pedra C.A.C.
Institution
(Botrel) Pesquisador da Evidencias - Credibilidade Cientifica, Campinas,
SP, Brazil
(Clark) Credibilidade Cientifica, Campinas, SP, Brazil
(Queiroga) Hospital da Unimed Joao Pessoa, Joao Pessoa, PB, Brazil
(Filho) Instituto de Cardiologia, Fundacao Universitaria de Cardiologia,
Porto Alegre, RS, Brazil
(Pilla) Servico de Cardiologia Pediatrica e Cardiologia Intervencionista,
Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
(Arrieta) Servico de Hemodinamica e Cardiologia Intervencionista,
Instituto do Coracao do Hospital das Clinica, Universidade de Sao Paulo,
Sao Paulo, SP, Brazil
(Cristovao) Hospital Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP,
Brazil
(Silva) Escola Paulista de Medicina, Universidade Federal de Sao Paulo,
Sao Paulo, SP, Brazil
(Esteves) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil
(Oliveira) Departamento de Cardiopatias Congenitas, Hospital de Clinicas,
Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
(Simoes) Instituto Nacional de Cardiologia, Hospital Laranjeiras, Rio de
Janeiro, RJ, Brazil
(Chamie) Hospital Federal dos Servidores do Estado, RJ, Brazil
(Neves) Instituto de Medicina Integral Prof. Fernando Figueira, Recife,
PE, Brazil
(Max) Departamento de Cardiologia Pediatrica Intervencionista, Hospital
Biocor, Belo Horizonte, MG, Brazil
(Pedra) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil
Title
Transcatheter pulmonary valve implantation: Systematic literature review.
Source
Revista Brasileira de Cardiologia Invasiva. 21 (2) (pp 176-187), 2013.
Date of Publication: 2013.
Publisher
Sociedade Brasileira de (Rua Beira Rio, 45 - Conjunto 71, Vila Olimpia/SP
CEP: 04548-050, Brazil)
Abstract
Surgical repair of some complex congenital heart diseases involves
reconstruction of the right ventricular outflow tract using homografts,
bioprostheses, bovine jugular grafts or other valved conduits between the
right ventricle and the main pulmonary artery. Although these surgical
procedures may be performed with low mortality rates, the life span of
these implanted valves or conduits is usually short (< 10 years) due to
either degeneration and/or calcification. Variable degrees of pulmonary
stenosis, often associated with pulmonary insufficiency, are consequences
of conduit degeneration. In 2000, Bonhoeffer et al. were the first to
report the transcatheter pulmonary valve implantation (TPVI) of a
bioprosthetic pulmonary valve later named Melody valve (Medtronic,
Minneapolis, USA). The technique was initially developed to limit the need
for multiple surgical procedures, and, ultimately, to work as a surrogate
of a new surgical valve replacement. Subsequent clinical studies in Europe
and the United States confirmed the safety and efficacy of this technique
in a larger number of patients. Since the National Sanitary Surveillance
Agency (Agencia Nacional de Vigilancia Sanitaria - Anvisa) granted
approval for clinical use of the Melody transcatheter pulmonary biological
valve in February 2103, we deemed that a judicious assessment of this new
technology was timely and necessary before the widespread use in our
country. The objective of this study was to perform a systematic
literature review on the use of TPVI in patients with dysfunctional
homografts, valved conduits and bioprostheses implanted surgically in the
right ventricular outflow tract.

<2>
Accession Number
2013713488
Authors
Biswas I. Mathew P.J. Singh R.S. Puri G.D.
Institution
(Biswas, Mathew, Puri) Department of Anaesthesia and Intensive Care,
Postgraduate Institute of Medical Education and Research, Chandigarh
160012, India
(Singh) Department of Cardiovascular and Thoracic Surgery, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
Title
Evaluation of closed-loop anesthesia delivery for propofol anesthesia in
pediatric cardiac surgery.
Source
Paediatric Anaesthesia. 23 (12) (pp 1145-1152), 2013. Date of Publication:
December 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objective The objective of this study was to compare the feasibility of
closed-loop anesthesia delivery with manual control of propofol in
pediatric patients during cardiac surgery. Methods Forty ASA II-III
children, undergoing elective cardiac surgery under cardiopulmonary bypass
(CPB) in a tertiary care hospital, were randomized to receive propofol
either through a closed-loop anesthesia delivery system (CL group) or
through traditional manual control (manual group) to achieve a target BIS
of 50. Patients were induced and subsequently maintained with a propofol
infusion. The propofol usage and the efficacy of closed-loop system in
controlling BIS within +/-10 of the target were compared with that of
manual control. Results The maintenance of BIS within +/-10 of target and
intraoperative hemodynamic stability were similar between the two groups.
However, induction dose of propofol was less in the CL group (2.06 +/-
0.79 mgkg^-1) than the manual group (2.95 +/- 1.03
mgkg^-1) (P = 0.006) with less overshoot of BIS during induction
in the closed-loop group (P = 0.007). Total propofol used in the off-CPB
period was less in the CL group (6.29 +/- 2.48 mgkg^-1
h^-1 vs 7.82 +/- 2.1 mgkg ^-1 h^-1) (P =
0.037). Phenylephrine use in the pre-CPB period was more in the manual
group (16.92 +/- 10.92 mugkg ^-1 vs 5.79 +/- 5.98
mugkg^-1) (P = 0.014). Manual group required a median of 18
(range 8-29) dose adjustments per hour, while the CL group required none.
Conclusion This study demonstrated the feasibility of closed-loop
controlled propofol anesthesia in children, even in challenging procedures
such as cardiac surgery. Closed-loop system needs further and larger
evaluation to establish its safety and efficacy. 2013 John Wiley & Sons
Ltd.

<3>
Accession Number
2013703891
Authors
Han S. Huang W. Liu Y. Pan S. Feng Z. Li S.
Institution
(Han, Huang, Liu) First College of Clinical Medicine, Guangxi Medical
University, Nanning, China
(Pan) Department of Pathophysiology, Guangxi Medical University, Nanning,
China
(Feng, Li) Department of Thoracic and Cardiovascular Surgery, First
Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road,
Nanning 530021, Guangxi Zhuang Autonomous Region, China
Title
Does leukocyte-depleted blood cardioplegia reduce myocardial reperfusion
injury in cardiac surgery? A systematic review and meta-analysis.
Source
Perfusion (United Kingdom). 28 (6) (pp 474-483), 2013. Date of
Publication: November 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Blood cardioplegia in cardiac surgery contains leukocytes, which causes
the inflammatory reaction and promotes myocardial reperfusion injury. The
removal of leukocytes from the cardioplegia line, using specialized
filters, has been proposed as one of the effective methods in attenuating
the inflammatory response. We performed a two-level search to identify
randomized, controlled trials concerning the effects of leukocyte-depleted
blood cardioplegia on myocardial reperfusion injury. Sixteen studies,
comprising 738 patients, met the selection criteria. There are significant
reductions in creatinine kinase isoenzyme MB (CK-MB) during 4-8h
postoperatively (SMD - 0.577; 95% CI -0.795 to -0.358; p=0.000), CK-MB
peak (SMD - 0.713; 95% CI -1.027 to -0.400; p=0.000), troponin in the
period of 4-8h postoperatively (SMD - 0.502; 95% CI -0.935 to -0.069;
p=0.023), troponin peak (SMD - 0.826; 95% CI -1.373 to -0.279; p=0.003)
and inotropic support (RR, 0.500; 95% CI 0.269 to 0.931; p=0.029).
Leukocyte-depleted blood cardioplegia may reduce myocardial reperfusion
injury in the early postoperative period, but there has been no evidence
to support the clinically significant difference. Larger and more precise
randomized control trials are needed to further elucidate the
cardioprotective effects of cardioplegia leukofiltration. The Author(s)
2013.

