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<1>
Accession Number
2013799604
Authors
Chun K.J. Kim J.S. Kim C.H. Kim J.H. Park Y.H. Kim J. Choi J.H. Lee S.H.
Kim E.J. Yu D.G. Ahn E.Y. Jeong M.H.
Institution
(Chun, Kim, Kim, Park, Kim, Choi, Lee) Department of Internal Medicine,
Yangsan Hospital, Pusan National University School of Medicine, Yangsan
626-770, South Korea
(Kim) Department of Preventive and Occupational Medicine, Pusan National
University, School of Medicine, Yangsan, South Korea
(Kim, Yu, Ahn) Department of Internal Medicine, Pusan Medical University,
Yangsan Hospital, Yangsan, South Korea
(Jeong) Heart Center, Research Institute of Medical Sciences, Chonnam
National University, Gwangju, South Korea
Title
Effects of trimetazidine in patients with acute myocardial infarction:
Data from the Korean Acute Myocardial Infarction Registry.
Source
Clinical Research in Cardiology. 102 (12) (pp 915-922), 2013. Date of
Publication: December 2013.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Background: Excess myocardial fatty acid oxidation can cause a range of
deleterious myocardial effects. Trimetazidine (TMZ) is a clinically
effective antianginal agent that selectively inhibits long-chain
3-ketoacyl CoA thiolase, reducing fatty acid oxidation and stimulating
glucose oxidation. The role of TMZ in acute myocardial infarction (AMI),
however, remains unclear. Our retrospective analysis explores the effect
on clinical outcomes of adding TMZ to standard treatment in patients with
AMI. Methods: All 13,733 AMI patients registered in the Korean Acute
Myocardial Infarction Registry from 2005 to 2008 were retrospectively
enrolled. Patients were divided into two groups: those treated with TMZ
during their in-hospital management period and those who were not. Primary
endpoints were all-cause death combined in-hospital and 12-month death and
major adverse cardiac events (MACE), which included all-cause death,
recurrent myocardial infarction (MI), repeated percutaneous coronary
intervention (PCI) for target lesion revascularization (TLR), and coronary
artery bypass graft. Propensity-matched patients were analyzed using an
adjusted Cox proportional hazards model. Results: Baseline clinical and
angiographic characteristics in the TMZ and no-TMZ groups were generally
similar, with the exceptions of pre-PCI thrombolysis in myocardial
infarction flow grade, stent type, and stent length. Over 12 months, the
relative risk of all-cause death fell by 59 % (event rate 2.3 vs. 6.4 %;
hazard ratio 0.41, 95 % CI 0.18-0.97, P = 0.042) and the relative risk of
MACE fell by 76 % (event rate 2.3 vs. 9.5 %; hazard ratio 0.24, 95 % CI
0.10-0.56, P = 0.001) in the TMZ group compared with those in the no-TMZ
group. Conclusions: Trimetazidine appeared to improve clinical outcomes in
AMI patients by significantly reducing all-cause mortality and MACE over
12 months. 2013 Springer-Verlag Berlin Heidelberg.

<2>
Accession Number
2013422453
Authors
Abid Shah M. Suleman S. Hussain Munir A.
Institution
(Abid Shah, Suleman) Department of Pharmacology, Khyber Medical College,
Peshawar, Pakistan
(Hussain Munir) Department of Pathology, Khyber Medical College, Peshawar,
Pakistan
Title
Comparative efficacy and safety profile of 5 MG rosuvastatin versus 10 MG
rosuvastatin in patients with ischemic heart disease.
Source
Journal of Medical Sciences (Peshawar). 21 (1) (pp 35-39), 2013. Date of
Publication: January 2013.
Publisher
Khyber Medical College (PeshawarPakistan)
Abstract
Objectives: To compare the efficacy and clinical profile of 5 mg
rosuvastatin versus 10 mg rosuvastatin in improving the management of
patients with IHD. Material and Methods: This study was jointly conducted
by Department of Pharmacology, Khyber Medical College, and Cardiology
Department of Khyber Teaching Hospital from January 2011 to August 2011.
The patients presenting to coronary care unit and cardiology OPD were
randomized into a two groups; Group A and Group B each comprising 50
patients. Group A recieved 5 mg of rosuvastatin and Group B received 10 mg
of resovuastatin for three months. National cholesterol Education
programme adult treat panel III (NCEP ATP III) guideline for LDL-C was
chosen as the primary objective while assessing the safety profile and
toxicity was considered the secondary end point. A rise in HDL-C was also
anticipated. Results: Thirty-four (68%) patients in group A and 41 (82%)
patients in group B were male. All the patients were resident of Peshawar.
Their mean ages were 51.4 +/- 7.6 and 49.35 +/- 5.65 years respectively in
group A and B. The LDL-C dropped to NCEP ATP III value of < 100 mg% in 3
(26%) patients in group A compared to 4 (88%) in group B P < 0.0004. LDL-C
levels after the 3 month treatment showed a mean reduction of 66.2 +/- 3.8
and 84.1 +/- 4.3 in group A and B respectively implying 39.02% and 48.38 %
reduction with a P value < 0.0001. The reduction to total cholesterol
(TLC) was 31.69% (mean 83.2 +/- 7.5) and 41.28% (mean 107.0 +/- 3.3) in
the respective groups with a P value of < 0.0001. The significant value
for triglycerids was a P < 0.04 for group B while the HDL-C improvement
was 0.0006 in group B (receiving 10 mg rosuvastatin). The reported
increased in the incidence of myalgia and muscle weakness was
statistically insignificant P < 0.06. Conclusion: Rosuvastatin; clinically
proven antilipidemic agent for the management of IHD has a better efficacy
with almost identical adverse effects in 10 mg doses as compared with 5 mg
doses and this satisfies the NCEPATP III guidelines.

