EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2013732698
Authors
Dong-Mei X. Jun-Hua Z. Li-Yuan K. Ming-Jun Z. Hong-Cai S.
Institution
(Dong-Mei, Jun-Hua, Hong-Cai) Evidence-based Medicine Center, Tianjin
University of Traditional Chinese Medicine, 312 Anshanxi Road, Tianjin
300193, China
(Li-Yuan) State Key Library of Moredern Traditional Chinese Medicine,
Tianjin, China
(Ming-Jun) First Affiliated Hospital of Henan College of Traditional
Chinese Medicine, Zhengzhou, China
Title
Traditional Chinese medicine for myocardial infarction: An overview.
Source
International Journal of Clinical Practice. 67 (12) (pp 1254-1260), 2013.
Date of Publication: December 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objectives: This overreview aimed to evaluate the methodological quality
and reporting quality of the systematic reviews of Chinese herbal
medicine. Methods: Electronic literature databases, including the PubMed,
Embase, Cochrane library two Chinese databases (China National Knowledge
Internet and Wanfang database) from inception to November 2011 were
searched. Systematic reviews and Meta-analyses of the Chinese medicine for
myocardial infarction were included. Data were extracted by two
independent reviewers. AMSTAR (Assessment of Multiple Systematic Reviews)
and PRIMSMA Preferred Reporting Items for Systematic Reviews and
Meta-Analysis were used to assess the methodological and reporting quality
of the included systematic reviews. Results: Ten reviews were included.
One SR was concerned with ventricular remodelling after myocardial
infarction, one was concerned with hypotension after myocardial
infarction, and the rest related to the myocardial infarction. The
interpretation of the included systematic reviews was poor. Conclusions: A
number of systematic reviews have become available, but the therapeutic
value of traditional Chinese medicine remains limited. 2013 John Wiley &
Sons Ltd.

<2>
Accession Number
2013729345
Authors
Westhoff-Bleck M. Schieffer B. Tegtbur U. Meyer G.P. Hoy L. Schaefer A.
Tallone E.M. Tutarel O. Mertins R. Wilmink L.M. Anker S.D. Bauersachs J.
Roentgen P.
Institution
(Westhoff-Bleck, Schieffer, Meyer, Schaefer, Tallone, Tutarel, Mertins,
Wilmink, Bauersachs, Roentgen) Department of Cardiology and Angiology,
Hannover Medical School, Carl-Neuberg-Str. 1, D 30625 Hannover, Germany
(Tegtbur) Institute of Sports Medicine, Hannover Medical School, Germany
(Hoy) Department of Biometrics, Hannover Medical School, Germany
(Anker) Applied Cachexia Research, Department of Cardiology,
Universitatsmedizin, Berlin, Germany
(Anker) Center for Clinical and Basic Research, IRCCS San Raffaele, Rome,
Italy
Title
Aerobic training in adults after atrial switch procedure for transposition
of the great arteries improves exercise capacity without impairing
systemic right ventricular function.
Source
International Journal of Cardiology. 170 (1) (pp 24-29), 2013. Date of
Publication: 05 Dec 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background Exercise training safely and efficiently improves symptoms in
patients with heart failure due to left ventricular dysfunction. However,
studies in congenital heart disease with systemic right ventricle are
scarce and results are controversial. In a randomised controlled study we
investigated the effect of aerobic exercise training on exercise capacity
and systemic right ventricular function in adults with d-transposition of
the great arteries after atrial redirection surgery (28.2 +/- 3.0 years
after Mustard procedure). Methods 48 patients (31 male, age 29.3 +/- 3.4
years) were randomly allocated to 24 weeks of structured exercise training
or usual care. Primary endpoint was the change in maximum oxygen uptake
(peak VO₂). Secondary endpoints were systemic right ventricular
diameters determined by cardiac magnetic resonance imaging (CMR). Data
were analysed per intention to treat analysis. Results At baseline peak
VO₂ was 25.5 +/- 4.7 ml/kg/min in control and 24.0 +/- 5
ml/kg/min in the training group (p = 0.3). Training significantly improved
exercise capacity (treatment effect for peak VO₂ 3.8 ml/kg/min,
95% CI: 1.8 to 5.7; p = 0.001), work load (p = 0.002), maximum exercise
time (p = 0.002), and NYHA class (p = 0.046). Systemic ventricular
function and volumes determined by CMR remained unchanged. None of the
patients developed signs of cardiac decompensation or arrhythmias while on
exercise training. Conclusions Aerobic exercise training did not
detrimentally affect systemic right ventricular function, but
significantly improved exercise capacity and heart failure symptoms.
Aerobic exercise training can be recommended for patients following atrial
redirection surgery to improve exercise capacity and to lessen or prevent
heart failure symptoms. (Clinical Trial Registration: ClinicalTrials.gov
#NCT00837603) 2013 Elsevier Ireland Ltd.

<3>
Accession Number
2013729351
Authors
Klersy C. Ferlini M. Raisaro A. Scotti V. Balduini A. Curti M. Bramucci E.
De Silvestri A.
Institution
(Klersy, De Silvestri) Service of Biometry and Statistics, IRCCS
Fondazione Policlinico San Matteo, 27100 Pavia, Italy
(Ferlini, Raisaro, Bramucci) Department of Cardiology, IRCCS Fondazione
Policlinico San Matteo, Pavia, Italy
(Scotti, Balduini, Curti) Center for Scientific Documentation, IRCCS
Fondazione Policlinico San Matteo, Pavia, Italy
Title
Use of IVUS guided coronary stenting with drug eluting stent: A systematic
review and meta-analysis of randomized controlled clinical trials and high
quality observational studies.
Source
International Journal of Cardiology. 170 (1) (pp 54-63), 2013. Date of
Publication: 05 Dec 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background/objectives Long term safety of DES, particularly regarding
thrombosis is of concern. The hypothesized underlying mechanisms (stent
underexpansion, malapposition) could be prevented by IVUS guidance. Aim of
this meta-analysis of randomized controlled clinical trials (RCT) and high
quality observational cohort studies (HQ-OBS) is to quantify the potential
clinical benefit of intravascular ultrasound (IVUS) guidance in
drug-eluting stents (DES) implantation. Methods We performed an extensive
literature search for full-text articles published in 2003-2013. The
primary outcome was the rate of major adverse cardiac events (MACE) in RCT
and HQ-OBS; secondary outcomes were death, myocardial infarction (MI),
revascularization, thrombosis and post-procedural minimum lumen diameter
(MLD). Fixed/random effect relative risks (RRs) or standardized mean
difference (SMD) and 95% confidence interval (95% CI) were computed for
the meta-analysis. Results Thirty-four articles were retrieved from 268
found; of these 3 were RCT and 9 were HQ-OBS; 18,707 patients were
enrolled, 1037 in RCT and 17,670 in OBS. Median follow-up was 20 months.
IVUS guidance was associated with a significantly lower rate of MACE (RR =
0.80, 95% CI 0.71-0.89, p < 0.001), death (RR = 0.60, 95% CI 0.48-0.74, p
< 0.001), MI (RR = 0.59, 95% CI 0.44-0.80, p = 0.001) and thrombosis (RR =
0.50, 95% CI 0.32-0.80, p = 0.007) and larger MLD (SMD = 0.15, 95% CI 0.03
to 0.27, p = 0.014), but not of revascularization (RR = 0.95, 95% CI
0.82-1.09, p = 0.75). Conclusions In this meta-analysis, IVUS guidance in
DES implantation appears to reduce MACE, mortality and MI, possibly by
reducing thrombosis rather than restenosis rate. Patients at high risk for
thrombosis might be identified as the best candidate for IVUS guidance.
2013 Elsevier Ireland Ltd.