<4>
Accession Number
2013703890
Authors
Kamra C. Beney A.
Institution
(Kamra) Memorial University of Newfoundland, 300 Prince Philip Drive, St.
John's, NL A1B 3V6, Canada
(Beney) Eastern Health, St. John's, NL, Canada
Title
Human albumin in extracorporeal prime: Effect on platelet function and
bleeding.
Source
Perfusion (United Kingdom). 28 (6) (pp 536-540), 2013. Date of
Publication: November 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Purpose: Synthetic starches have been positioned as an equivalent
substitute for human albumin in extracorporeal prime, with both providing
osmotic and oncotic pressure. Another effect of albumin is its ability to
coat the synthetic surfaces of an extracorporeal circuit with a
biopassivating protein monolayer. Whether this protein biopassivation has
any benefit to the patient, assessed by platelet count, platelet function
and 24-hour bleeding rate, is considered. Methods: Patients presenting for
coronary artery bypass at a Canadian tertiary care hospital were
randomized into two groups until a final study size of 20 patients was
obtained. The Study Group received 2.5 g of human albumin in the
extracorporeal prime and the Control Group remained protein free. Both
groups included Voluven 6% as a synthetic starch. Blood samples were
obtained at three intervals; Pre-bypass, During bypass (30 minutes after
initiation of bypass), and Post-bypass. These samples were assayed for
platelet function, platelet count and hemoglobin. Chest tube drainage over
a 24-hour period was monitored. Results: Platelet count was significantly
higher in the During sample in the Study Group (196 +/- 56.5 x
10₉/ml versus 160 +/- 18.5 x 10₉/ml, p>0.05),
however, this difference was no longer significant with the Post-bypass
sample (135 +/- 36.0 x 10 ₉/mL versus 127 +/- 19 x
10₉/mL). Platelet function assays (PFA) showed no significant
differences. Chest tube drainage after 24 hours was significantly lower in
the Study Group (586 +/- 131.8 ml/24 h versus 741 +/- 272.5 ml/24 h,
p>0.05). Conclusions: Human albumin can passivate the synthetic surfaces
of the extracorporeal circuit, which is supported by observations of
preserved platelet count and reduced chest tube drainage. Although some
statistically significant benefits were observed, the practical benefits
of passivating an extracorporeal circuit with human albumin may be
minimal. The Author(s) 2013.

<5>
Accession Number
2013703887
Authors
Kimenai D.M. Bastianen G.W. Daane C.R. Megens-Bastiaanse C.M. Van Der Meer
N. Scohy T.V. Gerritse B.M.
Institution
(Kimenai, Bastianen, Daane, Megens-Bastiaanse) Department of
Extracorporeal Circulation, Amphia Hospital, Molengracht 21, 4818 CK
Breda, Netherlands
(Van Der Meer, Scohy, Gerritse) Department of Anesthesiology, Amphia
Hospital, Breda, Netherlands
Title
Effect of the colloids gelatin and HES 130/0.4 on blood coagulation in
cardiac surgery patients: A randomized controlled trial.
Source
Perfusion (United Kingdom). 28 (6) (pp 512-519), 2013. Date of
Publication: November 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objective: The choice of the prime solution for cardiopulmonary bypass can
play an important role in limiting the effect on blood coagulation, but it
is still unclear what the effect of colloids on blood coagulation is. The
aim of this study was to investigate the effect of synthetic colloids on
blood loss and blood coagulation in patients after on-pump coronary artery
bypass graft (CABG) procedures. Methods: Sixty elective, on-pump CABG
patients were randomly assigned to receive the prime solutions lactated
Ringer's solution combined with hydroxyethyl starch 130/0.4 (HES, 6%
Volulyte, Fresenius Kabi Nederland BV, Zeist, the Netherlands) (HES group)
or gelatin (Gelofusin, B Braun Melsung AG, Melsungen, Germany) (Gelo
group). Blood loss was assessed using post-operative chest tube output;
secondary endpoints were number of blood component transfusions, routine
coagulation test values and rotation thromboelastometry values (Rotem
delta, Pentapharm GmbH, Munich, Germany). Results: Total post-operative
chest tube output was 500 420 ml in the HES group versus 465 +/- 390 ml in
the Gelo group (p = 0.48). No significant differences were observed in any
of the routine coagulation tests values, thromboelastometry parameters or
number of blood component transfusions between the groups. Conclusions: In
this randomized, controlled trial of adults after on-pump CABG procedures,
there was no significant difference in blood loss or blood coagulation
between the HES group and the Gelo group. The Author(s) 2013.

<6>
Accession Number
2013708264
Authors
Botelho-Nevers E. Verhoeven P. Paul S. Grattard F. Pozzetto B. Berthelot
P. Lucht F.
Institution
(Botelho-Nevers, Verhoeven, Paul, Grattard, Pozzetto, Berthelot, Lucht)
Groupe Immunite Muqueuse et Agents Pathogenes, EA 3064, PRES Lyon,
Universite Jean Monnet et CHU de Saint-Etienne, 42023 Saint-Etienne,
France
(Botelho-Nevers, Paul, Lucht) CIC CIE3 INSERM of the REIVAC network,
Centre Essai Vaccinal ANRS, Hopital Nord CHU de Saint-Etienne,
Saint-Etienne 42055, France
Title
Staphylococcal vaccine development: Review of past failures and plea for a
future evaluation of vaccine efficacy not only on staphylococcal
infections but also on mucosal carriage.
Source
Expert Review of Vaccines. 12 (11) (pp 1249-1259), 2013. Date of
Publication: 2013.
Publisher
Expert Reviews Ltd. (2 Albert Place, London N3 1QB, United Kingdom)
Abstract
Staphylococcal disease represents a universal burden including acute,
life-threatening infections as well as chronic infections usually
associated with foreign materials. Infections occur notably in permanent
carriers of Staphylococcus aureus. To date, all the attempts to develop an
efficacious vaccine against S. aureus have failed. Failures in vaccine
clinical trials might be related to a focus on single targets and
development of humoral-based vaccines rather than vaccines with a
combination of antigens stimulating both humoral and cellular immunity.
The end points of these unsuccessful trials were a reduction in mortality
or bacteremia, whereas the patient's decolonization was not assessed.
Adopting the latter point of view, the aim of this article is to discuss
nasal mucosal decolonization as a complementary marker of vaccine efficacy
for clinical research in vaccine development. 2013 Informa UK Ltd.

<7>
Accession Number
2013652678
Authors
D'Ascenzo F. Conrotto F. Giordana F. Moretti C. D'Amico M. Salizzoni S.
Omede P. La Torre M. Thomas M. Khawaja Z. Hildick-Smith D. Ussia G.
Barbanti M. Tamburino C. Webb J. Schnabel R.B. Seiffert M. Wilde S. Treede
H. Gasparetto V. Napodano M. Tarantini G. Presbitero P. Mennuni M. Rossi
M.L. Gasparini M. Biondi Zoccai G. Lupo M. Rinaldi M. Gaita F. Marra S.
Institution
(Thomas, Khawaja) Guy's and St. Thomas' NHS Foundation Trust, London,
United Kingdom
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University
Hospitals, Brighton, Interventional Structural and Congenital Heart
Disease, United Kingdom
(Ussia, Barbanti, Tamburino) Invasive Cardiology Division of Cardiology,
Ferrarotto Hospital, University of Catania, Catania, Italy
(Barbanti, Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Schnabel, Seiffert, Wilde, Treede) University Heart Center Hamburg,
Germany
(Gasparetto, Napodano, Tarantini) Division of Cardiology, Department of
Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
(Presbitero, Mennuni, Rossi) Division of Cardiology, Humanitas, Milan,
Italy
(Biondi Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Italy
(D'Ascenzo, Conrotto, Giordana, Moretti, D'Amico, Omede, Gaita, Marra)
Division of Cardiology, University of Turin, Corso Bramante 88-90, 10126
Turin, Italy
(Salizzoni, La Torre, Rinaldi) Division of Cardiac Surgery, University of
Turin, Italy
(Lupo) Division of Cardiovascular Anesthesia, Italy
(D'Ascenzo, Moretti, Biondi Zoccai) Meta-analysis and Evidence Based
Medicine Training in Cardiology (METCARDIO), Italy
(Gasparini) Department of Mathematical Sciences Polytechnic, University of
Turin, Italy
Title
Mid-term prognostic value of coronary artery disease in patients
undergoing transcatheter aortic valve implantation: A meta-analysis of
adjusted observational results.
Source
International Journal of Cardiology. 168 (3) (pp 2528-2532), 2013. Date of
Publication: 03 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Aims Coronary artery disease (CAD) negatively affects prognosis in
patients undergoing surgical aortic valve replacement, being currently
evaluated in the most common used risk score. Our meta-analysis aims to
clarify the prognostic role of CAD on mid-term survival in patients
undergoing TAVI. Methods and results Studies reporting multivariate
predictors of adverse outcomes in patients undergoing TAVI were
systematically searched for and pooled, when appropriate, using a
random-effect method. 960 citations were first screened and finally 7
studies (2472 patients) were included. Diagnosis of CAD was reported in
52%(42-65) of patients and 1169 Edwards SAPIEN and 1303 CoreValve
prostheses were implanted. After a median follow up of 452 days (357-585)
24% of patients (19-33) died, and 23 (14-32) for cardiovascular death. At
pooled analysis of multivariate approach, diagnosis of coronary artery
disease did not increase risk of death (OR 1.0, 95% CI, confidence
interval, 0.67-1.50 I² 0%). Conclusion CAD does not affect
mid-term TAVI outcome: this finding should be weighted to accurately
evaluate risk and strategies for patients with severe aortic stenosis.
2013 Elsevier Ireland Ltd. All rights reserved.