<3>
Accession Number
2013799602
Authors
Thilo C. Bluthgen A. Von Scheidt W.
Institution
(Thilo, Bluthgen, Von Scheidt) I. Medizinische Klinik, Klinikum Augsburg,
Herzzentrum Augsburg-Schwaben, Stenglinstr. 2, 86156 Augsburg, Germany
Title
Efficacy and limitations of a STEMI network: 3 years of experience within
the myocardial infarction network of the region of Augsburg - HERA.
Source
Clinical Research in Cardiology. 102 (12) (pp 905-914), 2013. Date of
Publication: December 2013.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Aims: The HERA Registry investigates logistics, adherence to standards,
time intervals, and mortality in a regional network for primary
percutaneous coronary intervention (PPCI) in ST-elevation myocardial
infarction (STEMI) in a mixed urban and rural area. Methods and results:
We included 826 consecutive patients (pts) within the HERA network with
its dedicated PPCI strategy (female n = 243, mean age 64 years, range
25-98 years) with acute STEMI (May 2007 until January 2010). 680 pts (82
%) received PPCI and 45 (5.4 %) acute bypass surgery. Of 512 pts seen by
an emergency physician (EP) as first medical contact (FMC) 87 % received
on-scene 12-lead ECG. ECG transmission rate to the PPCI center was 29 %.
Median FMC-to-balloon time (CBT) was 135 min and door-to-balloon time
(DBT) 70 min. With EP FMC DBT was 38 min with direct transfer to cath lab
(n = 70), 69 min via ICU (n = 240), and 132 min via ER (n = 91, p < 0.01).
Out of 826 pts, 143(17.3 %) presented in cardiogenic shock. In-hospital
mortality was 8.8 % (n = 73), 35.7 % for shock pts versus 3.2 % for
non-shock pts (p < 0.01). For pts receiving PPCI, in-hospital mortality
was 6.2 %, for shock pts (n = 107) 28.0 %, and for non-shock pts (n = 573)
2.1 % (p < 0.01). Conclusion: Prehospital management, CBT and DBT compare
favourably to data from studies and registries, but do not yet fulfill
strict guideline requirements. Real world mortality in non-shock pts is
very low. Direct transfer to cath lab reduces DBTs by 49 %. For this
crucial improvement, transmission of a 12-lead ECG to the PPCI center is
mandatory. 2013 Springer-Verlag Berlin Heidelberg.

<4>
Accession Number
2013801170
Authors
Kottenberg E. Musiolik J. Thielmann M. Jakob H. Peters J. Heusch G.
Institution
(Kottenberg, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Hufelandstr 55, Essen D-4511, Germany
(Musiolik, Heusch) Institut fur Pathophysiologie, Universitat
Duisburg-Essen, Universitatsklinikum Essen, Essen, Germany
(Thielmann, Jakob) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Universitat Duisburg-Essen, Universitatsklinikum Essen, Essen, Germany
Title
Interference of propofol with signal transducer and activator of
transcription 5 activation and cardioprotection by remote ischemic
preconditioning during coronary artery bypass grafting.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (1) (pp 376-382),
2014. Date of Publication: January 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Remote ischemic preconditioning protects the myocardium from
ischemia/reperfusion injury. We recently identified protection by remote
ischemic preconditioning to be associated with the activation of signal
transducer and activator of transcription 5 in left ventricular biopsy
specimens of patients undergoing coronary artery bypass grafting during
isoflurane anesthesia. Because remote ischemic preconditioning did not
protect the heart during propofol anesthesia, we hypothesized that
propofol anesthesia interferes with signal transducer and activator of
transcription 5 activation. Methods: In a randomized, single-blind,
placebo-controlled, prospective study, we analyzed an array of established
cardioprotective proteins during propofol anesthesia with or without
remote ischemic preconditioning in 24 nondiabetic patients with 3-vessel
coronary artery disease. Results: Remote ischemic preconditioning (n = 12)
compared with no remote ischemic preconditioning (n = 12) failed to
decrease the area under the troponin I time curve (273 +/- 184 ng/mL x 72
hours vs 365 +/- 301 ng/mL x 72 hours; P =.374). Although phosphorylation
of several protein kinases was increased from baseline to reperfusion,
signal transducer and activator of transcription 5 phosphorylation was not
increased and was not different between the remote ischemic
preconditioning and no remote ischemic preconditioning groups.
Conclusions: Remote ischemic preconditioning during propofol anesthesia
did not evoke either signal transducer and activator of transcription 5
activation or cardioprotection, implying interaction of propofol with
cardioprotective signaling upstream of signal transducer and activator of
transcription 5. Copyright 2014 by The American Association for Thoracic
Surgery.