<4>
Accession Number
2013724061
Authors
Hutchison A.W. Malaiapan Y. Cameron J.D. Meredith I.T.
Institution
(Hutchison, Malaiapan, Cameron, Meredith) Monash Cardiovascular Research
Centre, MonashHEART, Monash Health and Department of Medicine (MMC),
Monash University, Melbourne, Australia
Title
Pre-hospital 12 lead ECG to triage ST elevation myocardial infarction and
long term improvements in door to balloon times: The first 1000 patients
from the MonAMI project.
Source
Heart Lung and Circulation. 22 (11) (pp 910-916), 2013. Date of
Publication: November 2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Pre-hospital ECG is one strategy to improve door to balloon
times (D2BT), however its long term effectiveness to sustain reductions in
D2BT has not been evaluated. Methods: From 2007 to 2011 we conducted a
prospective interventional study involving 1000 patients undergoing
primary PCI (PPCI) at a single tertiary referral institution to determine
the long term impact of pre-hospital 12 lead ECG on D2BT. Results: The
median D2BT of patients (. n=. 414) who underwent PPCI following field
12-lead ECG was 54. min [IQR: 37-71. min] compared to the median time of a
contemporary group (. n=. 586) undergoing PPCI during the same period but
not presenting via field triage of 100. min [74-134] (p < 0.001). The
proportion of patients who achieved a D2BT of <=90. min in the
pre-hospital ECG group was greater than that in the contemporary group
(90% vs 42%, p < 0.001). A comparison of the first 250 patients compared
to subsequent 250 patient blocks showed no change in D2BT. Conclusions:
Introduction of pre-hospital ECG in the triage of STEMI resulted in a
sustained reduction in D2BT. 2013 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ).

<5>
Accession Number
2013770566
Authors
Qiao Y. Bian Y. Yan X. Liu Z. Chen Y.
Institution
(Qiao, Bian, Yan, Liu, Chen) Department of Emergency Medicine, Qilu
Hospital, Shandong Univeristy, Shandong, China
Title
Efficacy and safety of sirolimus-eluting stents versus bare-metal stents
in coronary artery disease patients with diabetes: A meta-analysis.
Source
Cardiovascular Journal of Africa. 24 (7) (pp 274-279), 2013. Date of
Publication: August 2013.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Objective: To compare by meta-analysis the efficacy and safety of
sirolimus-eluting and bare-metal stents in coronary artery disease (CAD)
patients with diabetes. Methods: PubMed, MEDLINE and EMBASE were searched
from 1971 to 2012. Data on the efficacy and safety of sirolimus-eluting
and bare-metal stents in patients with diabetes were collected. A
meta-analysis was then performed on a total of 1 259 CAD patients with
diabetes from six studies. The odds ratio (OR) was used for comparison.
Subgroup analysis was performed according to the sample size, year of
study, subjects' geographic area and study method. Results: Compared with
those in the bare-metal stent group (BMS), the subjects in the
sirolimus-eluting stent (SES) group had a reduced risk for major cardiac
events [OR 0.42, 95% confidence interval (CI): 024-0.74, p < 0.01] and
target-lesion revascularisation (OR 0.26, 95% CI: 0.11-0.59, p < 0.01).
There was no difference for myocardial infarction (OR 0.92, 95% CI:
0.61-1.40, p > 0.05) or mortality (OR 1.19, 95% CI: 0.74-1.92, p > 0.05).
Subgroup analysis showed a significant difference for overall risk of
major cardiac events between SES and BMS when the sample size was <= 90
(OR 0.28, 95% CI: 0.16-0.48, p < 0.01), when it was a randomised control
trial (RCT) (OR 0.28, 95% CI: 0.19-0.42, p < 0.01), or when it was
performed on European subjects (OR 0.45, 95% CI: 0.27-0.77, p < 0.01). The
sensitivity was not different when one study was removed at a time.
Conclusion: Our study confirmed that SES are safer and more effective than
BMS in CAD patients with diabetes, as far as major cardiac events are
concerned.

<6>
Accession Number
2013770562
Authors
Uzun A. Yener U. Cicek O.F. Yener O. Yalcinkaya A. Diken A. Ozkan T.
Turkvatan A. Ulas M.
Institution
(Uzun) Department of Cardiovascular Surgery, Ankara Education and Research
Hospital, Ankara, Turkey
(Yener, Cicek, Yalcinkaya, Diken, Ozkan, Ulas) Department of
Cardiovascular Surgery, Turkey Yuksek Ihtisas Education and Research
Hospital, Ankara, Turkey
(Yener, Turkvatan) Department of Radiology, Turkey Yuksek Ihtisas
Education and Research Hospital, Ankara, Turkey
Title
Does vitamin C or its combination with vitamin e improve radial artery
endothelium-dependent vasodilatation in patients awaiting coronary artery
bypass surgery?.
Source
Cardiovascular Journal of Africa. 24 (7) (pp 255-259), 2013. Date of
Publication: August 2013.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Background: We evaluated the vasodilatory effects of two antioxidants,
vitamins C (ascorbic acid) and E (alpha-tocopherol), on radial artery and
endothelium-dependent responses in patients awaiting coronary artery
bypass surgery. Methods: The study was performed in three groups. The
first group took 2 g of vitamin C orally (n = 31, vitamin C group), the
second group took 2 g of vitamin C with 600 mg of vitamin E orally (n =
31, vitamins C + E group), and the third group took no medication (n = 31,
control group). After baseline measurements were taken of the radial
artery lumen diameter, flow volume and lumen area in the non-dominant
radial artery, occlusion was maintained for five minutes with a pressure
cuff placed around the arm. The measurements were taken again at the time
of deflating the cuff, and 60 seconds later. The measurements were
repeated after medication in two of the groups and after placebo in the
third group. Results: We compared values of the vitamin C group with those
of the vitamins C + E group, and found that the latter were higher than
those of the vitamin C group but not statistically significant. In the
control group, there was no statistical difference. Conclusion: Vitamin C
or its combination with vitamin E significantly enhanced
endothelium-dependent vasodilatation in the radial circulation of patients
with coronary artery disease. Its combination with vitamin E was superior
to vitamin C administration alone for endothelial enhancement but this
difference was not statistically significant. We hypothesised that vitamin
C or its combination with vitamin E may be used as antioxidants for
arterial graft patency in patients undergoing coronary artery surgery.

<7>
Accession Number
2013769777
Authors
Nomura N. Asano M. Saito T. Nakayama T. Mishima A.
Institution
(Nomura, Asano, Saito, Nakayama, Mishima) Department of Cardiovascular
Surgery, Nagoya City University, Graduate School of Medical Sciences,
Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
Title
Sivelestat attenuates lung injury in surgery for congenital heart disease
with pulmonary hypertension.
Source
Annals of Thoracic Surgery. 96 (6) (pp 2184-2191), 2013. Date of
Publication: December 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background Pulmonary hypertension associated with congenital heart disease
increases the risk of surgery using cardiopulmonary bypass. Sivelestat is
a neutrophil elastase inhibitor thought to have a prophylactic effect
against lung injury after surgery using bypass. We elucidated that
Sivelestat had the protective effect on lung in patients with congenital
heart disease and pulmonary hypertension who underwent surgery using
bypass. Methods This study was a controlled prospective randomized trial
and enrolled 13 neonates or infants with ventricular septal defect and
pulmonary hypertension. The patients were assigned to either sivelestat
with the dose of 0.2 mg/kg per hour (sivelestat group, n = 7) or saline
(placebo group, n = 6) from the start of bypass until 6 hours after
bypass. Proinflammatory cytokines and adhesion molecules on leukocytes
were measured at 10 time points during the above period. Pulmonary
function was assessed perioperatively. Results Compared with the placebo
group, the sivelestat group had significantly lower values of
alveolar-arterial oxygen tension gradient at 24 hours (p = 0.038) and at
48 hours (p = 0.028) after bypass, and significantly better balance of
hydration at 48 hours after bypass (p = 0.012). The sivelestat group also
showed significantly lower plasma levels of interleukin-8 immediately
after bypass (p = 0.041) and interleukin-10 at 15 minutes after removal of
the aortic cross-clamp (p = 0.048), and immediately after bypass (p =
0.037). Conclusions Administration of sivelestat during bypass prevented
pulmonary damage and activities of proinflammatory cytokines at the
cardiac operation in neonates or infants. Our results show that sivelestat
may be considered to protect pulmonary function against the injury by
bypass. 2013 by The Society of Thoracic Surgeons.