<8>
Accession Number
2013652791
Authors
Morici N. Moja L. Rosato V. Oreglia J.A. Sacco A. De Marco F. Bruschi G.
Klugmann S. La Vecchia C. Savonitto S.
Institution
(Morici, Oreglia, Sacco, De Marco, Klugmann) Divisione di Cardiologia
1-Emodinamica, Dipartimento Cardio-toraco-vascolare A. de Gasperis,
Azienda Ospedaliera Ospedale Niguarda Ca Granda, Milan, Italy
(Moja) Departimento di Scienze Biomediche per la Salute, Universita di
Milano, Milan, Italy
(Rosato, La Vecchia) Dipartimento di Epidemiologia, Istituto di Ricerche
Farmacologiche Mario Negri, Milan, Italy
(Rosato, La Vecchia) Dipartimento di Medicina Del Lavoro, Universita di
Milano, Milan, Italy
(Bruschi) Divisione di Cardiochirurgia, Dipartimento
Cardio-toraco-vascolare A. de Gasperis, Azienda Ospedaliera Ospedale
Niguarda Ca Granda, Milan, Italy
(Savonitto) Divisione di Cardiologia, IRCCS Arcispedale S. Maria Nuova,
Reggio Emilia, Italy
(Moja) IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Title
Time from adenosine di-phosphate receptor antagonist discontinuation to
coronary bypass surgery in patients with acute coronary syndrome:
Meta-analysis and meta-regression.
Source
International Journal of Cardiology. 168 (3) (pp 1955-1964), 2013. Date of
Publication: 03 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background Adenosine di-phosphate receptor antagonists (ADPRAs) blunt
hemostasis for several days after administration. This effect, aimed at
preventing cardiac ischemic complications particularly in patients with
acute coronary syndromes (ACS), may increase perioperative bleeding in the
case of cardiac surgery. Practice Guidelines recommend withholding ADPRAs
for at least 5 days prior to surgery, though with a weak base of evidence.
The purpose of this study was to systematically review observational and
experimental studies of early or late preoperative discontinuation of
ADPRAs prior to coronary artery bypass grafting (CABG) for patients with
ACS. Methods MEDLINE, EMBASE, the Cochrane Library databases up to
December 2011; and reference lists. Observational and experimental studies
that compared early ADPRA discontinuation with late discontinuation, or no
discontinuation, in patients with ACS undergoing CABG. Results There were
19 studies, including 14,046 participants, 395 deaths and 309 reoperations
due to bleeding. ADPRA late discontinuation up to CABG was associated with
an increased risk of postoperative mortality (OR 1.46, 95% confidence
interval (CI) 1.10 to 1.93) and reoperations due to bleeding (OR 2.18; 95%
CI 1.47 to 2.62). Between-study heterogeneity was low. Meta-analysis
limited to high quality or prospective studies gave consistent results. In
most instances, the 95% prediction intervals for summary risk estimates
confirmed the risk across study groups. Conclusions ADPRA late
discontinuation prior to CABG is associated with an increased risk of
death and reoperations due to bleeding in patients with ACS. The
confidence in the estimates of risk for late discontinuation is moderate
to high. 2013 Elsevier Ireland Ltd. All rights reserved.

<9>
Accession Number
24156189
Authors
Ghetti C.M.
Institution
(Ghetti) Elizabeth Seton Pediatric Center, 300 Corporate Boulevard South,
Yonkers, NY 10701, USA.
Title
Effect of music therapy with emotional-approach coping on preprocedural
anxiety in cardiac catheterization: a randomized controlled trial.
Source
Journal of music therapy. 50 (2) (pp 93-122), 2013. Date of Publication:
2013 Summer.
Abstract
Individuals undergoing cardiac catheterization are likely to experience
elevated anxiety periprocedurally, with highest anxiety levels occurring
immediately prior to the procedure. Elevated anxiety has the potential to
negatively impact these individuals psychologically and physiologically in
ways that may influence the subsequent procedure. This study evaluated the
use of music therapy, with a specific emphasis on emotional-approach
coping, immediately prior to cardiac catheterization to impact
periprocedural outcomes. The randomized, pretest/posttest control group
design consisted of two experimental groups--the Music Therapy with
Emotional-Approach Coping group [MT/EAC] (n = 13), and a talk-based
Emotional-Approach Coping group (n = 14), compared with a standard care
Control group (n = 10). MT/EAC led to improved positive affective states
in adults awaiting elective cardiac catheterization, whereas a talk-based
emphasis on emotional-approach coping or standard care did not. All groups
demonstrated a significant overall decrease in negative affect. The MT/EAC
group demonstrated a statistically significant, but not clinically
significant, increase in systolic blood pressure most likely due to active
engagement in music making. The MT/EAC group trended toward shortest
procedure length and least amount of anxiolytic required during the
procedure, while the EAC group trended toward least amount of analgesic
required during the procedure, but these differences were not
statistically significant. Actively engaging in a session of music therapy
with an emphasis on emotional-approach coping can improve the well-being
of adults awaiting cardiac catheterization procedures.

<10>
Accession Number
23944209
Authors
Olper L. Corbetta D. Cabrini L. Landoni G. Zangrillo A.
Institution
(Olper) San Raffaele Scientific Institute, Milan, Italy.
Title
Effects of non-invasive ventilation on reintubation rate: a systematic
review and meta-analysis of randomised studies of patients undergoing
cardiothoracic surgery.
Source
Critical care and resuscitation : journal of the Australasian Academy of
Critical Care Medicine. 15 (3) (pp 220-227), 2013. Date of Publication:
Sep 2013.
Abstract
To estimate the effect of non-invasive mechanical ventilation (NIV) on the
rate of reintubation among patients undergoing cardiothoracic surgery. A
meta-analysis of randomised trials. Medline, Embase, and the Cochrane
Central Register of clinical trials were searched (April 2012) for
pertinent studies by two trained investigators. International experts were
contacted. Articles were assessed by two trained investigators, with
divergences resolved by consensus. Inclusion criterion was random
allocation to NIV versus standard treatment without restrictions on
duration or modalities of the treatment delivered. Fourteen studies
enrolling 1211 patients were included in the meta-analysis. NIV reduced
the reintubation rate (risk ratio [RR], 0.29; 95% CI, 0.16-0.53; P for
efficacy < 0.0001; I2 = 0), hospital length of stay and mortality.
Subgroup analyses suggested that the benefits of NIV are more important in
patients with ongoing acute respiratory failure (RR, 0.25; 95% CI,
0.07-0.89) and in those at high risk of developing postoperative pulmonary
complications (RR, 0.19; 95% CI, 0.04-0.84). Analyses including
prophylactic studies in patients at low risk did not show a significant
effect of NIV on reintubation rate (RR = 0.42; 95% CI, 0.12-1.48) and on
any of the outcomes considered except for oxygenation. NIV seems to be
effective in reducing reintubation rate after cardiothoracic surgery. The
results of this meta-analysis should be confirmed by large randomised
controlled studies.