<5>
Accession Number
2013801182
Authors
Landenhed M. Al-Rashidi F. Blomquist S. Hoglund P. Pierre L. Koul B.
Institution
(Landenhed, Al-Rashidi, Pierre, Koul) Department of Cardiothoracic
Surgery, Skane University Hospital in Lund, Block A, Floor 8, 221 85 Lund,
Sweden
(Blomquist) Department of Anesthesia and Intensive Care, Lund University,
Skane University Hospital, Lund, Sweden
(Hoglund) Clinical Research and Competence Center, Lund University, Skane
University Hospital, Lund, Sweden
Title
Systemic effects of carbon dioxide insufflation technique for de-airing in
left-sided cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (1) (pp 295-300),
2014. Date of Publication: January 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Systemic effects of carbon dioxide (CO₂)
insufflation during left-sided cardiac surgery were evaluated in a
prospective randomized study, with regard to acid-base status, gas
exchange, cerebral hemodynamics, and red blood cell morphology. Methods:
Twenty patients undergoing elective left-sided cardiac surgery were
randomized to de-airing procedure either by CO₂ insufflation
technique (CO₂ group, n = 10) or by Lund technique without
CO₂ insufflation (Lund group, n = 10). Groups underwent
assessment of acid-base status by intermittent arterial blood gases and
in-line blood gas monitoring. Capnography was used to determine volume of
CO₂ produced. Cerebral hemodynamics was measured by
transcranial Doppler sonography and near-infrared spectroscopy. Red cell
morphology from cardiotomy suction and vent tubing was studied by scanning
electron microscopy. Results: Patients in the CO₂ group
consequently developed significantly higher levels of hypercapnia with a
concomitant increase in the volume of CO₂ produced despite
significantly higher oxygenator gas flows compared with the Lund group.
Effects on cerebral hemodynamics were observed in the CO₂ group
with significantly higher blood flow velocities in the middle cerebral
artery and higher regional cerebral saturation. Red blood cell damage was
observed in the CO₂ group by scanning electron microscopy (97%
in CO₂ group vs 18% in Lund group). Conclusions: Insufflation
of CO₂ into the cardiothoracic wound cavity during left-sided
cardiac surgery can induce hypercapnic acidosis and increased cerebral
blood flow and local blood cell damage. These systemic effects should be
monitored by in-line capnography and acid-base measurements for early and
effective correction by increase in gas flows to the oxygenator. Copyright
2014 by The American Association for Thoracic Surgery.

<6>
Accession Number
2013801188
Authors
Angeloni E. Benedetto U. Takkenberg J.J.M. Stigliano I. Roscitano A.
Melina G. Sinatra R.
Institution
(Angeloni, Benedetto, Stigliano, Roscitano, Melina, Sinatra) Department of
Cardiac Surgery, Sapienza, Universita di Roma, Policlinico sant'Andrea,
Via di Grottarossa 1035, 00189, Roma, Italy
(Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
Title
Unilateral versus bilateral antegrade cerebral protection during
circulatory arrest in aortic surgery: A meta-analysis of 5100 patients.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (1) (pp 60-67), 2014.
Date of Publication: January 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Our objective was to determine whether the use of unilateral
(u-ACP) or bilateral antegrade cerebral perfusion (b-ACP) results in
different mortality and neurologic outcomes after complex aortic surgery.
Methods: PubMed, Embase, and the Cochrane Library were searched for
studies reporting on postoperative mortality and permanent (PND) and
temporary neurologic dysfunction (TND) in complex aortic surgery requiring
circulatory arrest with antegrade cerebral protection. Analysis of
heterogeneity was performed with the Cochrane Q statistic. Results:
Twenty-eight studies were analyzed for a total of 1894 patients receiving
u-ACP versus 3206 receiving b-ACP. Pooled analysis showed similar rates of
30-day mortality (8.6% vs 9.2% for u-ACP and b-ACP, respectively; P =.78),
PND (6.1% vs 6.5%; P =.80), and TND (7.1% vs 8.8%; P =.46). Age, sex, and
cardiopulmonary bypass time did not influence effect size estimates.
Higher rates of postoperative mortality and PND were among nonelective
operations and for highest temperatures and duration of the circulatory
arrest. The Egger test excluded publication bias for the outcomes
investigated. Conclusions: This meta-analysis shows that b-ACP and u-ACP
have similar postoperative mortality and both PND and TND rates after
circulatory arrest for complex aortic surgery. Copyright 2014 by The
American Association for Thoracic Surgery.

<7>
Accession Number
2013801103
Authors
Raveglia F. Rizzi A. Leporati A. Di Mauro P. Cioffi U. Baisi A.
Institution
(Raveglia, Rizzi, Leporati, Baisi) Department of Thoracic Surgery, A.O.
San Paolo, University of Milan, Milan, Italy
(Di Mauro) Intensive Care Unit, A.O. San Paolo, University of Milan,
Milan, Italy
(Cioffi) IRCCS Ospedale Maggiore, University of Milan, Milan, Italy
Title
Analgesia in patients undergoing thoracotomy: Epidural versus
paravertebral technique. A randomized, double-blind, prospective study.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (1) (pp 469-473),
2014. Date of Publication: January 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Pain control after thoracotomy prevents postsurgical
complications and improves respiratory function. The gold standard for
post-thoracotomy analgesia is the epidural catheter. The aim of this study
was to compare it with a new technique that involves placement of a
catheter in the paravertebral space at the end of surgery under a
surgeon's direct vision. Methods: From November 2011 to June 2012, 52
patients were randomized into 2 groups depending on catheter placement: an
epidural catheter for group A and a paravertebral catheter for group B. At
12, 24, 48, and 72 hours after surgery, the following parameters were
recorded: (1) pain control using the patient's completion of a visual
analog scale module, (2) respiratory function using forced expiratory
volume in 1 second and ambient air saturation, and (3) blood cortisol
values as an index of systemic reaction to pain. Results: Statistically
significant differences (P <.05) were found in favor of group B for both
cough and rest pain control (P =.002 and.002, respectively) and
respiratory function in terms of forced expiratory volume in 1 second and
ambient air saturation levels (P =.023 and.001, respectively). No
statistically significant differences were found in blood cortisol trends
between the 2 groups (P >.05). Collateral effects such as vomiting,
nausea, low pressure, or urinary retention were observed only in group A.
No collateral effects were recorded in the paravertebral group.
Conclusions: According to our data, drugs administered through a
paravertebral catheter are very effective. Moreover, it does not present
contraindications to its positioning or collateral effects. More studies
are necessary to confirm data we collected. Copyright 2014 by The
American Association for Thoracic Surgery.