<8>
Accession Number
2013725733
Authors
Deb S. Wijeysundera H.C. Ko D.T. Tsubota H. Hill S. Fremes S.E.
Institution
(Deb, Wijeysundera, Ko, Tsubota, Hill, Fremes) Schulich Heart Centre,
Division of Cardiology and Cardiac Surgery, Sunnybrook Health Sciences
Centre, Toronto, ON, Canada
(Deb, Wijeysundera, Ko, Fremes) Institute of Health Policy Management and
Evaluation, University of Toronto, Toronto, ON, Canada
(Wijeysundera, Ko) Institute for Clinical Evaluative Sciences, Toronto,
ON, Canada
Title
Coronary artery bypass graft surgery vs percutaneous interventions in
coronary revascularization: A systematic review.
Source
JAMA - Journal of the American Medical Association. 310 (19) (pp
2086-2095), 2013. Date of Publication: 2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
IMPORTANCE: Ischemic heart disease is the leading cause of death globally.
Coronary artery bypass graft (CABG) surgery and percutaneous coronary
intervention (PCI) are the revascularization options for ischemic heart
disease. However, the choice of the most appropriate revascularization
modality is controversial in some patient subgroups. OBJECTIVE: To
summarize the current evidence comparing the effectiveness of CABG surgery
and PCI in patients with unprotected left main disease (ULMD, in which
there is >50% left main coronary stenosis without protective bypass
grafts), multivessel coronary artery disease (CAD), diabetes, or left
ventricular dysfunction (LVD). EVIDENCE REVIEW: A search of OvidSP
MEDLINE, EMBASE, and Cochrane databases between January 2007 and June
2013, limited to randomized clinical trials (RCTs) and meta-analysis of
trials and/or observational studies comparing CABG surgery with PCI was
performed. Bibliographies of relevant studies were also searched.
Mortality and major adverse cardiac and cerebrovascular events (MACCE,
defined as all-cause mortality, myocardial infarction, stroke, and repeat
revascularization) were reported wherever possible. FINDINGS: Thirteen
RCTs and 5 meta-analyses were included. CABG surgery should be recommended
in patients with ULMD, multivessel CAD, or LVD, if the severity of
coronary disease is deemed to be complex (SYNTAX >22) due to lower cardiac
events associated with CABG surgery. In cases in which coronary disease is
less complex (SYNTAX <=22) and/or the patient is a higher surgical risk,
PCI should be considered. For patients with diabetes and multivessel CAD,
CABG surgery should be recommended as standard therapy irrespective of the
severity of coronary anatomy, given improved long-term survival and lower
cardiac events (5-year MACCE, 18.7% for CABG surgery vs 26.6% for PCI; P =
.005). Overall, the incidence of repeat revascularization is higher after
PCI, whereas stroke is higher after CABG surgery. Current literature
emphasizes the importance of a heart-team approach that should consider
coronary anatomy, patient characteristics, and local expertise in
revascularization options. Literature pertaining to revascularization
options in LVD is scarce predominantly due to LVD being an exclusion
factor in most studies. CONCLUSIONS AND RELEVANCE: Both CABG surgery and
PCI are reasonable options for patients with advanced CAD. Patients with
diabetes generally have better outcomes with CABG surgery than PCI. In
cases of ULMD, multivessel CAD, or LVD, CABG surgery should be favored in
patients with complex coronary lesions and anatomy and PCI in less
complicated coronary disease or deemed a high surgical risk. A heart-team
approach should evaluate coronary disease complexity, patient
comorbidities, patient preferences, and local expertise. Copyright 2013
American Medical Association. All rights reserved.

<9>
Accession Number
2013746524
Authors
Zhu G.-F. Wang D.-J. Liu S. Jia M. Jia S.-J.
Institution
(Zhu, Liu) Department of Respiratory and Critical Care Medicine, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart,
Lung and Blood Vessel Diseases, Beijing 100029, China
(Jia, Jia) Department of Surgical Intensive Care Unit, Beijing Anzhen
Hospital, Capital Medical University, Beijing Institute of Heart, Lung and
Blood Vessel Diseases, Beijing 100029, China
(Wang) Intensive Care Unit, Beijing Tongren Hospital, Capital Medical
University, Beijing 100730, China
Title
Efficacy and safety of noninvasive positive pressure ventilation in the
treatment of acute respiratory failure after cardiac surgery.
Source
Chinese Medical Journal. 126 (23) (pp 4463-4469), 2013. Date of
Publication: 2013.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Although noninvasive positive pressure ventilation (NPPV) has
been successfully used for various kinds of acute respiratory failure, the
data are limited regarding its application in postoperative respiratory
failure after cardiac surgery. Therefore, we conducted a prospective
randomized control study in a university surgical intensive care unit to
evaluate the efficacy and safety of NPPV in the treatment of acute
respiratory failure after cardiac surgery, and explore the predicting
factors of NPPV failure. Methods From September 2011 to November 2012
patients with acute respiratory failure after cardiac surgery who had
indication for the use of NPPV were randomly divided into a NPPV treatment
group (NPPV group) and the conventional treatment group (control group).
The between-group differences in the patients' baseline characteristics,
re-intubation rate, tracheotomy rate, ventilator associated pneumonia
(VAP) incidence, in-hospital mortality, mechanical ventilation time after
enrollment (MV time), intensive care unit (ICU) and postoperative hospital
stays were compared. The factors that predict NPPV failure were analyzed.
Results During the study period, a total of 139 patients who had acute
respiratory failure after cardiac surgery were recorded, and 95 of them
met the inclusion criteria, which included 59 males and 36 females with a
mean age of (61.5+/-11.2) years. Forty-three patients underwent coronary
artery bypass grafting (CABG), 23 underwent valve surgery, 13 underwent
CABG+valve surgery, 13 underwent major vascular surgery, and three
underwent other surgeries. The NPPV group had 48 patients and the control
group had 47 patients. In the NPPV group, the re-intubation rate was
18.8%, tracheotomy rate was 12.5%, VAP incidence was 0, and the
in-hospital mortality was 18.8%, significantly lower than in the control
group 80.9%, 29.8%, 17.0% and 38.3% respectively, P <0.05 or P <0.01. The
MV time and ICU stay (expressed as the median (P25, P75)) were 18.0 (9.2,
35.0) hours and 4.0 (2.0, 5.0) days, which were significantly shorter than
in the control group, 96.0 (26.0, 240.0) hours and 6.0 (4.0, 9.0) days
respectively, P <0.05 or P <0.01. The postoperative hospital stays of the
two groups were similar. The univariate analysis showed that the NPPV
success subgroup had more patients with acute lung injury (ALI) (17 vs. 0,
P=0.038), fewer patients with pneumonia (2 vs. 7, P <0.001) and lower
acute physiology and chronic health evaluation II (APACHE II) scores
(16.1+/-2.8 vs. 21.8+/-3.2, P <0.001). Multivariate analysis showed that
pneumonia (P=0.027) and a high APACHE II score >20 (P=0.002) were the
independent risk factors of NPPV failure. Conclusions We conclude that
NPPV can be applied in selected patients with acute respiratory failure
after cardiac surgery to reduce the need of re-intubation and improve
clinical outcome as compared with conventional treatment. Pneumonia and a
high APACHE II score >20 might be the independent risk factors of NPPV
failure in this group of patients.