<11>
Accession Number
2013708226
Authors
Topcuoglu M.A. Arsava E.M.
Institution
(Topcuoglu, Arsava) Hacettepe Univsersity, Faculty of Medicine, Department
of Neurology, Sihhiye 06100, Ankara, Turkey
Title
Neurosonology of emboli detection and monitoring.
Source
Turk Serebrovaskuler Hastaliklar Dergisi. 18 (3) (pp 59-71), 2012. Date of
Publication: 2012.
Publisher
Turkish Society of Cerebrovascular Diseases (Sair Fuzuli Cad. Kidan Ishani
20/2, Eskisehir 26010, Turkey)
Abstract
Cerebral embolism is the leading cause of ischemic stroke. Detection of
microembolic signals [MES] in cerebral circulation is uniquely attained by
several transcranial Doppler techniques, and can not be obtained with any
other available imaging modality. Albeit no uniform picture has emerged
from the studies, presence and amount of MES can identify a high-risk
status in the setting of potential arterial or cardiac sources of cerebral
embolism. Real-time MES monitoring during vascular procedures with high
cerebral embolism risk seems also promising. The potential of MES
detection in improvement of patient care is usually acknowledged, even
though several aspects remain yet to be scientifically established. We
herein review theory, technique and clinical potential of the
neurosonological emboli detection, and try to add to understanding of the
journal readership about the recent development on this subject.

<12>
Accession Number
2013671392
Authors
Chen Y. Zhang Y. Tang Y. Huang X. Xie Y.
Institution
(Chen, Zhang, Tang, Huang, Xie) Division of Cardiology, Xinhua Hospital
School of Medicine, Shanghai Jiaotong University, Shanghai, China
Title
High-Maintenance-Dose Clopidogrel in Patients Undergoing Percutaneous
Coronary Intervention: A Systematic Review and Meta-Analysis.
Source
PLoS ONE. 8 (10) , 2013. Article Number: e78549. Date of Publication: 23
Oct 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background:Despite routine use of clopidogrel, adverse cardiovascular
events recur among some patients undergoing percutaneous coronary
intervention (PCI). To optimize antiplatelet therapies, we performed a
meta-analysis to quantify the efficacy of high versus
standard-maintenance-dose clopidogrel in these patients.Methods:Randomized
controlled trials (RCTs) comparing high (>75 mg) and standard maintenance
doses of clopidogrel in patients undergoing PCI were included. The primary
efficacy and safety end-points were major adverse
cardiovascular/cerebrovascular events (MACE/MACCE) and major bleeding. The
secondary end-points were other ischemic and bleeding adverse effects. The
pooled odds ratio (OR) for each outcome was estimated.Results:14 RCTs with
4424 patients were included. Compared with standard-maintenance-dose
clopidogrel, high-maintenance-dose clopidogrel significantly reduced the
incidence of MACE/MACCE (OR 0.60; 95% CI 0.43 to 0.83), stent thrombosis
(OR 0.56; 95% CI 0.32 to 0.99) and target vessel revascularization (OR
0.38; 95% CI 0.20 to 0.74), without significant decrease of the risk of
cardiovascular death (OR 0.92; 95% CI 0.74 to 1.13) and myocardial
infarction (OR 0.83; 95% CI 0.51 to 1.33). For safety outcomes, it did not
significantly increase the risk of major bleeding (OR 0.73; 95% CI 0.41 to
1.32), minor bleeding (OR 1.29; 95% CI 1.00 to 1.66) and any bleeding (OR
1.14; 95% CI 0.91 to 1.43).Conclusion:High-maintenance-dose clopidogrel
reduces the recurrence of most ischemic events in patients post-PCI
without increasing the risk of bleeding complications. 2013 Chen et al.

<13>
[Use Link to view the full text]
Accession Number
22635060
Authors
Doering L.V. Chen B. Cross Bodan R. Magsarili M.C. Nyamathi A. Irwin M.R.
Institution
(Doering) Acute Care, School of Nursing, University of California, Los
Angeles 90095-6918, USA.
Title
Early cognitive behavioral therapy for depression after cardiac surgery.
Source
The Journal of cardiovascular nursing. 28 (4) (pp 370-379), 2013. Date of
Publication: 2013 Jul-Aug.
Abstract
Despite high rates of postcardiac surgery depression, studies of
depression treatment in this population have been limited. The aim of this
study was to evaluate early cognitive behavioral therapy (CBT) in a home
environment in patients recovering from cardiac surgery. : From July 2006
through October 2009, we conducted a randomized controlled trial and
enrolled 808 patients who were screened for depressive symptoms using the
Beck Depression Inventory (BDI) in the hospital and 1 month later.
Patients were interviewed using the Structured Clinical Interview for
DSM-IV; those who met criteria for clinical depression (n = 81) were
randomized to CBT (n = 45) or usual care (UC; n = 36). After completion of
the UC period, 25 individuals were offered later CBT (UC + CBT). Main
outcomes (depressive symptoms [BDI] and clinical depression [Structured
Clinical Interview for DSM-IV]) were evaluated after 8 weeks using
intention-to-treat principles and linear mixed models. Compared with the
UC group, in the CBT group, there was greater decline in BDI scores (beta
= 1.41; 95% confidence interval [CI], 0.81-2.02; P = < .001) and greater
remission of clinical depression (29 [64%] vs 9 [25%]; number need to
treat, 2.5; 95% CI, 1.7-4.9; P < .001). Compared with the early CBT group
(median time from surgery to CBT, 45.5 days) the later UC + CBT group
(median time from surgery to CBT, 122 days) also experienced a reduction
in BDI scores, but the group x time effect was smaller (beta = 0.79; 95%
CI, 0.10-1.47; P = .03) and remission rates between the 2 groups did not
differ. Early home CBT is effective in depressed postcardiac surgery
patients. Early treatment is associated with greater symptom reduction
than similar therapy given later after surgery.