<8>
Accession Number
2013801167
Authors
Butts R.J. Scheurer M.A. Zyblewski S.C. Wahlquist A.E. Nietert P.J.
Bradley S.M. Atz A.M. Graham E.M.
Institution
(Butts, Scheurer, Zyblewski, Atz, Graham) Division of Cardiology,
Department of Pediatrics, Medical University of South Carolina,
Charleston, SC, United States
(Wahlquist, Nietert) Division of Biostatistics and Epidemiology,
Department of Medicine, Medical University of South Carolina, Charleston,
SC, United States
(Bradley) Division of Cardiothoracic Surgery, Department of Surgery,
Medical University of South Carolina, Charleston, SC, United States
Title
A composite outcome for neonatal cardiac surgery research.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (1) (pp 428-433),
2014. Date of Publication: January 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The objective of this study was to determine whether a
composite outcome, derived of objective signs of inadequate cardiac
output, would be associated with other important measures of outcomes and
therefore be an appropriate end point for clinical trials in neonatal
cardiac surgery. Methods: Neonates (n = 76) undergoing cardiac operations
requiring cardiopulmonary bypass were prospectively enrolled. Patients
were defined to have met the composite outcome if they had any of the
following events before hospital discharge: death, the use of mechanical
circulatory support, cardiac arrest requiring chest compressions, hepatic
injury (2 times the upper limit of normal for aspartate aminotransferase
or alanine aminotransferase), renal injury (creatinine >1.5 mg/dL), or
lactic acidosis (an increasing lactate >5 mmol/L in the postoperative
period). Associations between the composite outcome and the duration of
mechanical ventilation, intensive care unit stay, hospital stay, and total
hospital charges were determined. Results: The median age at the time of
surgery was 7 days, and the median weight was 3.2 kg. The composite
outcome was met in 39% of patients (30/76). Patients who met the composite
outcome compared with those who did not had a longer duration of
mechanical ventilation (4.9 vs 2.9 days, P <.01), intensive care unit stay
(8.8 vs 5.7 days, P <.01), hospital stay (23 vs 12 days, P <.01), and
increased hospital charges ($258,000 vs $170,000, P <.01). In linear
regression analysis, controlling for surgical complexity, these
differences remained significant (R² = 0.29-0.42, P <.01).
Conclusions: The composite outcome is highly associated with important
early operative outcomes and may serve as a useful end point for future
clinical research in neonates undergoing cardiac operations.

<9>
Accession Number
2013745568
Authors
Bangalore S. Toklu B. Amoroso N. Fusaro M. Kumar S. Hannan E. Faxon D.
Feit F.
Institution
(Bangalore, Amoroso, Fusaro, Feit) New York University School of Medicine,
Leon H Charney Division of Cardiology, New York, NY 10016, United States
(Toklu) Virginia Commonwealth University, Richmond, VA, United States
(Hannan) School of Public Health, University at Albany, Albany, NY, United
States
(Faxon) Brigham and Women's Hospital, Boston, MA, United States
(Kumar) University of Nebraska, Omaha, Nebraska, NE, United States
Title
Bare metal stents, durable polymer drug eluting stents, and biodegradable
polymer drug eluting stents for coronary artery disease: Mixed treatment
comparison meta-analysis.
Source
BMJ (Online). 347 , 2013. Date of Publication: 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To compare the efficacy and safety of biodegradable polymer
drug eluting stents with those of bare metal stents and durable polymer
drug eluting stents. Design: Mixed treatment comparison meta-analysis of
258 544 patient years of follow-up from randomized trials. Data sources
and study selection: PubMed, Embase, and Central were searched for
randomized trials comparing any of the Food and Drug Administration
approved durable polymer drug eluting stents (sirolimus eluting,
paclitaxel eluting, cobalt chromium everolimus eluting, platinum chromium
everolimus eluting, zotarolimus eluting-Endeavor, and zotarolimus
eluting-Resolute) or biodegradable polymer drug eluting stents, with each
other or against bare metal stents. Outcomes: Long term efficacy (target
vessel revascularization, target lesion revascularization) and safety
(death, myocardial infarction, stent thrombosis). Landmark analysis at
more than one year was evaluated to assess the potential late benefit of
biodegradable polymer drug eluting stents. Results: From 126 randomized
trials and 258 544 patient years of follow-up, for long term efficacy
(target vessel revascularization), biodegradable polymer drug eluting
stents were superior to paclitaxel eluting stents (rate ratio 0.66, 95%
credibility interval 0.57 to 0.78) and zotarolimus eluting stent-Endeavor
(0.69, 0.56 to 0.84) but not to newer generation durable polymer drug
eluting stents (for example: 1.03, 0.89 to 1.21 versus cobalt chromium
everolimus eluting stents). Similarly, biodegradable polymer drug eluting
stents were superior to paclitaxel eluting stents (rate ratio 0.61, 0.37
to 0.89) but inferior to cobalt chromium everolimus eluting stents (2.04,
1.27 to 3.35) for long term safety (definite stent thrombosis). In the
landmark analysis after one year, biodegradable polymer drug eluting
stents were superior to sirolimus eluting stents for definite stent
thrombosis (rate ratio 0.29, 0.10 to 0.82) but were associated with
increased mortality compared with cobalt chromium everolimus eluting
stents (1.52, 1.02 to 2.22). Overall, among all stent types, the newer
generation durable polymer drug eluting stents (zotarolimus eluting
stent-Resolute, cobalt chromium everolimus eluting stents, and platinum
chromium everolimus eluting stents) were the most efficacious (lowest
target vessel revascularization rate) stents, and cobalt chromium
everolimus eluting stents were the safest with significant reductions in
definite stent thrombosis (rate ratio 0.35, 0.21 to 0.53), myocardial
infarction (0.65, 0.55 to 0.75), and death (0.72, 0.58 to 0.90) compared
with bare metal stents. Conclusions: Biodegradable polymer drug eluting
stents are superior to first generation durable polymer drug eluting
stents but not to newer generation durable polymer stents in reducing
target vessel revascularization. Newer generation durable polymer stents,
and especially cobalt chromium everolimus eluting stents, have the best
combination of efficacy and safety. The utility of biodegradable polymer
stents in the context of excellent clinical outcomes with newer generation
durable polymer stents needs to be proven. f6625.