<10>
Accession Number
2013728613
Authors
Harling L. Moscarelli M. Kidher E. Fattouch K. Ashrafian H. Athanasiou T.
Institution
(Harling, Moscarelli, Kidher, Ashrafian, Athanasiou) Department of Surgery
and Cancer, Imperial College London, St. Mary's Hospital, South Wharf
Road, London W2 1NY, United Kingdom
(Fattouch) University of Palermo, Palermo, Italy
Title
The effect of off-pump coronary artery bypass on mortality after acute
coronary syndrome: A meta-analysis.
Source
International Journal of Cardiology. 169 (5) (pp 339-348), 2013. Date of
Publication: 20 Nov 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background Patients requiring surgical revascularisation for acute
coronary syndrome (ACS) form a clinically heterogeneous group ranging from
haemodynamic stability to cardiogenic shock. Whilst 'off-pump'
revascularisation (OPCAB) is often considered, patient selection and
operative timing remain controversial. This study aims to identify whether
OPCAB may confer a mortality benefit over ONCAB in revascularisation for
ACS. Secondly, we review the impact of OPCAB on completeness of
revascularisation (CR) and long-term re-intervention. Methods A systematic
literature review identified 9 studies (1 randomised controlled trial) of
which 8 fulfilled criteria for meta-analysis. Outcomes for a total of 3001
patients (n = 817 OPCAB, 2184 'on-pump' (ONCAB)) were meta-analysed using
random effects modelling. Heterogeneity, subgroup analysis and quality
scoring were assessed. Primary endpoints were 30-day and mid-term
mortality. Secondary endpoints were CR, revascularisation index and
re-intervention. Results OPCAB conferred comparable mortality to ONCAB at
both 30-days and mid-term follow up (p = 0.08 and p = 0.46 respectively).
OPCAB was also associated with less CR (WMD - 0.60, 95% CI [- 0.82, -
0.38], p < 0.00001) and a lower revascularisation index (WMD - 0.25, 95%
CI [- 0.30, - 0.19], p < 0.00001), although no difference was observed in
re-intervention rate (OR 1.33; 95% CI [0.99, 2.07], p = 0.99). Conclusions
We conclude that OPCAB may be a safe and comparable alternative to ONCAB
in clinically stable ACS patients requiring urgent/emergent
revascularisation. However, in order to finally determine whether OPCAB
may provide any more than just comparability to ONCAB in the setting of
ACS, further research must clearly define selection criteria, better
characterize this heterogeneous patient group and assess the effects of
incomplete revascularisation on long-term outcomes. 2013 Elsevier Ireland
Ltd.

<11>
Accession Number
2013721487
Authors
Verma S. Farkouh M.E. Yanagawa B. Fitchett D.H. Ahsan M.R. Ruel M. Sud S.
Gupta M. Singh S. Gupta N. Cheema A.N. Leiter L.A. Fedak P.W.M. Teoh H.
Latter D.A. Fuster V. Friedrich J.O.
Institution
(Verma, Ahsan, Gupta, Gupta, Teoh, Latter) Division of Cardiac Surgery, St
Michael's Hospital Toronto, ON, Canada
(Fitchett, Cheema) Division of Cardiology, St Michael's Hospital Toronto,
ON, Canada
(Leiter, Teoh) Division of Endocrinology and Metabolism, St Michael's
Hospital Toronto, ON, Canada
(Friedrich) Departments of Critical Care and Medicine, St Michael's
Hospital Toronto, ON, Canada
(Verma, Farkouh, Fitchett, Gupta, Cheema, Leiter, Teoh, Latter, Friedrich)
Keenan Research Centre in the Li Ka Shing Knowledge Institute, St
Michael's Hospital Toronto, ON, Canada
(Farkouh) University Health Network, Toronto, ON, Canada
(Verma, Yanagawa, Latter) Department of Surgery, University of Toronto,
ON, Canada
(Farkouh, Fitchett, Sud, Gupta, Cheema, Leiter, Friedrich) Department of
Medicine, University of Toronto, ON, Canada
(Leiter) Department of Nutritional Sciences, University of Toronto, ON,
Canada
(Friedrich) Interdepartmental Division of Critical Care, University of
Toronto, ON, Canada
(Singh) Pramukhswami Medical College, Gujarat, India
(Ruel, Gupta) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Sud) Division of Critical Care, Department of Medicine, Trillium Health
Partners, Mississauga, ON, Canada
(Gupta) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Fedak) Libin Cardiovascular Institute of Alberta, University of Calgary,
Calgary, AB, Canada
(Fuster) Mount Sinai Medical Center, New York, NY, United States
(Fuster) National Center for Cardiovascular Research (CNIC), Madrid, Spain
Title
Comparison of coronary artery bypass surgery and percutaneous coronary
intervention in patients with diabetes: A meta-analysis of randomised
controlled trials.
Source
The Lancet Diabetes and Endocrinology. 1 (4) (pp 317-328), 2013. Date of
Publication: December 2013.
Publisher
Lancet Publishing Group (Langford Lane, Kidlington, Oxford OX5 1GB, United
Kingdom)
Abstract
Background: The choice between coronary artery bypass surgery (CABG) and
percutaneous coronary intervention (PCI) for revascularisation in patients
with diabetes and multivessel coronary artery disease, who account for 25%
of revascularisation procedures, is much debated. We aimed to assess
whether all-cause mortality differed between patients with diabetes who
had CABG or PCI by doing a systematic review and meta-analysis of
randomised controlled trials (RCTs) comparing CABG with PCI in the modern
stent era. Methods: We searched Medline, Embase, and the Cochrane Central
Register of Controlled Trials from Jan 1, 1980, to March 12, 2013, for
studies reported in English. Eligible studies were those in which
investigators enrolled adult patients with diabetes and multivessel
coronary artery disease, randomised them to CABG (with arterial conduits
in at least 80% of participants) or PCI (with stents in at least 80% of
participants), and reported outcomes separately in patients with diabetes,
with a minimum of 12 months of follow-up. We used random-effects models to
calculate risk ratios (RR) and 95% CIs for pooled data. We assessed
heterogeneity using I². The primary outcome was all-cause
mortality in patients with diabetes who had CABG compared with those who
had PCI at 5-year (or longest) follow-up. Findings: The initial search
strategy identified 3414 citations, of which eight trials were eligible.
These eight trials included 7468 participants, of whom 3612 had diabetes.
Four of the RCTs used bare metal stents (BMS; ERACI II, ARTS, SoS, MASS
II) and four used drug-eluting stents (DES; FREEDOM, SYNTAX, VA CARDS,
CARDia). At mean or median 5-year (or longest) follow-up, individuals with
diabetes allocated to CABG had lower all-cause mortality than did those
allocated to PCI (RR 067, 95% CI 052-086; p=0002; I²=25%; 3131
patients, eight trials). Treatment effects in individuals without diabetes
showed no mortality benefit (103, 077-137; p=078; I²=46%; 3790
patients, five trials; p_interaction=0.03). We identified no
differences in outcome whether PCI was done with BMS or DES. When present,
we identified no clear causes of heterogeneity. Interpretation: In the
modern era of stenting and optimum medical therapy, revascularisation of
patients with diabetes and multivessel disease by CABG decreases long-term
mortality by about a third compared with PCI using either BMS or DES. CABG
should be strongly considered for these patients. Funding: Canadian
Institutes of Health Research, Heart and Stroke Foundation of Canada, and
Canada Research Chairs programme. 2013 Elsevier Ltd.