<14>
Accession Number
2013696870
Authors
Helsing P. Togsverd-Bo K. Veierod M.B. Mork G. Haedersdal M.
Institution
(Helsing, Mork) Department of Dermatology, Oslo University
Hospital-Rikshospitalet, N-0027 Oslo, Norway
(Togsverd-Bo, Haedersdal) Department of Dermatology, Bispebjerg Hospital,
University of Copenhagen, Copenhagen 2400, Denmark
(Veierod) Department of Biostatistics, Institute of Basic Medical
Sciences, University of Oslo, N-0317 Oslo, Norway
Title
Intensified fractional CO2 laser-assisted photodynamic therapy vs. laser
alone for organ transplant recipients with multiple actinic keratoses and
wart-like lesions: A randomized half-side comparative trial on dorsal
hands.
Source
British Journal of Dermatology. 169 (5) (pp 1087-1092), 2013. Date of
Publication: November 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background Photodynamic therapy (PDT) is a well-documented treatment for
actinic keratosis (AK), but achieves inferior efficacy in organ transplant
recipients (OTRs), particularly in acral regions. Ablative fractional
laser (AFXL) intensifies the PDT response and may improve the efficacy of
AK clearance when used as monotherapy. Objectives To compare the efficacy
of a single treatment with AFXL-assisted PDT vs. AFXL alone for
difficult-to-treat AKs and wart-like lesions (WLLs) in OTRs. Methods Ten
OTRs were included with a total of 680 AKs (severity grade I-III) and 409
WLLs on the dorsal hands. Both hands were initially treated with targeted
fractional ablation of thick keratotic lesions followed by AFXL field
treatment. Treatment regions were then randomized to (i) PDT (AFXL-PDT) or
(ii) no further treatment (AFXL). The primary end point was complete
response (CR) at 4 months after treatment; secondary end points were
improvement of AK severity grade, overall patient assessment of efficacy
and tolerability of treatments. Results CR of AKs was significantly higher
for AFXL-PDT (73%) compared with AFXL alone (31%) (P = 0002). AFXL-PDT
improved 82% of AKs to lower lesion grades compared with 52% after AFXL
alone (P = 0008). For WLLs, the rate of CR was 37% for AFXL-PDT compared
with 14% for AFXL (P = 002). Overall assessment showed a preference for
AFXL-PDT compared with AFXL (AFXL-PDT, n = 8; AFXL, n = 0; equal, n = 2).
Mild pigment changes were observed in four patients (AFXL-PDT, n = 3;
AFXL, n = 1). No scarring was observed. Conclusions AFXL-PDT is more
effective than AFXL in the treatment of acral AKs and WLLs in OTRs. What's
already known about this topic? Photodynamic therapy (PDT) is effective
for actinic keratosis (AK), but inferior outcomes are obtained in organ
transplant recipients (OTRs) and in the treatment of acral locations.
Laser ablation clears AK, facilitates uptake of the photosensitizing drug
and intensifies PDT when used in combination. What does this study add?
Ablative fractional laser (AFXL)-assisted PDT is more effective than AFXL
alone in the treatment of acral AKs in OTRs. 2013 British Association of
Dermatologists.

<15>
Accession Number
2013646132
Authors
Ugur K.S. Karabayirli S. Demircioglu R.T. Ark N. Kurtaran H. Muslu B. Sert
H.
Institution
(Ugur, Ark, Kurtaran) Department of Otolaryngology, Head and Neck Surgery,
Turgut Ozal University Hospital, Ankara, Turkey
(Karabayirli, Demircioglu, Muslu, Sert) Department of Anesthesiology,
Turgut Ozal University Hospital, Ankara, Turkey
Title
The comparison of preincisional peritonsillar infiltration of ketamine and
tramadol for postoperative pain relief on children following
adenotonsillectomy.
Source
International Journal of Pediatric Otorhinolaryngology. 77 (11) (pp
1825-1829), 2013. Date of Publication: November 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objective: To investigate and compare the effectiveness of preincisional
peritonsillar infiltration of ketamine and tramadol for post-operative
pain on children following adenotonsillectomy. Study design: Prospective
randomized double blind controlled study. Methods: Seventy-five children
aged 3-10 years undergoing adenotonsillectomy were included in study.
Patients received injections in peritonsillar fossa of tramadol (2.
mg/kg-2. ml), ketamine (0.5. mg/kg-2. ml) or 2. ml serum physiologic.
During operation heart rate, oxygen saturation, average mean blood
pressures were recorded in every 5. min. Operation, anesthesia and the
time that Alderete scores 9-10, patient satisfaction, analgesic
requirements were recorded. Postoperatively nausea, vomiting, sedation,
dysphagia, bleeding scores were recorded at 0, 10, 30, 60. min and 2, 4,
8, 12, 18, 24. h postoperatively. Pain was evaluated using modified
Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at fixed
intervals after the procedure (15. min and 1, 4, 12, 16, and 24. h
postoperatively). Results: The recordings of heart rate, mean arterial
pressure, nausea, vomiting, sedation and bleeding scores were similar in
all groups (p>. 0.05). The mCHEOPS scores at 10. min, 30. min, 1. h, 8. h
were significantly lower in both tramadol and ketamine group when compared
with control (p<. 0.05). Use of additional analgesia at 10. min and 18. h
were higher in control group than ketamine, tramadol group (p<. 0.05).
Dysphagia scores were significantly lower for both ketamine and tramadol
group when compared with control group (p<. 0.05). mCHEOPS, additional
analgesia, dysphagia, patient satisfaction scores were similar in
tramadol, ketamine groups (p>. 0.05). Conclusions: Preincisional injection
of ketamine and tramadol prior to tonsillectomy is safe, effective method
and equivalent for post-tonsillectomy pain, patient satisfaction,
postoperative nausea, vomiting, dysphagia. 2013 Elsevier Ireland Ltd.

<16>
[Use Link to view the full text]
Accession Number
2013696704
Authors
Schulze C.J. Castro M.M. Kandasamy A.D. Cena J. Bryden C. Wang S.H. Koshal
A. Tsuyuki R.T. Finegan B.A. Schulz R.
Institution
(Schulze, Wang, Koshal) Division of Cardiac Surgery, Mazankowski Alberta
Heart Institute, University of Alberta, Edmonton, AB, Canada
(Castro, Kandasamy, Cena, Schulz) Department of Pediatrics, Mazankowski
Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
(Castro, Kandasamy, Cena, Schulz) Department of Pharmacology, Mazankowski
Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
(Bryden, Finegan) Department of Anesthesiology and Pain Medicine,
University of Alberta, Edmonton, AB, Canada
(Tsuyuki) EPICORE Centre, Department of Medicine, University of Alberta,
Edmonton, AB, Canada
Title
Doxycycline reduces cardiac matrix metalloproteinase-2 activity but does
not ameliorate myocardial dysfunction during reperfusion in coronary
artery bypass patients undergoing cardiopulmonary bypass.
Source
Critical Care Medicine. 41 (11) (pp 2512-2520), 2013. Date of Publication:
November 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVES: Matrix metalloproteinase-2 proteolyzes intracellular proteins
in the heart and induces acute myocardial contractile dysfunction in
ischemia-reperfusion injury. Doxycycline, a matrix metalloproteinase
inhibitor, prevented matrix metalloproteinase-2-induced troponin I
cleavage in rat hearts and improved contractile function following
ischemia-reperfusion. In patients undergoing coronary artery bypass graft
surgery with cardiopulmonary bypass, increased atrial matrix
metalloproteinase-2 activity was inversely correlated with cardiac
mechanical function at 3 hours reperfusion. We performed a study in
patients with coronary artery disease undergoing primary elective coronary
artery bypass graft surgery with cardiopulmonary bypass to determine
whether doxycycline reduces cardiac mechanical dysfunction, matrix
metalloproteinase activity, and troponin I degradation after reperfusion.
DESIGN: Randomized, double-blinded, placebo-controlled study. SETTING:
University of Alberta Hospital. PATIENTS: Forty-two patients with coronary
artery disease undergoing coronary artery bypass graft surgery with
cardiopulmonary bypass. INTERVENTIONS: Patients were randomized to receive
either oral administration of 20 mg of doxycycline or matching placebo
pill twice a day at least 2 days prior to surgery, on the day of surgery,
and for the first 3 postoperative days. MEASUREMENTS AND MAIN RESULTS:
Left ventricular stroke work index was examined prior to cardiopulmonary
bypass and at 24 hours reperfusion. Right atrial biopsies were collected
before cardiopulmonary bypass and 10 minutes after aortic cross-clamp
release to determine matrix metalloproteinase-2 activity and troponin I
level. Blood was collected to determine matrix metalloproteinase activity
and interleukin-6, C-reactive protein, and troponin I levels. Cardiac
72-kDa matrix metalloproteinase-2 activity was lower upon reperfusion in
biopsies from the doxycycline group (p = 0.01), and the increase of matrix
metalloproteinase-2 activity in the placebo group due to reperfusion did
not appear in the doxycycline group (p = 0.05). Doxycycline, however, did
not ameliorate cardiac mechanical dysfunction following reperfusion or the
cardiopulmonary bypass-coronary artery bypass graft-induced increased
plasma matrix metalloproteinase-9, interleukin-6, and C-reactive protein
levels. Cardiopulmonary bypass-coronary artery bypass graft or doxycycline
did not change tissue or plasma troponin I levels at 10 minutes
reperfusion. CONCLUSIONS: Although doxycycline did not improve myocardial
stunning following coronary artery bypass graft surgery with
cardiopulmonary bypass, it reduced cardiac matrix metalloproteinase-2
activity in these patients. A larger trial and/or higher dose of
doxycycline may yet be warranted. Copyright 2013 by the Society of
Critical Care Medicine and Lippincott Williams & Wilkins.