<10>
Accession Number
2013799636
Authors
Patel A.S. Bergman A. Moore B.W. Haglund U.
Institution
(Patel, Moore) Abacus International, Bicester, United Kingdom
(Bergman) Takeda Pharmaceuticals International GmbH, Glattpark-Opfikon,
Switzerland
(Haglund) Department of Surgical Sciences, Uppsala University, Uppsala,
Sweden
Title
The economic burden of complications occurring in major surgical
procedures: A systematic review.
Source
Applied Health Economics and Health Policy. 11 (6) (pp 577-592), 2013.
Date of Publication: December 2013.
Publisher
Springer International Publishing AG (Gewerbestrasse 11, Cham (ZG) 6330,
Switzerland)
Abstract
Objectives: On the basis of a systematic review, we aimed to establish the
cost and drivers of cost and/or resource use of intra- and perioperative
complications occurring as a result of selected major surgical procedures,
as well as to understand the relationship between costs and severity of
complication and, consequently, the economic burden they represent. We
also assessed the clinical and economic methodologies used to derive costs
and resource use across the studies with a view to providing guidance on
reporting standards for these studies. Methods: We searched EMBASE,
MEDLINE and Econlit (from 2002 to 2012) for study publications including
resource use/cost data relating to surgical complications. Results: We
identified 38 relevant studies on pancreatic (n = 14), urologic (n = 4),
gynaecological (n = 6), thoracic (n = 13) and hepatic surgery (n = 1). All
studies showed that complications lead to higher resource use and hospital
costs compared with surgical procedures without complications. Costs
depend on type of complication and complication severity, and are driven
primarily by prolonged hospitalisation. There was considerable
heterogeneity between studies with regard to patient populations, outcomes
and procedures, as well as a lack of consistency and transparency of
reporting of costs/resource use. Complication severity grading systems
were used infrequently. Conclusions: The overall conclusions of included
studies are consistent: complications represent an important economic
burden for health care providers. We conclude that more accurate and
consistent data collection is required to serve as input for good-quality
economic analyses, which in turn can inform hospital decisions on
cost-efficient allocation of their limited resources. 2013 Springer
International Publishing Switzerland.

<11>
Accession Number
2013741118
Authors
Eguchi T. Yoshida K. Kondo R. Hamanaka K. Shiina T. Komatsu Y. Yamamoto H.
Kubo K. Hasegawa J. Koizumi T.
Institution
(Eguchi, Yoshida, Kondo, Hamanaka, Shiina) Department of Thoracic Surgery,
Shinshu University School of Medicine, Matsumoto, Japan
(Komatsu, Yamamoto, Kubo) Department of Internal Medicine, Shinshu
University School of Medicine, Matsumoto, Japan
(Hasegawa) Department of Anesthesiology, Shinshu University School of
Medicine, Matsumoto, Japan
(Koizumi) Comprehensive Cancer Center, Shinshu University Hospital,
Matsumoto, Japan
Title
Sivelestat prevents cytoskeletal rearrangements in neutrophils resulting
from lung re-expansion following one-lung ventilation during thoracic
surgery.
Source
Inflammation. 36 (6) (pp 1479-1484), 2013. Date of Publication: December
2013.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Patients undergoing lobectomy are at risk of developing acute lung injury
resulting from one-lung ventilation (OLV) during surgery. We investigated
the morphological and functional behavior of neutrophils in patients who
underwent lobectomy and assessed the ability of sivelestat to inhibit
neutrophil activity. This was a blinded randomized study. Sixteen patients
who underwent lobectomy were given intravenous sivelestat (n = 8) or
intravenous saline (n = 8). We studied the cytoskeletal rearrangements of
circulating neutrophils by determining the localization of filamentous
actin (F-actin). Pulmonary oxygenation was evaluated by measuring the
partial pressure of arterial oxygen. We found that the number of
circulating, F-actin-rimmed neutrophils increased during OLV and after
lung re-expansion. Our results suggest that, in addition to the surgical
procedure and OLV, re-expansion of the remaining lung after lobectomy
increases the neutrophil activation levels. Furthermore, administration of
sivelestat limited neutrophil activation and improved pulmonary
oxygenation in our patients. 2013 Springer Science+Business Media New
York.