<12>
Accession Number
2013770605
Authors
Stefanini G.G. Baber U. Windecker S. Morice M.-C. Sartori S. Leon M.B.
Stone G.W. Serruys P.W. Wijns W. Weisz G. Camenzind E. Steg P.G. Smits
P.C. Kandzari D. Von Birgelen C. Galatius S. Jeger R.V. Kimura T. Mikhail
G.W. Itchhaporia D. Mehta L. Ortega R. Kim H.-S. Valgimigli M. Kastrati A.
Chieffo A. Mehran R.
Institution
(Stefanini, Windecker) Bern University Hospital, Bern, Switzerland
(Baber, Sartori, Mehran) Mount Sinai School of Medicine, New York, NY,
United States
(Leon, Stone, Weisz) Columbia University Medical Center, New York, NY,
United States
(Wijns) Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis
Ziekenhuis, Aalst, Belgium
(Camenzind) University of Geneva, Geneva, Switzerland
(Jeger) University Hospital Basel, Basel, Switzerland
(Steg) Departement Hospitalo- Universitaire Fibrose, Infl Ammation et
REmodelage, Universite Paris- Diderot, Paris, France
(Smits) Maasstad Hospital, Rotterdam, Netherlands
(Von Birgelen) Thoraxcentrum Twente, Enschede, Netherlands
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Galatius) Gentofte University Hospital, Hellerup, Denmark
(Kimura) Kyoto University Graduate School of Medicine, Kyoto, Japan
(Mikhail) Imperial College Healthcare NHS Trust, London, United Kingdom
(Kim) Seoul National University Main Hospital, Seoul, South Korea
(Valgimigli) University of Ferrara, Ferrara, Italy
(Kastrati) Deutsches Herzzentrum, Munich, Germany
(Serruys) Erasmus MC, Rotterdam, Netherlands
(Itchhaporia) Hoag Memorial Hospital Presbyterian, Newport Beach, CA,
United States
(Ortega) Society of Cardiovascular Angiography and Interventions,
Washington, DC, United States
(Mehta) Ohio State University Medical Center, Columbus, OH, United States
(Chieffo) San Raffaele Hospital, Milan, Italy
(Morice) Institut Cardiovasculaire, Paris-Sud, France
Title
Safety and effi cacy of drug-eluting stents in women: A patient-level
pooled analysis of randomised trials.
Source
The Lancet. 382 (9908) (pp 1879-1888), 2013. Date of Publication: 2013.
Publisher
Lancet Publishing Group (Langford Lane, Kidlington, Oxford OX5 1GB, United
Kingdom)
Abstract
Background The safety and effi cacy of drug-eluting stents (DES) in the
treatment of coronary artery disease have been assessed in several
randomised trials. However, none of these trials were powered to assess
the safety and effi cacy of DES in women because only a small proportion
of recruited participants were women. We therefore investigated the safety
and effi cacy of DES in female patients during long-term follow-up.
Methods We pooled patient-level data for female participants from 26
randomised trials of DES and analysed outcomes according to stent type
(bare-metal stents, early-generation DES, and newer-generation DES). The
primary safety endpoint was a composite of death or myocardial infarction.
The secondary safety endpoint was defi nite or probable stent thrombosis.
The primary effi cacy endpoint was target-lesion revascularisation.
Analysis was by intention to treat. Findings Of 43 904 patients recruited
in 26 trials of DES, 11 557 (26.3%) were women (mean age 67.1 years [SD
10.6]). 1108 (9.6%) women received bare-metal stents, 4171 (36.1%)
early-generation DES, and 6278 (54.3%) newergeneration DES. At 3 years,
estimated cumulative incidence of the composite of death or myocardial
infarction occurred in 132 (12.8%) women in the bare-metal stent group,
421 (10.9%) in the early-generation DES group, and 496 (9.2%) in the
newer-generation DES group (p=0.001). Defi nite or probable stent
thrombosis occurred in 13 (1.3%), 79 (2.1%), and 66 (1.1%) women in the
bare-metal stent, early-generation DES, and newer-generation DES groups,
respectively (p=0.01). The use of DES was associated with a signifi cant
reduction in the 3 year rates of targetlesion revascularisation (197
[18.6%] women in the bare-metal stent group, 294 [7.8%] in the
early-generation DES group, and 330 [6.3%] in the newer-generation DES
group, p<0.0001). Results did not change after adjustment for baseline
characteristics in the multivariable analysis. Interpretation The use of
DES in women is more effective and safe than is use of bare-metal stents
during longterm follow-up. Newer-generation DES are associated with an
improved safety profi le compared with earlygeneration DES, and should
therefore be thought of as the standard of care for percutaneous coronary
revascularisation in women.

<13>
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Accession Number
2013769523
Authors
Orioles A. Morrison W.E. Rossano J.W. Shore P.M. Hasz R.D. Martiner A.C.
Berg R.A. Nadkarni V.M.
Institution
(Orioles, Morrison, Berg, Nadkarni) Department of Anesthesiology and
Critical Care Medicine, Children's Hospital of Philadelphia, University of
Pennsylvania School of Medicine, Philadelphia, PA, United States
(Rossano) Department of Pediatrics, Cardiac Center, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Shore) Department of Pediatrics, Saint Christopher's Hospital for
Children, Drexel University College of Medicine, Philadelphia, PA, United
States
(Hasz, Martiner) Gift of Life Donor Program, Philadelphia, PA, United
States
Title
An under-recognized benefit of cardiopulmonary resuscitation: Organ
transplantation*.
Source
Critical Care Medicine. 41 (12) (pp 2794-2799), 2013. Date of Publication:
December 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVE:: For many patients who suffer cardiac arrest, cardiopulmonary
resuscitation does not result in long-term survival. For some of these
patients, the evolution to donation of organs becomes an option. Organ
transplantation after cardiopulmonary resuscitation is not reported as an
outcome of cardiopulmonary resuscitation and is therefore overlooked. We
sought to determine the number and proportion of organs transplanted from
donors who received cardiopulmonary resuscitation after a cardiac arrest
in the United States and to compare survival of organs from donors who had
cardiopulmonary resuscitation (cardiopulmonary resuscitation organs)
versus donors who did not have resuscitation (noncardiopulmonary
resuscitation organs). DATA SOURCE:: We retrospectively analyzed a
nationwide, population-based database of all organ donors and recipients
from the United Network for Organ Sharing between July 1999 and June 2011.
STUDY SELECTION:: We queried the database for all organs from deceased
donors between July 1999 and June 2011. Organs from living donors (n =
76,015), all organs with missing cardiopulmonary resuscitation data (n =
59), and organs procured following a circulatory determination of death (n
= 12,030) were excluded. DATA EXTRACTION:: We report donor demographic
data and organ survival outcomes among organs from donors who received
cardiopulmonary resuscitation (cardiopulmonary resuscitation organs) and
donors who had not received cardiopulmonary resuscitation
(noncardiopulmonary resuscitation organs). Graft survival of
cardiopulmonary resuscitation organs versus noncardiopulmonary
resuscitation organs was compared using Kaplan-Meier estimates and
stratified log-rank test. DATA SYNTHESIS:: In the United States, among the
224,076 organs donated by donors who were declared dead by neurologic
criteria between 1999 and 2011, at least 12,351 organs (5.5%) were
recovered from donors who received cardiopulmonary resuscitation. Graft
survival of cardiopulmonary resuscitation organs was not significantly
different than that of noncardiopulmonary resuscitation organs.
CONCLUSIONS:: At least 1,000 organs transplanted per year in the United
States (> 5% of all organs transplanted from patients declared dead by
neurologic criteria) are recovered from patients who received
cardiopulmonary resuscitation. Organ recovery and successful
transplantation is an unreported beneficial outcome of cardiopulmonary
resuscitation. Copyright 2013 by the Society of Critical Care Medicine
and Lippincott Williams & Wilkins.