<17>
[Use Link to view the full text]
Accession Number
2013696700
Authors
Ranucci M. Castelvecchio S. Biondi A. De Vincentiis C. Ballotta A. Varrica
A. Frigiola A. Menicanti L.
Institution
(Ranucci, Castelvecchio, Ballotta) Department of Cardiothoracic-Vascular
Anesthesia, Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
(Biondi, De Vincentiis, Varrica, Frigiola, Menicanti) Department of
Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
Title
A Randomized controlled trial of preoperative intra-aortic balloon pump in
coronary patients with poor left ventricular function undergoing coronary
artery bypass surgery.
Source
Critical Care Medicine. 41 (11) (pp 2476-2483), 2013. Date of Publication:
November 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVE: Preoperative intra-aortic balloon pump use in high-risk
patients undergoing surgical coronary revascularization is still a matter
of debate. The objective of this study is to determine whether the
preoperative use of an intra-aortic balloon pump improves the outcome
after coronary operations in high-risk patients. DESIGN: Single-center
prospective randomized controlled trial. SETTING: Tertiary cardiac surgery
center, research hospital. PATIENTS: One hundred ten subjects undergoing
coronary operations, with a poor left ventricular ejection fraction (<
35%) and no hemodynamic instability. INTERVENTIONS: Patients randomized to
receive preincision intra-aortic balloon pump or no intervention.
MEASUREMENTS AND MAIN RESULTS: The primary outcome measurement was
postoperative major morbidity rate, defined as one of prolonged mechanical
ventilation, stroke, acute kidney injury, surgical revision,
mediastinitis, and operative mortality. There was no difference in major
morbidity rate (40% in intra-aortic balloon pump group and 31% in control
group; odds ratio, 1.49 [95% CI, 0.68-3.33]). No differences were observed
for cardiac index before and after the operation; at the arrival in the
ICU, patients in the intra-aortic balloon pump group had a significantly
(p = 0.01) lower mean systemic arterial pressure (80.1 +/- 15.1 mm Hg)
versus control group patients (89.2 +/- 17.9 mm Hg). Fewer patients in the
intra-aortic balloon pump group (24%) than those in the control group
(44%) required dopamine infusion (p = 0.043). CONCLUSIONS: This study
demonstrates that in patients undergoing nonemergent coronary operations,
with a stable hemodynamic profile and a left ventricular ejection fraction
less than 35%, the preincision insertion of intra-aortic balloon pump does
not result in a better outcome. Given the possible complications of
intra-aortic balloon pump insertion, and the additional cost of the
procedure, this approach is not justified. Copyright 2013 by the Society
of Critical Care Medicine and Lippincott Williams & Wilkins.

<18>
Accession Number
2013637843
Authors
Capodanno D. Capranzano P. La Manna A. Tamburino C.
Institution
(Capodanno, Capranzano, La Manna, Tamburino) Cardiology Department,
Ferrarotto Hospital, University of Catania, Via Citelli 6, 95124, Catania,
Italy
Title
Meta-analysis of everolimus-eluting stents versus first-generation
drug-eluting stents in patients with left main coronary artery undergoing
percutaneous coronary intervention.
Source
International Journal of Cardiology. 168 (2) (pp 1718-1719), 2013. Date of
Publication: 30 Sep 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<19>
Accession Number
2013645013
Authors
Di Molfetta A. Forleo G.B. Santini L. Fresiello L. Papavasileiou L.P.
Magliano G. Sergi D. Capria A. Romeo F. Ferrari G.
Institution
(Di Molfetta, Fresiello, Ferrari) Cardiovascular Engineering Group,
Institute of Clinical Physiology, Italian National Research Council, via
San Martino della Battaglia, 44, 00185 Rome, Italy
(Forleo, Santini, Papavasileiou, Magliano, Sergi, Capria, Romeo) Division
of Cardiology, Department of Internal Medicine, University of Tor Vergata,
Rome, Italy
Title
A novel methodology for AV and VV delay optimization in CRT: Results from
a randomized pilot clinical trial.
Source
Journal of Artificial Organs. 16 (3) (pp 273-283), 2013. Date of
Publication: 2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
The aim of this work was to determine whether the use of a newly developed
methodology (Alg1) for AV and VV optimization improves cardiac
resynchronization therapy (CRT) clinical and echocardiographic (ECHO)
outcomes. In this single-center pilot clinical trial, 80 consecutive
patients (79 % male; 70.1 +/- 11.2 years) receiving CRT were randomly
assigned to AV and VV optimization using Alg1 (group A) or standard
commercial procedures (group B). Clinical status and ECHOs were analyzed
at baseline (-0), 3 (fu1), and 6 months (fu2) of follow-up evaluating left
ventricular end systolic (LVESV) and end diastolic (LVEDV) volumes,
ejection fraction (EF), Minnesota test, and 6-min walk test (6MWT). Alg1
is based on a cardiovascular model fed with patient data. Baseline
characteristics did not differ significantly between groups. Group A had a
better clinical outcome and reverse remodeling. Remodeling was calculated
as the difference () between fu1 and -0 and between fu2 and fu1,
respectively: [LVESV (ml): A-fu1 = -55.3, B-fu1 = -13.5, p-fu1 = 0.002;
A-fu2 = -22.8, B-fu2 = 3.0, p-fu2 = 0.04], [LVEDV (ml): A-fu1 = -61.9,
B-fu1 = -16.1, p-fu1 = 0.01; A-fu2 = -30.4, B-fu2 = 11.3, p-fu2 = 0.02];
Minnesota test: total (p-fu1 = 0.01; p-fu2 = 0.04), physical (p-fu1 =
0.01; p-fu2 = 0.03) and emotional scores (p-fu1 = 0.04; p-fu2 = 0.03) and
in 6MWT (m) (p-fu2 = 0.008). No statistically significant difference was
observed in QRS width. Compared with current standard of care, CRT
optimization using Alg1 is associated with better outcomes, showing the
power of a tailored CRT. 2013 The Japanese Society for Artificial Organs.

<20>
Accession Number
71225661
Title
27th Annual Meeting of the European Association for Cardio-Thoracic
Surgery, EACTS 2013.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 27th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2013 Vienna Austria. Conference Start: 20131005 Conference End: 20131009.
Conference Publication: (var.pagings). 17 , 2013. Date of Publication:
October 2013.
Publisher
Oxford University Press
Abstract
The proceedings contain 343 papers. The topics discussed include: visceral
protection during surgery of the thoracic aorta: the safety of moderate
hypothermia; selective antegrade cerebral perfusion with different blood
flow rates: are there differences in cerebral tissue oxygenation and mean
cerebral blood flow velocity?; a new indicator of postoperative delayed
awakening after total aortic arch replacement; aortic arch surgery for
octogenarians: is it justified?; differential selective hypothermic
inter-costal artery perfusion: a new method for confirming spinal cord
perfusion during thoracoabdominal aortic aneurysm repair; embolism is
emerging as a major cause of spinal cord injury after descending and
thoracoabdominal aortic repair with a contemporary approach; a
computational fluid dynamics simulation study of coronary blood flow
affected by graft placement; and searching for the second best graft for
coronary artery bypass surgery: a network meta-analysis of randomized
controlled trials.