<12>
Accession Number
2013741100
Authors
Baki E.D. Aldemir M. Kokulu S. Koca H.B. Ela Y. Sivaci R.G. Ozturk N.K.
Emmiler M. Adali F. Uzel H.
Institution
(Baki, Kokulu, Ela, Sivaci) Department of Anesthesia and Reanimation,
Faculty of Medicine, Afyon Kocatepe University, Ali Cetinkaya kampusu
Afyon-Izmir Karayolu8.km, 03200 Afyonkarahisar, Turkey
(Aldemir, Adali) Department of Cardiovascular Surgery, Afyon Kocatepe
University, Afyonkarahisar, Turkey
(Koca) Department of Biochemistry, Afyon Kocatepe University,
Afyonkarahisar, Turkey
(Ozturk) Clinic of Anesthesia and Reanimation, Antalya Training and
Research Hospital, Antalya, Turkey
(Emmiler) Clinic of Cardiovascular Surgery, Antalya Training and Research
Hospital, Antalya, Turkey
(Uzel) Department of Public Health, Afyon Kocatepe University,
Afyonkarahisar, Turkey
Title
Comparison of the effects of desflurane and propofol anesthesia on the
inflammatory response and S100beta protein during coronary artery bypass
grafting.
Source
Inflammation. 36 (6) (pp 1327-1333), 2013. Date of Publication: December
2013.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Cardiopulmonary bypass (CPB) contributes to the secretion of
anti-inflammatory cytokines that mediate the inflammatory response
observed during open heart surgery. In addition to many factors, type of
anesthesia management affects immune response and central nervous system
in cardiac surgery. The aim of this study was to assess the effect of
propofol versus desflurane anesthesia on systemic immune modulation and
central nervous system on patients undergoing coronary artery bypass
grafting. Forty patients undergoing elective coronary artery bypass graft
surgery with CPB were included in this prospective randomized study.
Patients were allocated to receive propofol (n = 20) or desflurane (n =
20) for maintenance of anesthesia. The blood samples for IL-6, IL-8,
TNF-alpha, and S100beta were drawn just prior to the operation before the
induction of anesthesia, second before cardiopulmonary bypass, third after
CPB, fourth 4 h postoperatively at the ICU. Major finding in our study is
that S100beta levels were lower in propofol group when compared to
desflurane anesthesia. And also immune reaction was less in patients
exposed to desflurane anesthesia when compared to propofol anesthesia as
indicated by lower plasma concentrations of IL-8 and IL-6. Propofol is
more preferable in terms of S100beta for anesthetic management for CABG.
2013 Springer Science+Business Media New York.

<13>
Accession Number
2013741095
Authors
Hao X. Han J. Xing Z. Hao Y. Jiang C. Zhang J. Yang J. Hou X.
Institution
(Hao, Xing, Jiang, Yang, Hou) Department of Extracorporeal Circulation,
Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road,
Chaoyang District, Beijing 100029, China
(Han, Hao, Zhang) Beijing Key Laboratory of Emerging Infectious Diseases,
Beijing 100015, China
(Han, Hao, Zhang) Institute of Infectious Diseases, Beijing Ditan
Hospital, Capital Medical University, Beijing 100015, China
Title
Urinary trypsin inhibitor attenuated inflammatory response of patients
undergoing cardiopulmonary bypass by inducing activated treg cells.
Source
Inflammation. 36 (6) (pp 1279-1285), 2013. Date of Publication: December
2013.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
The urinary trypsin inhibitor (ulinastatin) is used in the clinic to
prevent inflammatory responses in patients undergoing cardiopulmonary
bypass (CPB); however, the anti-inflammatory mechanism is unclear. In the
current study, we recruited 40 patients undergoing selective cardiac valve
replacement surgery; and these patients were randomly divided into two
groups (ulinastatin group [UG] and control group [CG]). We collected
peripheral blood preoperatively, at the end of CPB, and postoperative days
1 and 3 and analyzed the kinetic changes in regulatory T (Treg) cell
subsets. There was no statistically significant difference in the number
of CD4⁺ T cells between the two groups. The number of
CD4⁺CD25⁺ Treg cells, especially the suppressive
activated Treg (aTreg) subset, was higher in the UG than the CG 1 and 3
days postoperatively. Thus, ulinastatin alleviated the inflammatory
response during CPB by inducing the expansion of aTreg cells. 2013
Springer Science+Business Media New York.