<14>
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Accession Number
2013769457
Authors
Mathew J.P. White W.D. Schinderle D.B. Podgoreanu M.V. Berger M. Milano
C.A. Laskowitz D.T. Stafford-Smith M. Blumenthal J.A. Newman M.F.
Institution
(Mathew, White, Podgoreanu, Berger, Stafford-Smith, Newman) Department of
Anesthesiology, Duke University Medical Center, Durham, NC 27710, United
States
(Laskowitz) Department of Neurology, Duke University Medical Center,
Durham, NC 27710, United States
(Blumenthal) Department of Psychiatry, Duke University Medical Center,
Durham, NC 27710, United States
(Milano) Department of Surgery, Duke University Medical Center, Durham, NC
27710, United States
(Schinderle) Duke University Medical Center, Durham, NC, United States
(Schinderle) Department of Anesthesiology, Sentara Cardiovascular Research
Institute, Norfolk, VA, United States
Title
Intraoperative magnesium administration does not improve neurocognitive
function after cardiac surgery.
Source
Stroke. 44 (12) (pp 3407-3413), 2013. Date of Publication: December 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND AND PURPOSE - Neurocognitive decline occurs frequently after
cardiac surgery and persists in a significant number of patients.
Magnesium is thought to provide neuroprotection by preservation of
cellular energy metabolism, blockade of the N-methyl-D-aspartate receptor,
diminution of the inflammatory response, and inhibition of platelet
activation. We therefore hypothesized that intraoperative magnesium
administration would decrease postoperative cognitive impairment. METHODS
- After approval by the Duke University Health System Institutional Review
Board, 389 patients undergoing cardiac surgery were enrolled in this
prospective, randomized, double-blind, placebo-controlled clinical trial.
Subjects were randomized to receive magnesium as a 50 mg/kg bolus followed
by another 50 mg/kg infusion for 3 hours or placebo bolus and infusion.
Cognitive function was assessed preoperatively and again at 6 weeks
postoperatively using a standardized test battery. Mean CD11b fluorescence
and percentage of platelets expressing CD62P, which are markers of
leukocyte and platelet activation, respectively, were assessed by flow
cytometry as a secondary outcome. The effect of magnesium on postoperative
cognition was tested using multivariable regression modeling, adjusting
for age, years of education, baseline cognition, sex, race, and weight.
RESULTS - Among the 389 allocated subjects (magnesium: n=198; placebo:
n=191), the incidence of cognitive deficit in the magnesium group was
44.4% compared with 44.9% in the placebo group (P=0.93). The cognitive
change score and platelet and leukocyte activation were also not different
between the groups. Multivariable analysis revealed a marginal interaction
between treatment group and weight such that heavier subjects receiving
magnesium were less likely to have cognitive deficit (P=0.06). CONCLUSIONS
- Magnesium administered intravenously during cardiac surgery does not
reduce postoperative cognitive dysfunction. CLINICAL TRIAL REGISTRATION -
: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00041392.
2013 American Heart Association, Inc.

<15>
Accession Number
71256027
Authors
Kumar S. Benjo A.M. Pamidimukala C.K. Javed F. Garcia W. Macedo F.Y.
Garcia D.C. Santana O. Nascimeto F.O. Pierce M. Herzog E. Aziz E.F.
Institution
(Kumar, Benjo, Pamidimukala, Javed, Garcia, Garcia, Nascimeto, Pierce,
Herzog, Aziz) St. Luke's and Roosevelt Hosps, Columbia Univ, College of
Physicians and Surgeons, New York, NY, United States
(Macedo, Santana) Mount Sinai Heart Institute, Miami Beach, FL, United
States
Title
Vitamin C decreases atrial fibrillation in cardiac surgery patients but
vitamin e may decrease response: A randomized-controlled trial
meta-analysis.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: American
Heart Association's Quality of Care and Outcomes Research in
Cardiovascular Disease and Stroke 2013 Scientific Sessions, QCOR 2013
Baltimore, MD United States. Conference Start: 20130515 Conference End:
20130517. Conference Publication: (var.pagings). 6 (3 SUPPL. 1) , 2013.
Date of Publication: May 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Due to the population aging, atrial fibrillation (AF) is
becoming a more prevalent disease, it also commonly presents as a cardiac
surgery complication. Randomized controlled trials (RCT) concerning
anti-oxidant vitamins for atrial fibrillation (AF) prophylaxis have
yielded inconsistent outcomes. Similar inconsistencies were found in other
cardiovascular studies, as the HOPE and FATS studies, suggesting that
vitamin E in special may not be helpful, perhaps harmful. Methods: All
randomized controlled trials on anti-oxidant vitamins supplementation for
atrial fibrillation prevention for patients undergoing cardiac surgery
were sought in Medline and Cochrane databases during May 2012. Data was
extracted by 3 reviewers. Results: Seven studies were found, three with
vitamin C, two with Vitamin E and two combining both. We found an overall
significant 60% decrease in the overall chance for AF occurrence mostly
driven by (Figures1A and 1B) as the studies with vitamin E or vitamin C
and E combined (Figures 1 C and 1D) did not show a statistically
significant difference. When all studies with Vitamin E alone or in
combination with Vitamin C (Figure 1E). Conclusions: Vitamin C
supplementation decreases the incidence of post cardiac surgery AF but the
data on Vitamin E is inconsistent, it may even decrease the Vitamin C
benefit. As vitamin self-supplementation is extremely common in the US,
large trials are extremely important not only for benefit confirmation but
to exclude potential harms.

<16>
Accession Number
71256359
Authors
Lambert L.J. Boothroyd L.J. Spaziano M. Guertin J.R. Josep R.-C. Noiseux
N. Nguyen M. Dumont E. Carrier M. De Varennes B. Ibrahim R. Martucci G.
Xiao Y. Morin J.E. Bogaty P.
Institution
(Lambert, Boothroyd, Spaziano, Guertin, Xiao, Morin) INESSS, Montreal,
Canada
(Josep, Dumont, Bogaty) Institut Universitaire Cardiologie et Pneumologie,
Quebec, QC, Canada
(Noiseux) Cntr Hospier d'Universite de Montreal, Montreal, Canada
(Nguyen) Hopital Fleurimont, Sherbrooke, Canada
(Carrier, Ibrahim) Institut de Cardiologie de Montreal, Montreal, Canada
(De Varennes) Cntr Universitaire de Sante McGill, Montreal, Canada
(Martucci) Hopital Royal-Victoria, Montreal, Canada
Title
Where clinical practice, emerging medical technology, and evaluation
intersect in a healthcare system based on equal access: The example of
transcatheter aortic valve replacement.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: Quality of
Care and Outcomes Research in Cardiovascular Disease and Stroke 2012
Scientific Sessions, QCOR 2012 Atlanta, GA United States. Conference
Start: 20120509 Conference End: 20120511. Conference Publication:
(var.pagings). 5 (3 SUPPL. 1) , 2012. Date of Publication: May 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an emerging
treatment for frequently elderly patients with severe symptomatic aortic
stenosis considered at too high risk for conventional surgery. However,
this less invasive treatment has important implications in a universal
public payer healthcare system with limited resources. In early 2011, the
province of Quebec's Ministry of Health requested an evaluation of TAVR by
INESSS, a government-funded independent body that assists evidence-based
policy-making with literature reviews, field evaluations and outcomes
research. The Ministry also asked INESSS to be involved in the creation of
a provincial registry. At the time of the request, 4 centers were already
performing TAVR and others were developing programs. METHODS: We conducted
a systematic literature review (2008-2011) on effectiveness, safety,
economic, and ethical issues, in collaboration with a committee of
independent clinical experts (4 interventional cardiologists, 4 cardiac
surgeons). The committee's role was to help interpret and contextualize
existing evidence and to collaborate in the development of a provincial
registry. We proposed clinical, process of care and economic variables for
a registry based on the literature review and the clinicians'
perspectives. RESULTS: According to the literature, outcomes of TAVR are
promising for carefully selected patients with respect to 1-year survival,
functional improvement, and quality of life. Limitations in the evidence
base include uncertain longer-term benefits and device durability due to a
lack of studies with lengthy follow-up; an important risk of stroke and
high rates of hospitalization post-intervention in the one available
randomized controlled trial; lack of standardization of data definitions
across studies; and insufficient evidence on cost-effectiveness and
cost-utility. We recommended that: (1) TAVR be offered only to patients
declined for surgery and who would likely have improved quality of life as
a result of the procedure; (2) patients be fully informed of the relative
novelty of the procedure and uncertainty about associated risks and
longer-term benefits; (3) selection of patients involve a
multi-disciplinary team and be uniform in terms of criteria and process
across centers to ensure equal access; (4) the patient selection process
be documented; (5) TAVR programs receive specific funding that includes
financing of a registry; (6) a mandatory registry be used to collect data
on baseline patient characteristics, procedures, outcomes, and costs, to
inform both participating centres and the Ministry; and (7) TAVR be
performed by a limited number of expert centers to maintain a sufficient
volume of procedures. CONCLUSIONS: The practice of TAVR in the province of
Quebec will be guided by the results of a systematic review of existing
evidence and future evidence from a provincial registry developed by an
independent body in collaboration with clinical experts. We believe that
this evaluation model will meet the challenges posed by the introduction
of innovative technology in a universal healthcare system with limited
resources.