<21>
Accession Number
71225645
Authors
Sarzaeem M.R. Sandoughdaran S.
Institution
(Sarzaeem, Sandoughdaran) Cardiac Surgery and Transplantation Research
Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Randomized controlled trial of low-dose amiodarone for prevention of
postoperative atrial fibrillation.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 27th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2013 Vienna Austria. Conference Start: 20131005 Conference End: 20131009.
Conference Publication: (var.pagings). 17 (pp S149), 2013. Date of
Publication: October 2013.
Publisher
Oxford University Press
Abstract
Objectives: Postoperative atrial fibrillation occurs in 20% to 40% of
patients after coronary artery bypass grafting (CABG) and is associated
with prolongation of hospitalization and increase in the risk of adverse
events. The aim of this study was to test whether low-dose oral amiodarone
would prevent atrial fibrillation and decrease hospital stay after CABG.
Methods: Three-hundred and twenty-nine patients undergoing CABG were
included in this prospective, randomized, double-blind and placebo
controlled study. Patients were given 600 mg of amiodarone (n = 119) or
placebo (n = 211) on the night before and on the morning of surgery,
followed by 200 mg of amiodarone or placebo three times daily for the
first five postoperative days. The endpoints were atrial fibrillation
occurrence and hospital stay after CABG. Results: Postoperative atrial
fibrillation occurred in four of the 119 patients in the amiodarone group
(3.4%) versus 27 of the 210 patients in the placebo group (87%), P =
0.005. Patients in the amiodarone group were hospitalized for
significantly fewer days than were patients in the placebo group (5.95 +/-
4.2 vs 7.1 +/- 2.4 days, P = 0.002). Postoperative complications occurred
in 18 amiodarone- treated patients (15%) and in 36 patients receiving
placebo (17.1%, P = 0.63). No differences were noted in baseline variables
or mortality. Conclusions: Low-dose oral amiodarone is safe and effective
in reducing the incidence of atrial fibrillation after CABG and
significantly reduces the duration of hospitalization.

<22>
Accession Number
71225600
Authors
Ad N. Halpin L. Rongione A.J. Speir A.M. Pritchard G. Holmes S.D.
Institution
(Ad, Halpin, Rongione, Speir, Pritchard, Holmes) Department of Cardiac
Surgery Research, Inova Heart and Vascular Institute, Falls Church, United
States
Title
Practice changes in blood glucose management following open heart surgery:
From a prospective randomized study to everyday practice.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 27th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2013 Vienna Austria. Conference Start: 20131005 Conference End: 20131009.
Conference Publication: (var.pagings). 17 (pp S138), 2013. Date of
Publication: October 2013.
Publisher
Oxford University Press
Abstract
Objectives: Targeted blood glucose (BG) levels following cardiac surgery
continues to be debated. According to STS guidelines BG should be <180
mg/dl following surgery while the Surgical Care Improvement Project
recommends <200 mg/dl. However, based on published data, our practice and
others shifted to stricter BG control (90-110 mg/dl). Recently, a
randomized controlled trial (RCT) published by our group suggested no
added value to stricter control over liberal control and we therefore
shifted our management accordingly. The purpose of this study was to
compare patient outcomes before and after the change to liberal BG
management (BGM). Methods: BGM was changed in June 2011 from strict
(90-110) to liberal (120- 180). Insulin drips managed through a
computerized algorithm controlled BG for the first 72 hours post-surgery.
Consecutive cardiac surgery patients operated throughout the one year
prior to BGM change (n = 934) were propensity score matched to patients
operated on throughout one year after the change (n = 927). Results: After
matching there were 846 patient pairs. There was no difference between
cohorts for length of stay and perioperative complications and both
cohorts achieved acceptable outcomes. The incidence of perioperative renal
failure (P = 0.02) and renal failure requiring dialysis (P = 0.004) was
better for the cohort with liberal BGM. One-year cumulative survival did
not differ between cohorts (log-rank = 0.03, P = 0.87). Conclusions:
Implementation of liberal BGM into clinical practice did not increase
morbidity. The present results confirm our prior findings that a liberal
strategy to maintain BG is equal to the stricter target range. These
findings are significant for patient care and demonstrate the safety and
efficacy of practice change for all patients following a successful RCT.

<23>
Accession Number
71225549
Authors
Rafiq S. Steinbruchel D.A. Moeller C.H. Lund J. Thiis J.J. Koeber L.
Lilleoer N.B. Olsen P.S.
Institution
(Rafiq, Steinbruchel, Moeller, Lund, Thiis, Lilleoer, Olsen) Department of
Cardiothoracic Surgery, Copenhagen, Denmark
(Koeber) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
Title
Earlyanticoagulation therapy after bioprosthetic aortic valve
implantation: Comparing warfarin versus aspirin.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 27th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2013 Vienna Austria. Conference Start: 20131005 Conference End: 20131009.
Conference Publication: (var.pagings). 17 (pp S125-S126), 2013. Date of
Publication: October 2013.
Publisher
Oxford University Press
Abstract
Objectives: To compare warfarin therapy (target INR of 2.0 to 3.0) against
aspirin 150 mg daily as anticoagulation therapy for the first three months
after implantation of a bioprosthetic aortic valve. The aim was to
evaluate thromboembolic complications (myocardial infarction [MI],
stroke), bleeding complications and death. Methods: This was a
single-centre, prospective, randomized controlled trial. During the
enrolment period 2005-2012, 370 patients were included, of whom 333 were
available for data analysis. Patients undergoing aortic valve replacement
either isolated or in combination with coronary artery bypass grafting
were included. Results: At baseline, the warfarin and aspirin groups were
comparable, with a mean EuroSCORE of 5.7 +/- 2.3 vs 5.4 +/- 2.1, P = NS,
respectively. Three-month results showed the following: MI occurred in two
patients in the warfarin group vs five in the aspirin group, P = NS;
stroke six vs four, P = NS; gastrointestinal bleeding eight vs one, P =
0.37; all-cause mortality eight vs five, P = NS. The final presentation
will include multivariate analysis of factors. Conclusions: This is to
date the largest randomized trial comparing warfarin to aspirin as early
anticoagulation therapy after implantation of bioprosthetic aortic valves.
The results are not conclusive, but aspirin therapy seems as safe as
warfarin therapy, and with significantly fewer gastrointestinal bleeding
events, three months after surgery.

<24>
Accession Number
71225545
Authors
Deppe A.C. Liakopoulos O.J. Kuhn E.W. Slottosch I. Scherner M. Rahmanian
P. Choi Y. Wahlers T.
Institution
(Deppe, Liakopoulos, Kuhn, Slottosch, Scherner, Rahmanian, Choi, Wahlers)
Department of Cardiothoracic Surgery, Heart Center, University of Cologne,
Cologne, Germany
Title
Minimally invasive direct coronary bypass grafting versus percutaneous
coronary intervention for single-vessel disease: A systematic review with
meta-analysis of 2731 patients.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 27th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2013 Vienna Austria. Conference Start: 20131005 Conference End: 20131009.
Conference Publication: (var.pagings). 17 (pp S124-S125), 2013. Date of
Publication: October 2013.
Publisher
Oxford University Press
Abstract
Objectives: Percutaneous coronary intervention (PCI) and minimally
invasive direct coronary artery bypass grafting (MIDCAB) are both
established therapeutic options for single-vessel disease of the left
anterior descending artery (LAD). The present systematic review with
meta-analysis aims to determine the current strength of evidence for or
against PCI and MIDCAB for revascularization of the LAD. Methods: We
performed a meta-analysis of randomized (RCT) and observational trials
(OT) that reported clinical outcome after isolated LAD revascularization.
Analysed postoperative outcomes included major adverse cardiac and
cerebrovascular events (MACCE), all-cause mortality, myocardial infarction
and stroke. Pooled treatment effects (odds ratio [OR] or weighted mean
difference [WMD], 95% confidence intervals [95% CI]) were assessed using a
fixed or random effects model. Results: A total of 2731 patients from 11
studies (5 RCT, 6 OT) were identified after a literature search of major
databases using a predefined keywords list. PCI of the LAD was performed
in 61.3% (n = 1673) and MIDCAB in 38.4% of patients (n = 1050). Pooled
effect estimates revealed an increased incidence for postprocedural MACCE
after PCI (OR 2.03; 95% CI 1.21-3.40, P < 0.007). In addition, PCI was
associated with increased odds for the endpoint myocardial infarction (OR
1.81; 95% CI 1.11-2.94, P = 0.02), target vessel revascularization (OR
2.52; 95% CI 1.72-3.69, P < 0.00001). No differences with regard to stroke
and all-cause mortality were observed between the revascularization
strategies. Patients after PCI had a shorter length of hospital stay (WMD
3.22 days; 95% CI [-]3.47-[-]2.98, P < 0.0001). Conclusions: The present
systematic review underscores the superiority of MIDCAB over PCI for the
treatment of single-vessel disease of the LAD.