<14>
Accession Number
2013797894
Authors
Rengifo-Moreno P. Palacios I.F. Junpaparp P. Witzke C.F. Morris D.L.
Romero-Corral A.
Institution
(Rengifo-Moreno, Witzke, Morris, Romero-Corral) Institute for Heart and
Vascular Health, Cardiovascular Diseases, Einstein Medical Center,
Philadelphia, PA, United States
(Palacios) Cardiology Service, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Junpaparp) Department of Internal Medicine, Einstein Medical Center,
Philadelphia, PA, United States
(Morris) Department of Medicine, Jefferson Medical College, Philadelphia,
PA, United States
(Romero-Corral) Division of Cardiovascular Diseases, Einstein Medical
Center, Philadelphia PA 19141, United States
Title
Patent foramen ovale transcatheter closure vs. medical therapy on
recurrent vascular events: A systematic review andmeta-analysis of
randomized controlled trials.
Source
European Heart Journal. 34 (43) (pp 3342-3352), 2013. Date of Publication:
14 Nov 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Background In patients with cryptogenic stroke, transcatheter (TC) closure
of a patent foramen ovale (PFO) has not been shown to better prevent
recurrent vascular events than medical therapy. However, randomized
controlled trials (RCT) to date have included few vascular events, and
lack of power has been raised as an important concern. Objective To
conduct a systematic review and meta-analysis of existing RCT published
studies assessing the recurrence of vascular events after TC PFO closure
when compared to medical therapy. Methods Using the search terms "patent
foramen ovale", "PFO", "stroke", "percutaneous closure" and "transcatheter
closure", Medline, Pubmed, Embase, and Cochrane databases were reviewed
from inception through April 2013, with no language restrictions. Only
studies in adult humans were considered. Additional references were
obtained from the bibliographies of studies reviewed. The following
criteria were used for study selection: 1) randomized controlled trial, 2)
subjects were adult patients with cryptogenic strokewhowere randomized to
TCPFOclosure or medical treatment (antiplatelet therapy and/or
anticoagulation), and 3) reported outcomes included cardiac death, all
death, stroke, transient ischemic attack, and peripheral embolism.
Methodological and descriptive data, adverse events (including raw data
and risk estimates), as well as procedural success and complications were
abstracted in duplicate from each study independently, and agreementwas
tested.We followed rigorously the recommended guidelines for reporting and
conducting and assessing quality of meta-analysis of RCT. The primary
endpoints pre-specified in advance were recurrent vascular events, and
composite endpoint of death, and recurrent vascular events. Results Three
studies were identified as meeting selection criteria. These included a
total of 2,303 patients, with 1,150 patients randomized to TC PFO closure
and 1,153 patients randomized to medical therapy. Mean follow-upwas 3.5
years. Baseline characteristics (age, sex, and cardiovascular risk
factors) were similar across studies. Intention-to-treat analyses showed a
statistically significant risk reduction in stroke and/or transient
ischemic attack in the TC PFO closure group when compared to medical
treatment, pooled HR = 0.59, 95%CI (0.36-0.97), P = 0.04. The combined
outcome of death, and vascular events, showed a borderline statistically
significant benefit for TC PFO closure when compared to medical treatment,
pooled HR = 0.67, 95%CI (0.44-1.00), P = 0.05 Subjects with a substantial
PFO shunt seem to benefit the most with TC PFO closure, pooled HR = 0.35,
95%CI (0.12-1.03), P = 0.06, however, it did not reach statistical
significance. Conclusion These results suggest that in patients with
cryptogenic stroke, TC PFO closure may be beneficial in reducing the risk
of recurrent vascular events when compared to medical treatment. The
benefit of TC PFO closure may be greater in patients with a substantial
shunt. The Author 2013.

<15>
Accession Number
2013787054
Authors
Tran D.H.D. Wong G.T.C. Chee Y.E. Irwin M.G.
Institution
(Tran, Wong, Chee, Irwin) University of Hong Kong, Queen Mary Hospital,
Department of Anaesthesiology, 102 Pokfulam Road, Hong Kong, Hong Kong
Title
Effectiveness and safety of erythropoiesis-stimulating agent use in the
perioperative period.
Source
Expert Opinion on Biological Therapy. 14 (1) (pp 51-61), 2014. Date of
Publication: January 2014.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Introduction: Erythropoiesis-stimulating agents (ESAs) are widely used in
treating anemia associated with renal failure. They are also now used
perioperatively to reduce the use of allogeneic blood transfusions (ABTs)
in patients undergoing surgery with anticipated high blood loss. Although
they can reduce the risks associated with ABT and improve quality of life,
the use of ESAs is still associated with adverse effects. Areas covered: A
narrative review is provided on ESAs and a systematic review has been
conducted to examine the current evidence for the efficacy and safety of
perioperative ESAs use. A search of PubMed and Medline databases has been
performed using a combination of search terms including erythropoietin,
perioperative, surgical, safety and efficacy. Expert opinion: Current
evidence supports the use of perioperative ESAs to reduce the need for
ABT. However, large studies assessing safety in anemic patients with
chronic renal disease have found adverse effects including cardiovascular,
stroke and thromboembolic events. However, whether these concerns can be
conferred onto the surgical population remains to be seen as the
perioperative dosing strategies have been more variable in timing, dose
and duration in comparison with those used for chronic diseases. Future
research needs to address the questions of optimal dosing strategies in
order to maximize the positive effects and minimize adverse events. 2014
Informa UK, Ltd.

<16>
Accession Number
2013743077
Authors
Zei P.C.
Institution
(Zei) Department of Medicine, Cardiac Electrophysiology, Stanford
University, 300 Pasteur Drive, Stanford, CA 94305, United States
Title
Is the wearable cardioverter-defibrillator the answer for early
post-myocardial infarction patients at risk for sudden death?: Mind the
gap.
Source
Journal of the American College of Cardiology. 62 (21) (pp 2008-2009),
2013. Date of Publication: November 19-26, 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)

<17>
Accession Number
2013791927
Authors
Mares M.A. McNally S.
Institution
(Mares, McNally) University of Western Sydney, The New South Wales Centre
for Evidence Based Health Care, Australia
Title
The effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery: A systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 11 (11) (pp
21-32), 2013. Date of Publication: 2013.
Publisher
Joanna Briggs Institute (North Terrace, Adelaide SA 5005, Australia)
Abstract
Review question/objective Do nurse-led cardiac rehabilitation programs
following coronary artery bypass graft surgery improve patients'
health-related quality of life and reduce hospital readmissions? Inclusion
Criteria Types of participants This systematic review will consider
studies that include male or female, post-CABG surgery patients, aged 60
years and older with a history of cardiovascular disease (CVD). Types of
interventions(s) This systematic review will consider studies that
evaluate nurse-led CR programs. Comparator(s) Non-participation in a
nurse-led CR program, or usual care. Types of Outcomes The outcomes of
interest for this systematic review will focus on HRQoL and readmissions.
Measures of HRQoL will be focusing on various validated instruments, such
as the Medical Outcomes Study 36 Item Short Form (SF-36) and disease
specific Seattle Angina Questionnaire (SAQ). Hospital readmission will be
considered as the total number of cardiac-related admissions in the
follow-up period following the CABG intervention. Any validated and
published scales measuring readmission rates, for example the General
Health Questionnaire, will be included.