<17>
[Use Link to view the full text]
Accession Number
71256791
Authors
Marzouka G.R. Martinez C. Tamariz L.
Institution
(Marzouka, Tamariz) Univ of Miami - Miller, Sch of Medicine, Miami, FL,
United States
(Martinez) Florida International Univ, Miami, FL, United States
Title
Depression increases all-cause mortality in post cardiac surgery patients:
A meta-analysis of prospective cohort studies.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: Quality of
Care and Outcomes Research in Cardiovascular Disease and Stroke 2010
Scientific Sessions, QCOR 2010 Washington, DC United States. Conference
Start: 20100519 Conference End: 20100521. Conference Publication:
(var.pagings). 4 (6 MeetingAbstracts2010) , 2011. Date of Publication:
November 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Studies have shown that depression is a prevalent condition
among cardiac patients, especially after cardiac surgery, and that it's
presance has been related to negative outcomes. The purpose of this study
was to perform a meta-analysis to evaluate depression as a risk factor for
all-cause mortality in patients status post cardiac surgery. Methods: A
search of MEDLINE (1966 - October 2009) database was performed and we
selected all prospective cohort studies in which depression was measured
pre-operatively, postoperatively, or both by an established depression
index with all-cause mortality recorded after a minimum follow up of 1
year. The pooled relative risk (RR) with corresponding 95% confidence
interval (CI) was calculated for all cause mortality using the fixed
effects method to evaluate the effects of depression on all-cause
mortality in post cardiac surgery patients. Results: Our search strategy
yielded 144 studies, of which only 6 met our inclusion criteria. The
studies comprised of 1,906 patients, predominately white, males who have
undergone coronary artery bypass grafting (64% or 1228 of 1906) or cardiac
valve replacement (36% or 678 of 1906) and where evaluated for depression.
The RR of all-cause mortality was 1.8; 95% CI (1.4-2.5) for patients with
significant depression compared to patients without. Conclusion:
Depression is associated with higher all-cause mortality in patients
status-post cardiac surgery. All patients should be evaluated for
depression after cardiac surgery and treated aggressively. (Table
Presented).

<18>
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Accession Number
71251662
Authors
Wu Q.W. Shan J. Sun X.G. Zhou N.Y. Yang T. Guo J.Y. Xia J.M. Feng L. Li
P.Y.
Institution
(Wu, Shan, Sun, Zhou, Yang, Guo, Xia, Feng, Li) West China Hospital,
Sichuan University, Key Laboratory of Transplant Engineering and
Immunology of Health Ministry of China, Chengdu, China
(Li) West China Hospital, Sichuan University, Chinese Evidence-Based
Medicine Centre, Chengdu, China
Title
Adoptive transfusion of tolerance dendritic cells prolong the survival of
cardiac allograft: A systematic review on 44 animal studies.
Source
Transplantation. Conference: 24th International Congress of the
Transplantation Society Berlin Germany. Conference Start: 20120715
Conference End: 20120719. Conference Publication: (var.pagings). 94 (pp
942), 2012. Date of Publication: 27 Sep 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Objective: Tolerogenic DCs (Tol-DCs) , a group of cell with
imDC phenotype, can stablely induce T cells low-reactivity and immune
tolerance. We systematically reviewed the reinfusion of Tol-DCs induced by
different ways to prolong cardiac allograft survival and its possible
mechanism. Methods: The MEDLINE (1966 to March 2011), EMBASE (1980 to
March 2011), and ISI (inception to March 2011) were searched for
identification of relevant studies. We use allogeneic heart graft survival
time as the endpoint outcome to analyze the effect of adoptive transfusion
of Tol-DC on cardiac allograft. By integrating into the studies'
information, summary the mechanisms of Tol-DC prolonging cardiac grafts.
Results: Four methods were used to induce Tol-DC in all of the 44 included
studies: gene modification, drug-intervention, cytokine-induced, and
other-derived(liver-derived & spleen-derived) DCs. The results show that
all types of Tol-DC can effectively prolong graft survival, and the
average extension of graft survival time for each group is as follows:
22.02+/-21.9 days (3.2 folds to control group) for Gene-intervention,
25.94+/-16.9 days (4.3 folds) for drug-induced groups, 9.00+/-8.13
days(1.91 folds) for cytokine-induced and 10.69+/-9.94 days(2.07folds) for
other-derived groups. The main mechanisms of Tol-DCs to prolong graft
survival are as follows: (1) induceT-cell hyporeactivity (detected by MLR)
;(2) reduce the effect of cytotoxic lymphocyte(CTL) ;(3) Promote Th2
differentiation; (4) Induce Treg; (5) Induce chimerism; Conclusion: For
fully MHC mismatched allogeneic heart transplant recipients of inbred
mouse, adoptive transfusion of Tol-DC, which can be gene-modified,
drug-intervened, cytokine-induced, spleen-derived or liver-derived, can
clearly prolong the survival of cardiac allograft or induce immune
tolerance. Gene-modified and drug-induced tol-DC prolong graft survival
most obviously. Because of better reliability and stability than the
drug-induced, the gene-modification is the best way to induce Tol-DCs at
present. One-time intravenous infusion of 2 x 106Tol-DC is a simple and
feasible way to induce long-term graft survival .Multiple infusions will
prolong it, but increase the risk and cost. Reinfusion of Tol-DC in
conjunction with immunosuppressive agents may also prolong graft survival
time .

<19>
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Accession Number
71251652
Authors
Didsbury M. Craig J. Tong A. Chapman J. Kable K. Wong G.
Institution
(Didsbury, Craig, Tong, Wong) University of Sydney, School of Public
Health, Sydney, Australia
(Chapman, Kable, Wong) Centre for Kidney Research, Sydney, Australia
Title
Exercise training in solid organ transplant recipients-a systematic
review.
Source
Transplantation. Conference: 24th International Congress of the
Transplantation Society Berlin Germany. Conference Start: 20120715
Conference End: 20120719. Conference Publication: (var.pagings). 94 (pp
937), 2012. Date of Publication: 27 Sep 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Loss of exercise capacity, reduction in bone mineral density
and excessive weight gain are common after solid organ transplantation.
The benefits of exercise training on improving physical and
cardiopulmonary capacity are well-established in at-risk populations such
as those with cardiovascular disease and those who have undergone major
procedures such as cardiopulmonary bypass, but unclear after major solid
organ transplantation. Our study aims to assess the health benefits and
harms of supervised exercise training programs in solid organ transplant
recipients. Method: We systematically reviewed all randomized controlled
trials (RCTs) that compared the outcomes of supervised exercise training
program in solid organ transplant recipients against standard care.
Medline (1948 to 2011), Embase (2010 to 2011), the Cochrane Central
Register of Controlled Trials (CENTRAL, Issue 4 2011) were searched
without language restriction. Two authors independently extracted data
from the individual studies and results were summarized using random
effects meta-analysis. Results: A total of 585 patients from thirteen RCTs
(eight cardiac [n=227 patients]; two kidney [n=166 patients]; two lung
[n=76 patients] and one liver transplant [n=119]) were included. No
pancreas RCTs were identified. Compared with standard care, cardiac
transplant recipients who engaged in an exercise training program showed
significant improvement in maximal oxygen uptake (VO2peak)
(+2.79mL/min/kg, CI: 0.74-4.83, P = 0.008, I2=66%), maximum power output
(+14.32W, CI: -10.22, 38.86, P < 0.01, I2=92%), and minute ventilation
(+7.45 L/ min, CI: -7.63-22.53, P < 0.01, I2=93%). The heterogeneity
observed between studies was attributed to differences in the duration of
the exercise intervention, and the length of time between the surgery and
commencement of the program. Compared with standard care, exercise
training programs lasting for 12 weeks or more (+4.06 mL/ min/kg, CI:
3.02-5.09, P < 0.01, I² = 0%) were more effective than those
lasted for 8 weeks or less (+1.15mL/min/kg, CI: -1.47-3.78, P = 0.39,
I² = 48%). Exercise programs commencing within one year (+3.91
mL/ min/kg, CI: 2.85-4.97, P < 0.01, I² = 0%) and four years
after cardiac transplant (+5.72 mL/min/kg, CI: 2.62-8.82, P=0.0003,
I² = 0%), but not between 1 and 3 years, were associated with
significant improvement in VO2 peak compared with standard care. Single
studies showed no significant improvement in VO2peak in kidney recipients
(+3.60mL/ min/kg, CI: -0.22-7.42, P=0.06), lung recipients
(-1.80mL/min/kg, CI: -4.49-0.89, P=0.19) or liver recipients
(+1.60mL/min/kg, CI: -1.13-4.33, P=0.25). There was also no significant
improvement in the overall serum lipid profile, body morphology, blood
pressure and glycaemic control between exercise training and standard care
in kidney, lung and cardiac transplant recipients. Conclusion: Exercise
training is effective in improving physical capacity in cardiac transplant
recipients, but the measured benefits of exercise training in kidney and
lung transplant recipients are limited to cardiopulmonary capacity and did
not examine clinically relevant outcomes such as quality of life,
sustainable weight control, graft and patient survival.