<25>
Accession Number
71225465
Authors
Hassouna A.A.A.M. Allam H.
Institution
(Hassouna) Department of Cardiovascular, Thoracic Surgery, Ain Shams
University, Cairo, Egypt
(Allam) Medical Department, National Research Center, Cairo, Egypt
Title
Low-dose warfarin throughout pregnancy in patients with mechanical heart
valve prostheses: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 27th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2013 Vienna Austria. Conference Start: 20131005 Conference End: 20131009.
Conference Publication: (var.pagings). 17 (pp S105), 2013. Date of
Publication: October 2013.
Publisher
Oxford University Press
Abstract
Objectives: The continuation of warfarin throughout pregnancy in patients
with mechanical heart valve prostheses is a valid anticoagulation regimen,
provided that warfarin dose does not exceed 5 mg/day. Two decades after
being introduced, the efficacy and safety of this regimen merit
evaluation. Methods: We performed a systematic review of cases published
between 1991 and January 2012. We compiled our prospective data on 55
pregnancies and calculated pooled estimates (95% confidence interval) of
adverse foetal and maternal outcomes. Events were expressed as proportions
of total pregnancies, except embryopathy and maternal death, which were
related to the numbers of live births and number of patients respectively.
Results: There were 429 eligible pregnancies, 56.4% of which were studied
prospectively. The rate of embryopathy was 0.85% (0.2-1.8%) and most of
the 15.3% (7.3-24.6%) foetal losses were due to the 14.5% (7.5-23.5%) rate
of spontaneous abortion. No maternal mortality was encountered (0-1.3%)
but 0.8% (0.2-1.9%) prosthetic valve thrombosis, 1.9% (0.9-3.4%) total
thromboembolic events and 3.6% (2.1-.6%) major maternal bleeding events
were recorded. On the other hand, no embryopathy, prosthetic valve
thrombosis or maternal mortality was recorded among the 242 prospective
cases (0-1.49%). Although foetal loss and spontaneous abortion dropped to
7% (4.1-10.5%) and 6.7% (3.9- 10.1%), total maternal thromboembolic
complications and major bleeding events were slightly increased to 2.26%
(0.8-4.5%) and 4.1% (2-6.9%), compared to overall results. Conclusions:
Low dose warfarin throughout pregnancy was associated with improved foetal
outcomes, without jeopardizing maternal safety. Those outcomes were better
when patients were followed up prospectively, as expected.

<26>
Accession Number
71225418
Authors
Saczkowski R. Malas T. El Khoury G. Mesana T. Boodhwani M.
Institution
(Saczkowski, Malas, Mesana, Boodhwani) Department of Cardiac Surgery,
University of Ottawa, Heart Institute, Ottawa, Canada
(El Khoury) Department of Cardiac Surgery, St. Luc Hospital, Brussels,
Belgium
Title
Aortic valve repair in acute type a aortic dissection.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 27th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2013 Vienna Austria. Conference Start: 20131005 Conference End: 20131009.
Conference Publication: (var.pagings). 17 (pp S93), 2013. Date of
Publication: October 2013.
Publisher
Oxford University Press
Abstract
Objectives: Repair and preservation of the aortic valve (AV) in type A
aortic dissection remains controversial. We performed a meta-analysis of
outcomes for AV repair and preservation in acute type A aortic dissection
focusing on long-term valve-related events. Methods: Structured searches
were performed in Embase (1980-2012) and PubMed (1966-2012) for studies
reporting AV repair or preservation in acute type A aortic dissection.
Early mortality and linearized rates for late mortality and valve-related
events were derived. Outcome data were pooled with an inverse-variance
weighted random-effects model. Results: Of 5325 screened articles, 19
observational studies met eligibility criteria, consisting of 2402
patients with a median follow-up of 4.1 years (range 3.1-12.6, total 13
733 patient-years). The cohort was principally male (median = 68.1%,
39-89) with a median age of 59 years (range 55-68) and Marfan syndrome was
present in 2.5%. AV resuspension was performed in 85% and the remainder
underwent valve-sparing root replacement. Pooled early and late mortality
were 18.7% (CI 12.2-26.2), and 4.7%/patient-year (CI 3.3- 6.4),
respectively. Linearized rate for AV reintervention was 2.8%/patient-year
(CI 1.5-4.4), recurrent AI (>2+) was 4.6%/patient-year (CI 3.1-6.2), and
endocarditis was 0.5%/patient-year (CI 0.08-1.3). The composite rate of
thromboembolism and bleeding was 1.4%/patient-year (CI 0.7-2.3).
Conclusions: Repair of acute type A aortic dissection is associated with
poor long-term survival. Preservation and repair of the aortic valve is
associated with a moderate risk of reoperation and recurrent AI and a low
risk of thromboembolism, bleeding, and endocarditis.

<27>
Accession Number
71225325
Authors
Benedetto U. Codispoti M.
Institution
(Benedetto, Codispoti) Department of Cardiothoracic Surgery, Papworth
Hospital, NHS Foundation Trust, Cambridge, United Kingdom
Title
Searching for the second best graft for coronary artery bypass surgery: A
network meta-analysis of randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 27th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2013 Vienna Austria. Conference Start: 20131005 Conference End: 20131009.
Conference Publication: (var.pagings). 17 (pp S70-S71), 2013. Date of
Publication: October 2013.
Publisher
Oxford University Press
Abstract
Objectives: Additional arterial conduits such as the right internal
mammary artery (RIMA), radial artery (RA) and gastroepiploic artery (GEA)
have been proposed as second best conduits after the left internal mammary
artery (LIMA) in the search for a graft that would achieve a better
patency than the saphenous vein graft (SVG). However, it remains unknown
which of these grafts should be considered as the best second conduit for
coronary artery bypass grafting (CABG). We aimed to identify the second
best conduit by means of a network meta-analysis of all published direct
comparisons. Methods: PubMed and the Cochrane Library were searched for
randomized controlled trials (RCTs) comparing the angiographic patency
(less than 70% stenosis) of second conduits including RIMA, RA, GEA and
SVG. A Bayesian meta-analysis was conducted for occlusion and failure
(more than 70% stenosis) rate using published RCTs. Data were extracted
and analysed via indirect comparisons using random effects Bayesian models
in WinBUGS version 1.4.3. Results: A total of seven RCTs involving 1736
patients were included: two studies compared RIMA vs RA, five studies
compared RA vs SVG; one RCT compared GEA vs SVG and RIMA vs SVG. When the
occlusion rate was the outcome of interest, only the RA was found to be
significantly superior to SVG (OR vs SVG: RA 0.35 [0.13-0.94]; RIMA 0.37
[0.07-2.00]; GEA 1.03 [0.16-6.80]). However, none of the arterial conduits
was significantly superior to SVG in terms of failure rate (OR vs SVG: RA
0.59 [0.25-1.40]; RIMA 0.58 [0.13-2.55]; GEA 0.95 [0.17-5.42]). RIMA was
not superior to RA in terms of overall occlusion rate (OR 0.94
[0.20-4.46]) and failure rate (OR 1.01 [0.26-3.96]). Conclusions:
According to the best available evidence to date, the RA emerges as the
second best conduit for CABG. Further randomized controlled trials are
needed to confirm this finding.