<18>
Accession Number
2013797920
Authors
Groenink M. Den Hartog A.W. Franken R. Radonic T. De Waard V. Timmermans
J. Scholte A.J. Van Den Berg M.P. Spijkerboer A.M. Marquering H.A.
Zwinderman A.H. Mulder B.J.M.
Institution
(Groenink, Den Hartog, Franken, Zwinderman, Mulder) Department of
Cardiology, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ
Amsterdam, Netherlands
(Groenink, Den Hartog, Franken, Mulder) Interuniversity Cardiology
Institute of the Netherlands, Utrecht, Netherlands
(Groenink, Spijkerboer, Marquering) Department of Radiology, Academic
Medical Centre Amsterdam, Amsterdam, Netherlands
(Radonic, Zwinderman) Department of Clinical Epidemiology and
Biostatistics, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
(De Waard) Department of Medical Biochemistry, Academic Medical Centre
Amsterdam, Amsterdam, Netherlands
(Timmermans) Department of Cardiology, St Radboud University Nijmegen
Medical Centre, Nijmegen, Netherlands
(Scholte) Department of Cardiology, Leiden University Medical Centre,
Leiden, Netherlands
(Van Den Berg) Department of Cardiology, University Medical Centre
Groningen, Groningen, Netherlands
(Marquering) Department of Biomedical Engineering and Physics, Academic
Medical Centre Amsterdam, Amsterdam, Netherlands
Title
Losartan reduces aortic dilatation rate in adults with Marfan syndrome: A
randomized controlled trial.
Source
European Heart Journal. 34 (45) (pp 3491-3500), 2013. Date of Publication:
01 Dec 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aim Patients with Marfan syndrome have an increased risk of
life-threatening aortic complications, mostly preceded by aortic
dilatation. Treatment with losartan, an angiotensin-II receptor-1 blocker,
may reduce aortic dilatation rate in Marfan patients. Methods and results
In this multicentre, open-label, randomized controlled trial with blinded
assessments, we compared losartan treatment with no additional treatment
in operated and unoperated adults with Marfan syndrome. The primary
endpointwas aortic dilatation rate at any predefined aortic level after 3
years of follow-up, as determined by magnetic resonance imaging. A total
of 233 participants (47% female) underwent randomization to either
losartan (n = 116) or no additional treatment (n = 117). Aortic root
dilatation rate after 3.1+/-0.4 years of follow-up was significantly lower
in the losartan group than in controls (0.77+/-1.36 vs. 1.35+/-1.55 mm, P
= 0.014). Aortic dilatation rate in the trajectory beyond the aortic root
was not significantly reduced by losartan. In patients with prior aortic
root replacement, aortic arch dilatation rate was significantly lower in
the losartan group when compared with the control group (0.50+1.26 vs.
1.01+1.31 mm, P = 0.033).Nosignificant differences in separate clinical
endpoints or the composite endpoint (aortic dissection, elective aortic
surgery, cardiovascular death) between the groups could be demonstrated.
Conclusion In adult Marfan patients, losartan treatment reduces aortic
root dilatation rate. After aortic root replacement, losartan treatment
reduces dilatation rate of the aortic arch. The Author 2013.

<19>
Accession Number
71271675
Authors
De S.D.
Institution
(De) University of Cambridge, Cambridge, United Kingdom
Title
Pre-operative topical antiseptics and post-operative infection rates in
cardiothoracic surgery: Meta-analyses of prospective studies.
Source
International Journal of Surgery. Conference: Association of Surgeons in
Training, ASiT Conference 2013 Manchester United Kingdom. Conference
Start: 20130405 Conference End: 20130407. Conference Publication:
(var.pagings). 11 (8) (pp 614), 2013. Date of Publication: 2013.
Publisher
Elsevier Ltd
Abstract
Aim: To investigate the role of routine pre-operative topical antiseptic
agents in cardiothoracic surgery. Background: Staphylococcus aureus is a
major cause of post-operative infection after open-heart surgery, with the
patient's endogenous flora as the principal source. However the routine
use of pre-operative topical antiseptics in all cardiothoracic patients
has not been established. In a meta-analysis, we quantitatively assessed
the associations reported in prospective studies of routine use of
preoperative topical antiseptics. Methods and Results: Studies were
identified by computer-assisted searches of the published literature and
scanning of relevant reference lists. The following was abstracted: size
and type of cohort, mean age, mean duration of follow-up, and the relative
risk ratio of developing a post-operative infection when using topical
antiseptic agents. There were 5 studies reporting the use of pre-operative
chlorhexidine and 4 studies on topical mupirocin. The combined relative
risk ratio of developing a postoperative infection when using topical
chlorhexidine versus the control armwas 0.47 (CI 0.39-0.63, p<0.05). The
combined relative risk ratio when using topical mupirocin of developing an
infection was 0.43 (CI 0.32-0.72, p<0.05). Conclusion: Published
prospective studies provide good evidence to support the routine use of
preoperative topical antiseptic agents.