<20>
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Accession Number
71251541
Authors
Wong G. Kable K. Chapman J.R. Tong A. Didsbury M. Craig J.
Institution
(Wong, Kable, Chapman) University of Sydney, Centre for Transplant and
Renal Research, Sydney, Australia
(Tong, Didsbury, Craig) University of Sydney, Sydney, Australia
Title
Exercise training and dietary program in kidney transplant recipients.
Source
Transplantation. Conference: 24th International Congress of the
Transplantation Society Berlin Germany. Conference Start: 20120715
Conference End: 20120719. Conference Publication: (var.pagings). 94 (pp
883), 2012. Date of Publication: 27 Sep 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Aim: Obesity leading to metabolic complications such as new onset diabetes
mellitus after transplantation (NODAT) and hypertension is a major public
health burden for kidney transplant recipients. Maintaining a
well-balanced, healthy diet and regular exercise in is one of the major
strategies found to be successful in improving patient outcomes such as
cardiovascular risk factors in the general and cardiac transplant
populations. Little information is known about the health benefits of
supervised exercise training and diet management in kidney transplant
recipients. Methods: A six-week supervised exercise training and dietary
pilot study was developed for newly transplanted patients (6 weeks after
the transplant surgery) between May, 2011 and December, 2011. The
intervention was comprised of a weekly structured programme of supervised
physical activity and exercise provided by exercise specialists, with
individualised nutritional advices given by expert nutritionists over a
6-weeks period in a single centre, Sydney Australia. The functional,
cardiopulmonary and physical capacities were assessed at baseline and at
week 7. Other cardiovascular parameters and body composition profiles such
as body mass index, blood pressure and heart rate were also measured at
the two specific time points (baseline and at week 7). Results: Of the 45
eligible transplant recipients, a total of 30 (66.7%) were recruited for
the study. Of those recruited, a total of 18 (60%) had completed the
6-week supervised exercise training and dietary program. Table 1 shows the
results of the physical, functional and body composition parameters at
baseline and after completion of the exercise training and dietary
program. A total of 13 (72.2%) patients achieved significant improvement
in lower limb muscle endurance (mean improvement of 3.88s repetitions in
60 s) and the six-minute walk test (mean improvement of 5.44 m) compared
with baseline. A significant increase in body mass index (mean increase of
3.12 kg/m²) and heart rate (mean increase by 5.51 seconds) was
observed between baseline and at week 7. Conclusions: Findings from our
pilot study suggest that exercise training and diet control may improve
the physical and functional capacity of recipients after kidney
transplantation. Well-power and quality randomised controlled trials are
needed to assess the health benefits and costs of a multidisciplinary
supervised exercise training and diet program versus standard care in
kidney transplant recipients.

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Accession Number
71250037
Authors
Kaczmarek I. Zaruba M.-M. Sadoni S. Meiser B.
Institution
(Kaczmarek, Sadoni) Klinikum Grosshadern, LMU Munchen, Herzchirurgische
Klinik, Munchen, Germany
(Kaczmarek, Meiser) Klinikum Grosshadern, LMU Munchen, Transplantation
Center, Munich, Germany
(Zaruba) Klinikum Grosshadern, LMU Munchen, Cardiology, Munich, Germany
Title
Prospective randomized 3-ARM trial comparing tacrolimus with mycophenolate
mofetil (MMF) or sirolimus with calcineurininhibitor-free
immunosuppression (sirolimus/MMF) after heart transplantation: 5-year
results.
Source
Transplantation. Conference: 24th International Congress of the
Transplantation Society Berlin Germany. Conference Start: 20120715
Conference End: 20120719. Conference Publication: (var.pagings). 94 (pp
126), 2012. Date of Publication: 27 Sep 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Despite improvements in immunosuppressive therapy the most
advantageous combination for cardiac transplant recipients has not yet
been established. Therefore, we performed a randomized controlled trial to
evaluate the efficacy and safety of three immunosuppressive protocols.
Methods: Between April 2003 and October 2005, 78 de novo cardiac
transplant recipients were randomized on a 2:2:1 basis to receive steroids
and either tacrolimus (TAC)+mycophenolate mofetil (MMF) (n=32),
TAC+sirolimus (SRL) (n=31), or SRL+MMF (n=15). Antilymphocyte induction
therapy was given in the SRL+MMF group. Steroids were withdrawn after 6
months. All patients received statins. Results: Cumulative survival at 5
years was: 86.1% (TAC/MMF), 93.1% (TAC/SRL) and 86.7% (SRL/MMF) (p=ns).
Freedom from biopsy proven rejection or hemodynamic compromise rejection
requiring treatment at 5 years was 82.4% (TAC/MMF), 85.2% (TAC/SRL) and
73.3% SRL/MMF (p=ns). Freedom from cardiac allograft vasculopathy (CAV)
was: TAC/ MMF 72.2%, TAC/SRL 80.8%, and SRL/MMF 93.3%, revealing superior
CAV-prevention for SRL/MMF (p=0.01) and TAC/SRL (p=0.02) when compared to
TAC/MMF treatment. Freedom from CMV-infection was: TAC/MMF 72.2%, TAC/SRL
89.7%, and SRL/MMF 86.7%. There was a superiority for freedom from
CMVinfection for SRL/MMF (p=0.01) and TAC/SRL (p=0.01) when compared to
TAC/MMF. Mean serum creatinine at 5 years was TAC/MMF = 1.44+/-0.5 mg/dL ,
TAC/SRL = 1.65+/-0.9 mg/dL and SRL/MMF = 1.25+/-0.3 mg/dL, revealing a
trend towards superior renal function for SRL/MMF. Total cholesterol at 5
years was TAC/MMF = 167+/-42 mg/dL, TAC/SRL = 179+/-34 mg/dL, and SRL/MMF
= 183+/-33 mg/dL, triglyceride levels at 5 years were TAC/ MMF = 160+/-112
mg/dL, TAC/SRL = 146+/-98 mg/dL, and SRL/MMF = 161+/-90 mg/dL (p=ns). In
the SRL/MMF group 10 patients temporarily discontinued SRL treatment
because of side effects. Conclusions: Both tacrolimus groups proved to be
efficacious for the prevention of acute rejection. The side effect profile
for the SRL/MMF group is inferior to the TAC groups resulting in a high
discontinuation rate while this calcineurininhibitor-free protocol results
in a lower incidence of CAV and CMV-infections.